Catatonia can freeze a person for days, yet many remember everything afterwards
Someone with catatonia may hold a strange posture against gravity, stay silent for days, or instead move frantically without purpose. Long tied to schizophrenia, it turns up more often with mood disorders, and patients who seem absent can later recall their surroundings in detail. With treatment, most recover.
Catatonia is a syndrome rather than a disease of its own. Both the DSM-5 and ICD-11 require at least three signs from a list of psychomotor features, among them stupor, mutism, waxy flexibility, where a limb stays wherever an examiner places it, echoing another person's movements, and repetitive gestures with no goal. Because the mix of signs differs between people and can change within a single episode, diagnosis is tricky; one estimate puts the average delay at up to 15 days.
Clinicians describe several subtypes. The stuporous form looks frozen, with no eating, drinking or speech. The excited form brings restlessness, odd mannerisms, agitation and mimicry. Malignant catatonia adds fever, racing heart and swings in blood pressure and is life-threatening. A periodic form comes in repeated bouts with normal intervals between them, and the same patient may move between types over time.
Bipolar disorder and depression are the conditions most often underneath, followed by psychotic disorders, autism and post-traumatic stress disorder. About one case in five, though, stems from a medical cause: encephalitis, strokes, thyroid problems, low sodium, Lyme disease or drugs such as disulfiram and corticosteroids. Anti-NMDA receptor encephalitis offers a revealing example, because antibodies attack the very receptor that glutamate uses to switch neurons on.
The brain mechanics remain poorly understood. Leading ideas point to low levels of GABA, the main braking chemical, and of dopamine, which drives movement, or to faulty communication between the basal ganglia, cortex and thalamus. Studies cannot yet say whether observed abnormalities cause catatonia or result from it. Benzodiazepines and electroconvulsive therapy are the most effective treatments and bring remission in most cases, though long-term outcome depends on the underlying illness.
Source: Catatonia
