Breaking Down Emerging Research on Catatonia in Schizophrenia

Catatonic schizophrenia is a term mired in some controversy. For this reason, the term has generally fallen out of favor among professionals. That’s probably because the condition remains poorly understood.

Also, evidence suggests the condition isn’t a standalone disease, but rather one of many manifestations of schizophrenia.

Recent studies suggest that schizophrenia affects 1.1% of adults in the United States or about 2.8 million people.

Catatonic schizophrenia is a complication that occurs in a small, yet significant, number of schizophrenics. Research on the topic has been relatively scarce lately.

But it’s worth noting that in the past few years the scientific community has:

• Removed catatonic schizophrenia as a standalone condition and considered catatonia to be one of the diverse ways schizophrenia manifests itself.
• Discovered that schizophrenic catatonia responds poorly to benzodiazepines (BZDs).
• Established various modalities of non-invasive brain stimulation as effective methods for catatonic schizophrenia treatment.

Declassification of Catatonic Schizophrenia as a Disease

Recent revisions of both the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) have removed catatonic schizophrenia as a distinct diagnosis.

And that’s because newer research suggests that catatonia is one of the possible symptoms of schizophrenia rather than a subset of the condition. Furthermore, some authors argue for the classification of catatonia as a disease entity of its own.

Those outside the medical community have long associated the word “catatonic” with a coma-like or unresponsive state. However, a person with catatonic schizophrenia could be hyperactive and speak incoherently. Therefore, catatonic schizophrenia symptoms vary widely. Scientists have broadly classified them as hypokinetic (withdrawn) and hyperkinetic (excited).

Hypokinetic catatonia can manifest as mutism (an inability or unwillingness to speak), negativism (a tendency to ignore both external and internal stimuli), abnormal posturing, and stupor.

Conversely, restlessness, severe agitation, echolalia (meaningless repetition of words recently uttered by another person), cataplexy (a sudden loss of muscle control caused by strong emotions), paranoia, delusions, and hallucinations demonstrate hyperkinetic catatonia.

Catatonia in Schizophrenics Responds Poorly to BZDs

Benzodiazepines have been an effective treatment for catatonia for quite some time. However, growing bodies of evidence reveal that catatonia in schizophrenics responds more poorly to BZDs than catatonia caused by other conditions such as drug-withdrawal, post-traumatic stress disorder (PTSD), autism, obsessive-compulsive disorders (OCDs), and so on.

Studies show a high rate of remission when BZDs such as lorazepam treat catatonia. However, less encouraging results were noted amongst schizophrenics who were treated with the same trial of BZDs, with a significant number showing only partial response or no response at all.

One of the possible explanations for this was the fact that the catatonia observed in schizophrenics is usually chronic, which was noted to lead to poorer outcomes with all treatment methods.

Another suggestion was that the catatonia noted in this group of patients was a different entity from the type of catatonia noted in other conditions.

Brain Stimulation for the Treatment of Catatonia in Schizophrenics

Despite the relatively poor response to benzodiazepines seen in catatonic schizophrenics, certain non-drug treatments have shown real promise. This especially includes various methods of non-invasive brain stimulation (NIBS) techniques such as electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS).

A review of the different NIBS techniques showed that ECT was the most effective form of therapy for catatonia in schizophrenia, surpassing both other non-invasive techniques and drug therapy with benzodiazepines.

However, it’s important to note that other technologies such as rTMS and tDCS have been less studied and require further research.

Conclusion 

Modern psychiatry generally considers catatonic schizophrenia an obsolete term. While some studies suggest that catatonia is merely a symptom of schizophrenia or a distinct entity.

Several treatment options do exist, including the use of benzodiazepines such as lorazepam. However, these are less effective in this group of individuals. And non-invasive brain stimulation techniques, such as electroconvulsive therapy, serve as the cornerstone for treating BZD-resistant catatonic schizophrenia.

Further Reading

The Economic Burden of Schizophrenia in the United States

Catatonia and Competency to Stand Trial With Unique Response to Haloperidol

The Weekly Mind Reader: Catatonia Challenges and Solutions