Catatonic Schizophrenia 2010

Catatonic Schizophrenia
With Catatonic Schizophrenia[8]


Classification
Catatonic Schizophrenia is a subtype of Schizophrenia [1]


Definition & Description
Schizophrenia that includes disordered movements, inability to move or frantic behaviors. [2] More specifically, holding a position that could be uncomfortable for days or weeks. 'In other situations, a person with catatonic schizophrenia may be extremely active, but the activity appears bizarre, purposeless, and unconnected to the situation or surroundings.' (direct quotation) [7]
Although catatonic schizophrenia could be diagnosed to any race, culture, age it is most common in teenagers or 20s. Gender doesn't differentiate the possibility of having the disorder and children over 5 years old can develop schizophrenia, although it's highly unlikely. [3]
Causes could be (1)Heredity, a person with schizophrenic relatives is ten times as likely to develop schizophrenia as someone who has no history of the disease in the family, (2) Viral infection, a virus attack on the brain that interprets messages from senses, (3) Chemical Imbalance, an imbalance of neurotransmitters in the brain. However there isn't a firm consensus of any of these theories. [6]


List of symptoms
'Patients with this subtype of Schizophrenia may exhibit extremes of behavior including catatonia. Some may allow there posture to be rearranged, holding the new position (catalepsy or waxy flexibility). Others may imitate sounds (echolalia) or movements (echopraxia) of others.

A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:
  • motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
  • excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
  • extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
  • peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
  • echolalia or echopraxia
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994 American Psychiatric Association' (direct quote)[1]

  • 'Having beliefs not based on reality (delusions)
  • Seeing or hearing things that don't exist (hallucinations), especially voices
  • Incoherent speech
  • Neglect of personal hygiene
  • Lack of emotions
  • Emotions inappropriate to the situation
  • Angry outbursts
  • Trouble functioning at school or work
  • Social isolation
  • Clumsy, uncoordinated movements' (direct quote) [4]

Therapies and Treatments
"Medications: The primary medications used to treat schizophrenia are called antipsychotics. These medicines do not cure schizophrenia but help relieve the most troubling symptoms, including delusions, hallucinations, and thinking problems. Older medications used include: Thorazine, Prolixin, Haldol, Navane, Stelazine, Trilafon and Mellaril. Newer medications used to treat schizophrenia include: Risperdal, Clozaril, Seroquel, Geodon, Zyprexa, and Abilify.

Psychosocial therapy: While medication may help relieve symptoms of schizophrenia, various psychosocial treatments can help with the behavioral, psychological, social, and occupational problems associated with the illness. Through therapy, patients also can learn to control their symptoms, identify early warning signs of relapse, and develop a relapse prevention plan. Psychosocial therapies include:
  • Rehabilitation, which focuses on social skills and job training to help people with schizophrenia function in the community and live as independently as possible.
  • Family therapy, which can help families deal more effectively with a loved one who has schizophrenia, enabling them to better help their loved one.
  • Group therapy/support groups, which can provide continuing mutual support.
Hospitalization: Most people with schizophrenia may be treated as outpatients. However, people with particularly severe symptoms, or those in danger of hurting themselves or others may require hospitalization to stabilize their condition.

Electroconvulsive therapy (ECT): This is a procedure in which electrodes are attached to the person's head and a series of electric shocks are delivered to the brain. The shocks induce seizures, causing the release of neurotransmitters in the brain. This form of treatment is rarely used today in the treatment of schizophrenia. ECT may be useful when all medications fail or if severe depression or catatonia makes treating the illness difficult.

Psychosurgery: Lobotomy, an operation used to sever certain nerve pathways in the brain, was formerly used in some patients with severe, chronic schizophrenia. It is now performed only under extremely rare circumstances. This is because of the serious, irreversible personality changes that the surgery may produce and the fact that far better results are generally attained from less drastic and hazardous procedures' (direct quote)[3]

'Individual therapy. Psychotherapy with a skilled mental health provider can help you learn ways to cope with the distress and daily life challenges brought on by having a chronic mental illness like catatonic schizophrenia. Therapy can help improve communication skills, relationships, your ability to work and your motivation to stick to your treatment plan. Learning about catatonic schizophrenia can help you understand it better, cope with lingering symptoms, and understand the importance of taking your medications. Therapy also can help you cope with stigma surrounding catatonic schizophrenia.' (direct quote)[4]


