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Catatonic Schizophrenia: definition, symptoms, and treatments

Reading time: 9 mins
Catatonic Schizophrenia: definition, symptoms, and treatments

Catatonic schizophrenia is a subtype of schizophrenia that causes an individual to experience extreme changes in the way he or she moves. These changes either involve abnormal movements or no movement at all.

The symptoms of catatonic schizophrenia mainly involve switching between complete stillness and hyperactivity, but also include lack of movement, inability to talk, hesitant response, staring, meaningless repetition of someone else’s actions or speech, and repetitive tapping of the foot.

The treatments for catatonic schizophrenia include psychotherapy, electroconvulsive therapy (ECT), and medications.

What is catatonic schizophrenia?

Catatonic schizophrenia is a now-defunct mental health disorder that was – and still is – characterized by either a lack of physical movement or hyperactive behavior. Today, experts recognize catatonia as a syndrome – a group of medical signs and symptoms – that tend to occur together and are associated with a specific disease or disorder.

Catatonia is a psychomotor syndrome that has been historically associated with schizophrenia. However, according to a 2015 study entitled, “Catatonia is a systemic medical syndrome,” published in Acta Psychiatrica Scandinavica, catatonia also occurs in patients with infections, an endocrine disorder, metabolic derangements, and neurologic disorders.

How common is catatonic schizophrenia?

According to the article “5 Schizophrenia Subtypes” published in, catatonic schizophrenia is now considered a rare schizophrenia subtype because it is thought to have largely stemmed from untreated schizophrenia. Recent studies, however, were successful in determining the prevalence of the condition prior to 2013, or before catatonic schizophrenia was removed from the list of official diagnoses of the American Psychiatric Association.

For instance, results from a meta-analysis and meta-regression analysis on the prevalence of catatonia and its moderators in clinical samples from the journal Schizophrenia Bulletin – which analyzed 74 studies reporting catatonia prevalence from 1935 to 2017 across all continents – found that the prevalence of catatonia among children/teens was 4.9%, or around 22,883 from a total of 110,559 subjects.

A 2012 cohort prospective study on catatonic schizophrenia published in Schizophrenia Bulletin stated that males and females were equally at risk for catatonic schizophrenia. Contrasting findings, however, have also been found in another study on gender differences in the frequency of schizophrenic subtypes in unselected hospitalized patients published in Schizophrenia Research which indicated that men outnumbered women by a ratio of 6:1 for the catatonic behavior in schizophrenia.

Lastly, Solmi et al., in their study entitled, “Prevalence of Catatonia and Its Moderators in Clinical Samples: Results from a Meta-analysis and Meta-regression Analysis,” claimed that the prevalence of catatonic schizophrenia among older people aged 65 years old and above was 8.5%, or about 552 individuals out of the 110,559 total population.

What are the causes of catatonic schizophrenia?

woman crying out loud

The causes of catatonic schizophrenia are not fully understood. However, experts speculate that a complex combination of factors plays a key role in the development of the condition. The causes of catatonic schizophrenia are listed below.

  • Chemical imbalance in the brain: In her 2009 article published in The Journal of Neuropsychiatry and Clinical Neurosciences, Jessica Daniels, MD suggested that because current medications for catatonic schizophrenia modify the gamma-aminobutyric acid (GABA), glutamate, and dopamine neurotransmitter systems, it is widely believed that an imbalance in each of these brain chemicals may be involved in catatonia.
  • Structural and functional brain abnormalities: According to findings reported by Sean A. Rasmussen, Michael F. Mazurek, and Patricia I. Rosebush from McMaster University in their study published in the World Journal of Psychiatry, functional imaging studies have shown that catatonia is linked to unusual activity in the orbitofrontal, prefrontal, parietal, and motor cortical regions of the brain. This suggests that these cortical structures may influence the development of the syndrome.
  • Psychiatric conditions: An article entitled “Catatonic Symptoms in Schizophrenia and Other Conditions” published in Verywell Mind suggests that although catatonic behavior has long been associated with schizophrenia, it can also occur in other psychiatric conditions, such as bipolar disorder, schizoaffective disorder, and major depressive disorder (MDD).

What are the symptoms of catatonic schizophrenia?

The symptoms of catatonic schizophrenia involve certain types of movement changes that may last for minutes, hours, or even days when left untreated. The most common symptoms of catatonic schizophrenia are listed below.

1. No movement

Lack of movement or immobility means that someone in a catatonic state may not move at all or assume statuesque positions, remaining motionless within hours or even days. A 2018 study on Catatonic Stupor in Schizophrenic Disorders and Subsequent Medical Complications and Mortality published in the journal Psychosomatic Medicine suggests that one of the physical effects of catatonia is dehydration, due to the fact that people who experience immobility often do not eat or drink. Catatonia is also associated with other physical effects, including renal failure, neuroleptic malignant syndrome, rhabdomyolysis, urinary tract infections, and deep venous thrombosis. On the other hand, the behavioral effects of being in a catatonic state include general unhappiness or depression, lack of interest in previously enjoyed activities, poor self-image, and low self-esteem.

