Expressions of Catatonia
What are the different expressions of Catatonia?
Retarded (Akinetic) Catatonia
Retarded Catatonia is the most well-known type of Catatonia. Its symptoms include bizarre or inappropriate body position or attitude for an extended period of time, muscle rigidity, mutism (limited or no speaking aloud), repetitive actions (rocking, biting, sniffing, chewing), and failure to respond to painful stimuli.
When the patient exhibits stupor (extreme hypoactivity, immobility, minimally responsive to stimuli), patients may require IV feeding and extended nursing care.
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Catatonia has many expressions with certain symptoms commonly associated with each expression. Each of the expressions and their associated symptoms are described below.
Excited Catatonia
Excited Catatonia is characterized by extreme talkativeness, psychomotor agitation (restless unintentional movements), frenzy (excitement or wild behavior), rapid onset of delirium (disorientation, confusion, not able to think or remember clearly), psychosis (perception of reality is very different from other people), decreased sleep, etc.
Excited Catatonia should be distinguished from Delirious Mania because treatment options are very different. Delirious Mania may respond to antipsychotic medication. A patient with Excited Catatonia who is given antipsychotic medication will likely deteriorate even more. The introduction of this medication may cause Malignant Catatonia, a potentially fatal condition.
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Agitated Catatonia - Catatonia in Autism Spectrum Disorder (ASD) and Other Developmental Disorders
Agitated Catatonia is often associated with self-injurious and stereotyped behavior (well-defined behavioral acts which are repeated over and over again and which seem to be without any apparent adaptive function such as hitting one’s head, rocking, pacing, flapping hands), commonly seen in autism. Agitated Catatonia may also include unprovoked severely aggressive behavior in patients with ASD.
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Malignant Catatonia
Malignant Catatonia is a syndrome of acute onset and is characterized by stupor (extreme hypoactivity, immobility, minimally responsive to stimuli), mutism (verbally unresponsive or minimally responsive), catalepsy (spontaneous maintenance of postures including mundane postures - sitting or standing for long periods without reacting), waxy flexibility (during repositioning a patient offers initial resistance before allowing self to be repositioned), negativism (apparently motiveless resistance to instructions or attempts to move or examine the patient), fever, autonomic dysfunction (abnormal blood pressure, tachycardia and tachypnea), muscle rigidity and increased CPK levels (indicating injury to muscle tissue of the heart or the brain).
Malignant Catatonia can be fatal if not treated with urgency.
Malignant Catatonia may be brought on by certain medications (e.g. antipsychotic and serotonergic medication).
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Periodic Catatonia
Periodic Catatonia is a rare type of Catatonia syndrome, in which the catatonic phases (either retarded or excited phases) often repeat regularly. Between the catatonic periods, the symptoms totally disappear and make the diagnosis difficult.
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Catatonia due to Anti-NMDA Receptor Encephalitis
Anti–NMDA Receptor Encephalitis was first described in 2007 and is now recognized as one of the most common forms of encephalitis.
It is considered a multistage disease, typically starting with nonspecific flu-like symptoms, followed by sudden onset of psychiatric manifestations such as psychosis (perceiving or interpreting reality in a very different way from people around you), delusions (false belief or judgment about external reality held despite incontrovertible evidence to the contrary), hallucinations (an experience involving the apparent perception of something that’s not there), anxiety, insomnia, repetitive behaviors, echolalia (repeating statements or questions of another person), and mutism.
This phase is usually followed by a change in level of alertness with periods of extreme agitation, bizarre movements of the jaw, face, mouth and tongue or other movement disorders, and dysfunction of the nerves that regulate involuntary body functions such as heart rate, blood pressure and sweating. Coma may occur as well. Patients (especially children) may develop focal or generalized seizures.
Anti-NMDA Receptor Encephalitis can be associated with a tumor, especially ovarian teratomas in female patients older than 12 years.
A brain MRI will show normal results in up to 67% of patients. An EEG test will show abnormal results in 90% of patients.
The diagnosis of Anti-NMDA Receptor Encephalitis is confirmed by the presence of NMDA antibodies in the cerebrospinal fluid.
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COVID-19 Associated Catatonia
The COVID-19 virus may be responsible for the onset of Catatonia without a prior mental health condition. This has been explored in several articles addressing psychiatric disturbances in COVID-19.
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