Case Study
'This 21 year-old Asian man first presented to the psychiatric services as an out-patient at the age of 19. He gave a two month history of social withdrawal associated with paranoid ideation, delusions of reference and delusions of thought interference. He had been using cannabis regularly in the two years prior to presentation. CT brain scanning, EEG and routine blood testing were all normal. A diagnosis of probable paranoid schizophrenia was made and he was treated in the community with sulpiride.
However, his condition continued to deteriorate. Over the next two months he became retarded and mute, and was admitted to hospital. At this time he was also noted to be exhibiting several abnormalities of movement and behaviour including posturing, grimacing, rigidity, negativism and ambitendency. He had a course of ECT with some improvement but treatment with the conventional neuroleptic droperidol caused a severe dystonic reaction. His therapy was changed to olanzapine 10mg per day and diazepam 5mg on an as required basis for agitation. After two months there was a significant improvement and he was discharged home.
Despite satisfactory compliance, he was readmitted six months later with prominent signs of mutism and movement disorder. He was noted to be walking backwards and exhibited the distinctive facial expression of schnauzkrampf. At this point his diagnosis was changed to that of catatonic schizophrenia. Further history revealed that he had been treated with growth hormone at the age of 9. Therefore the possibility of Creutzfeldt-Jacob Disease was also considered and a neurological opinion was obtained. This resulted in his transfer to a neurology ward for further investigation but extensive testing there failed to reveal any clear organic pathology. A repeat CT brain, EEG, MRI, SPECT, EMG conduction studies, ophthalmological assessment, virology screen, auto-antibody screen and serum caeruloplasmin levels were all within normal limits. The patient refused a lumbar puncture. It was subsequently found that the growth hormone he had received was not in fact human in origin but derived from recombinant DNA, but prior to this knowledge becoming available a brain biopsy was considered.
The patient was transferred back to the psychiatric ward and was treated with a further course of ECT plus olanzapine at a dose of 10mg per day. Diazepam, 15mg per day, was added to his treatment because he reported a strong anxiolytic effect from benzodiazepines. Over the next two months a gradual resolution of his catatonic symptoms occurred and he was discharged home.' (direct quote) [5]


Related Disorders
Paranoid Schizophrenia
Undifferentiated Schizophrenia
Paranoid Schizophrenia
Disorganized Schizophrenia
Residual Schizophrenia

Additional Information Links
1. CNN health
2. Psych Central
3. Mayo Clinic
4. Encyclopedia of Mental Disorders
5. eMed TV
6. Symptoms and treatments
7. Another case
8. In depth case study
9. Mental Health Counseling
10. Psychnet-uk


Related Videos
[9]

[10]

WAPA citation
1. BehaveNet® Clinical CapsuleĀ™: DSM-IV-TR Classification. (n.d.). BehaveNet®. Retrieved March 18, 2010, from http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm#Schizophrenia
2. Maitland, L. L., & Hannah, P. (2008). 5 steps to a 5: AP Psychology. New York: Mcgraw Hill.
3. Mental Health and Schizophrenia. (n.d.). WebMD - Better information. Better health.. Retrieved March 18, 2010, from http://www.webmd.com/schizophrenia/guide/mental-health-schizophrenia?page=3
4. Catatonic schizophrenia. (n.d.). CNN.com International - Breaking, World, Business, Sports, Entertainment and Video News. Retrieved March 18, 2010, from http://edition.cnn.com/HEALTH/library/catatonic-schizophrenia/DS00863.html
5. Catatonic Schizophrenia and the Options for Treatment. (n.d.). Psychiaty Online. Retrieved March 19, 2010, from www.priory.com/psych/cataton.htm
6. Causes - Schizophrenia - body, infection, brain, virus, disease, people, mental. (n.d.). Internet FAQ Archives - Online Education. Retrieved March 18, 2010, from http://www.faqs.org/health/Sick-V4/Schizophrenia-Causes.html
7. Catatonic disorders - causes, DSM, functioning, effects, therapy, drug, person, people, used, brain, women, health, mood, Definition, Description, Causes and symptoms, Demographics. (n.d.). Encyclopedia of Mental Disorders. Retrieved March 18, 2010, from http://www.minddisorders.com/Br-Del/Catatonic-disorders.html
8. Catatonic disorders. (n.d.). Encyclopedia of Mental Disorders. Retrieved March 19, 2010, from www.minddisorders.com/images/gemd_01_img0029.jpg
9. YouTube - patch adams - Catatonic schizophrenia - benie . (n.d.). YouTube - Broadcast Yourself. . Retrieved March 18, 2010, from http://www.youtube.com/watch?v=KbdlzXPJV7U
10. YouTube - HYDE . (n.d.). YouTube - Broadcast Yourself. . Retrieved March 18, 2010, from http://www.youtube.com/watch?v=5mDdN1ueO60

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