2. Not speaking

One of the key symptoms of catatonic schizophrenia is the inability to talk or mutism, which is characterized by having no or very little verbal response. The physical effects of catatonic mutism include impaired personal relationships, decreased socialization, and decreased work or academic performance. Meanwhile, the behavioral effects of being in a state of catatonia include nervous feelings, speech difficulties, fears and social anxieties.

3. Hesitant response

One of the symptoms of catatonic schizophrenia is hesitant response or ambitendency, which is characterized by appearing stuck in an indecisive or hesitant movement. This may lead to physical effects, such as autonomic instability and other sensory or motor abnormalities, while behavioral effects may include unfinished motor reactions, sudden changes in personality, and behavioral disturbances.

4. Staring

Catatonic staring refers to one of the catatonic symptoms of schizophrenia wherein a person stares at a fixed point, often with decreased blinking and with widely opened eyes. This may also be accompanied by lack of movement or speech that persists even when someone tries to get the afflicted individual’s attention. The physical effects of a catatonic stare include being motionless and loss of awareness that can increase one’s risk for life-threatening accidents. Behavioral effects may include unusual movements or reaction to stimuli, immobility, and abnormal behaviors.

5. Repeatedly mimicking someone’s actions or speech

Mimicry in someone with catatonia comes in two forms – they may mimic someone else’s actions (echopraxia), or they may also mimic someone’s speech (echolalia). The physical effects of both echolalia and echopraxia include the imitation of harmful movements and slowed movements, while behavioral effects may include social difficulties, miscommunication, self-injurious behaviors, and socially inappropriate behaviors.

6. Tapping of the foot or other repetitive motions

Repetitive yet purposeless movements in catatonic schizophrenia are also called stereotypies, which are habits that can follow a predictable pattern and that tend to occur during times of strong emotions. Repetitive movements can include tapping of the foot, hand, or finger, wrist twirling, mouth stretching, body rocking, and eye movements. The physical effects of tapping the foot or other repetitive motions may include pain, numbness, weakness, and damage to the muscles or nerves due to strain injuries. Behavioral effects may also include increased irritability, anxiety, social isolation, and peer victimization.

What are the risk factors for catatonic schizophrenia?

female with mental issue

The risk factors for catatonic schizophrenia can increase someone’s likelihood of developing either catatonia or schizophrenia. The risk factors for catatonic schizophrenia are listed below.

  • Genetics: Catatonic schizophrenia may run in families. Having blood relatives who suffer from the condition may up an individual’s risk of developing catatonic schizophrenia themselves.
  • Being female: According to an article entitled, “What You Need to Know About Catatonia” from Healthline, women are at a higher risk of developing catatonia, and this risk increases with advanced age.
  • Childhood neglect or trauma: Current findings and research perspectives on childhood trauma in schizophrenia published in Frontiers in Neuroscience suggest that childhood trauma is a severe form of stress that makes someone more vulnerable to developing schizophrenia. Traumatic experiences during childhood are also associated with impaired working memory, verbal learning, executive function, and attention in schizophrenic patients.
  • Substance misuse: The relationship between schizophrenia and substance misuse goes both ways. While the use of drugs, alcohol, and other substances may cause a person to experience a full episode of catatonic schizophrenia, being diagnosed with schizophrenia also makes someone more vulnerable to substance use disorders. In fact, results from an Epidemiological Catchment Area study published in The Journal of the American Medical Association stated that 47% of schizophrenic patients struggle with drug or alcohol use during their lifetime compared to 16% of the general population.
  • Prenatal nutritional deficiency: Fetal malnutrition is one of the various prenatal conditions that has a detrimental impact on the risk of adult schizophrenia.

How is catatonic schizophrenia diagnosed?

Catatonic schizophrenia is diagnosed with the help of medical and psychological tests, such as a physical exam, an MRI or CT scan, an EEG (electroencephalogram), or psychological evaluation.

Diagnosing the condition involves ruling out other possible causes and related complications through a physical exam. The doctor may also request imaging tests, such as an MRI or CT scan to check for abnormalities in brain structure.

An EEG may be used as well to record electrical activity in the brain and help rule out other conditions, such as epilepsy. Lastly, a psychiatric evaluation is done by the doctor by asking about the patient’s symptoms, thoughts, delusions, hallucinations, moods, and feelings. A doctor may give a diagnosis if the criteria listed in the DSM-5 for schizophrenia was met, namely having at least two of the five main symptoms, which are delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms, most of the time for a month.

When does catatonic schizophrenia occur?

An overview of schizophrenia from the National Alliance on Mental Illness (NAMI) states that the onset of schizophrenia symptoms typically tends to be in the late teens to early 20s for men, and late 20s to early 30s for women. NAMI adds that it is extremely rare for schizophrenia to be diagnosed in children younger than age 12 and adults older than 40.

How does catatonic schizophrenia affect the body?

