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Catatonic schizophrenia was once considered a subtype of schizophrenia. However, the American Psychiatric Association (APA) removed it as a separate diagnosis in 2013 in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This change reflects a shift in how medical professionals understand catatonia.
Today, catatonia is recognized as a syndrome (a group of symptoms), rather than a distinct diagnosis. While catatonia can occur in people living with schizophrenia, it may also appear with other mental health or medical conditions. The hallmark symptoms of catatonia involve unusual movements or behaviors.
Psychiatry experts now understand schizophrenia as a spectrum of symptoms rather than as distinct types. This means a person may be diagnosed with schizophrenia with or without symptoms of catatonia. What was once called “catatonic schizophrenia” is now seen as schizophrenia with catatonic features.
This article explains what catatonia is, including its signs, risk factors, and treatment options.
Catatonia refers to a group of symptoms that involve unusual movements or behaviors. It may be linked to how the brain processes signals that control muscle movements. This disruption in brain function can cause people with catatonia to react to their surroundings in ways that may seem unusual or out of sync with the situation.
The exact cause of catatonia isn’t fully understood. However, researchers believe that brain chemicals called neurotransmitters may play a role. One possible cause involves disruptions in GABA, a neurotransmitter that helps regulate movement, mood, and cognition (brain function). Other theories suggest that low dopamine or high glutamate levels may also contribute to catatonia.
There are several types of catatonia, each defined by different patterns of behavior. The three most common are:
Studies estimate that 10 percent to 25 percent of people living with schizophrenia experience catatonia. Studies have also shown that 45 percent of people with catatonia have underlying mood disorders or other medical conditions. Left untreated, catatonia can lead to other serious complications, including malnutrition, dehydration, or other medical issues.
The causes of catatonia are not fully understood. However, certain factors may increase a person’s risk. These include having a psychiatric, neurological, or other mental health condition. In some cases, suddenly stopping medications for mental illness — such as antipsychotics or mood stabilizers — may also trigger catatonia.
Schizophrenia also does not have one single known cause. However, research suggested that several risk factors may increase a person’s likelihood of developing the condition, such as:
What was once called catatonic schizophrenia is now described as schizophrenia with catatonic features. This means a person experiences symptoms of both schizophrenia and catatonia.
Common symptoms of schizophrenia include:
When catatonia occurs with schizophrenia, a person may also show unusual movements or behaviors. These can include staying in the same position for a long time, holding stiff or awkward poses, or becoming unusually agitated or overly active.
The DSM-5-TR (a text revision of DSM-5) includes the following 12 characteristic signs of catatonia.
Catalepsy describes a state where a person holds a rigid pose that someone else places them in. They don’t move out of the position on their own, but they may take on a new one if moved. This behavior is involuntary and can last for extended periods.
Echolalia is when someone involuntarily repeats words or sounds they hear. Echopraxia is the involuntary imitation of someone else’s movements or gestures.
These behaviors may occur in catatonia or other neurological or developmental conditions, such as autism or Tourette syndrome. Echolalia is also common in young children as they learn to speak, and is not usually a cause for concern unless it continues beyond the typical age of language development.
Posturing involves holding an unusual or uncomfortable body position for a long time. Unlike catalepsy, the person places themselves in the pose rather than being moved into it.
Grimacing refers to holding a facial expression — often tense or distorted — regardless of the situation.
Stereotypy means repeating the same motion over and over without an obvious purpose. These movements may seem random or disconnected from what’s going on around the person.
Mutism is when someone speaks very little or not at all, even when expected to respond. Mutism in catatonia is diagnosed only when other causes — such as primary speech or language disorders — are ruled out.
Stupor refers to a complete lack of response to the environment, including to pain or voices. It is often what people mean when they describe a “catatonic state.”
Waxy flexibility describes how a person’s limb stays in place after being moved, as if the muscles offer light resistance and then slowly release. The motion is similar to bending warm wax.
Mannerism means doing a typical action, such as waving or walking, in an odd, exaggerated, or out-of-context way. The action itself may be normal, but the timing, setting, or repetition makes it seem unusual.
Negativism is resistance to instructions or external stimuli. A person may either not respond at all or may do the opposite of what’s asked. They may, for example, turn away when asked to look at someone.
Agitation in catatonia refers to excessive movement or restlessness that doesn’t seem triggered by anything around the person. It’s different from ordinary agitation, which usually has an emotional or situational cause.
Antipsychotic medications are commonly prescribed to treat schizophrenia. However, when catatonia is present, some antipsychotics may worsen symptoms of catatonia in certain cases and increase the risk of a rare but serious condition called malignant catatonia. This form of catatonia can affect parts of the nervous system that control automatic functions, such as breathing and heart rate, and may be life-threatening. Because of this risk, antipsychotics aren’t usually recommended to manage schizophrenia with catatonia.
The first-line treatment for catatonia is typically a type of medication called benzodiazepines. These medications work by enhancing the effect of GABA, a brain chemical involved in mood and movement regulation. Lorazepam is the most commonly used benzodiazepine for catatonia. Studies show that between 60 percent and 90 percent of people with catatonia experience improvement with this treatment.
If benzodiazepines aren’t effective, doctors may recommend electroconvulsive therapy (ECT). ECT involves applying a controlled electrical current to the brain while the person is under anesthesia, causing a brief seizure. This treatment can quickly improve symptoms of catatonia and is considered safe and effective for most people. ECT is often the first choice when someone has malignant catatonia because it can work quickly to prevent serious complications.
When catatonia symptoms improve, it’s important to return to a comprehensive treatment plan to manage schizophrenia. This may include antipsychotic medications, mood stabilizers, and talk therapy. Early diagnosis and treatment of catatonia are linked to better outcomes.
On MyDepressionTeam, people share their experiences with schizophrenia and other related mental health disorders, get advice, and find support from others who understand.
Have you or a loved one had schizophrenia with catatonia? Let others know in the comments below.
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