Catatonic schizophrenia affects the body by causing abnormalities in movements. The resulting movements often manifest in extreme ways, and someone with the condition may switch between being very active or very still for varying periods of time. On a certain day, an individual with catatonic schizophrenia may exhibit extremely high levels of physical movement and be completely still and mute the next day.

How does catatonic schizophrenia affect the brain?

Catatonic schizophrenia affects the brain by disrupting how it works, which involves an imbalance of brain chemicals that control processes related to thinking, behavior, emotions, and memories.

Certain regions of the brain that are affected in the condition may either have abnormally high or low activity, and experts also believe that the brain of someone with schizophrenia tends to lose tissue over time.

What are the possible treatments for catatonic schizophrenia?

psychiatrist evaluating a woman lying on couch for catatonic schizophrenia

The possible treatments for catatonic schizophrenia involve interventions for the condition that make it possible for people to manage their symptoms and live happy and healthy lives. The possible treatments for catatonic schizophrenia are listed below.

1. Psychotherapy

Psychotherapy, or talk therapy, is a general term for a variety of treatment techniques that help a person identify and challenge negative thoughts, emotions, and behaviors by talking with a licensed mental health professional. In particular, a type of psychotherapy that is widely used for numerous mental health conditions, including schizophrenia, is cognitive behavioral therapy (CBT). CBT works by helping a person become aware of negative thought patterns that may be contributing to negative emotions and behaviors, and modifying these harmful thoughts or beliefs so the patient can develop better coping strategies. This way, CBT helps people with schizophrenia build a battery of healthy coping skills and strategies that will help them manage stress and reduce the severity of their symptoms.

2. Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a form of treatment for schizophrenia that involves passing small electric currents to your brain while you are under general anesthesia, causing a brief seizure. This short seizure triggers changes in brain chemistry and activity. Although ECT is a second-line treatment and is only used for patients who did not respond to medications, it is still a very effective way to treat catatonic schizophrenia symptoms.

3. Medications

A class of medications called benzodiazepines is the first-line of treatment for catatonic schizophrenia. Benzodiazepines are a type of sedative medication often prescribed to treat anxiety and seizures, but have also been increasingly used for the treatment of schizophrenia, with the most common benzodiazepines recommended for those with the condition being diazepam (Valium) and alprazolam (Xanax). The administration of benzodiazepines helps sedate and calm agitated people experiencing acute schizophrenic episodes, as reported by Leucht et al., in their study entitled, “Evidence-based pharmacotherapy of schizophrenia” published in the International Journal of Neuropsychopharmacology.

How to prevent catatonic schizophrenia?

Catatonic schizophrenia cannot be prevented from occurring, because even experts to this day still do not fully understand why it develops in people. Therefore, there is no evidence-based and proven way to prevent the condition.

However, according to an article entitled “Is It Possible to Prevent Schizophrenia?” from WebMD, if schizophrenia runs in your family, you may take precautionary measures to lower your risk of developing it. These include avoiding drugs, limiting alcohol intake, avoiding abusive or traumatic situations, strengthening your support network, and consulting with a mental health expert if you think you are having unusual thoughts. The website also adds that around 85% of people with a family history of schizophrenia do not develop the condition themselves, so you should try not to worry too much.

What to expect in catatonic schizophrenia condition?

Having schizophrenia with catatonic features affects how a person acts and perceives reality. This means that they may be times when they feel disconnected from reality, especially when they are experiencing hallucinations and delusions. They may see, hear, or perceive things that aren’t really there.

However, this does not mean that they are entirely unaware of everyday reality – it’s just that they are too aware of the reality that they have created in their minds. In fact, in an article written by Dr. Jonathan Rogers, a Wellcome Trust Clinical Fellow in the UCL Division of Psychiatry, for The Conversation, he shared his experiences in treating patients with catatonia and said that they may not be able to move or speak, but they are often conscious, overwhelmed with feelings, and even aware of the pain of staying in the same position for too long, while being unable to move.

Catatonic schizophrenia that is left untreated can have serious repercussions in an individual’s life, causing health, behavioral, financial, and even legal issues. They may struggle to find or keep a job, have intimate relationships, or maintain friendships. However, seeking relief from symptoms is possible with the help of professional treatment. Patients who stick to their treatment plan have better chances of living full quality lives.

What is the difference between catatonic schizophrenia and paranoid schizophrenia?

The difference between catatonic schizophrenia and paranoid schizophrenia lies in their most dominant feature. While catatonic schizophrenia is characterized by catatonia or unusual, unexpected movements and behaviors, paranoid schizophrenia is dominated by hallucinations and/or delusions, but speech and emotions may not always be affected.

Just like catatonic schizophrenia, paranoid schizophrenia is now an obsolete term, after The American Psychiatric Association (APA) combined the five subtypes under the general category of schizophrenia. But while it is an outdated term, paranoia is still an indication of schizophrenia that experts consider when treating the condition, according to an article about paranoid schizophrenia from Cleveland Clinic.

In paranoid schizophrenia, delusions are made up of elements of persecution and grandeur, with hallucinations supporting the delusions, which may also be present, but are not defining features of catatonic schizophrenia.