Catatonia: meaning, definition, causes, synonyms and cures

By Cristiano Antonino On Jul 13, 2022

The word ‘catatonia’, pronounced with the accent on the I, derives from the Greek κατά ‘under’ and τόνος ‘tone’, and indicates a psychopathological syndrome with a dissociative basis, in which the subject’s actions become almost completely disengaged from rational and affective motivations, remaining stuck in automatic, rigid, stereotyped attitudes that are resistant to external action

It is a syndrome recognised and listed within the DSM (Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association).

Catatonia can affect any age of life, occurring among both children and, especially, adults and the elderly

Catatonic persons generally remain still in statuesque attitudes, silent and as if absorbed in themselves, with eyes closed, with ‘strange’ and incoherent facial expressions, or stiffened.

The catatonic patient has:

loss of motor initiative;
insensitivity to external stimuli;
increased muscle tone at rest;
attitudes that are difficult to maintain over time, remaining in static ‘statue-like’ postures for a long time.

They react antagonistically (negativism) to the behaviour of those around them, e.g. by refusing food, only to eat spontaneously when they see themselves alone, or by strenuously resisting body movements.

Even the stimuli of organic functions are actively resisted: the sick do not eat although they are hungry; they forcibly withhold faeces and urine and so on.

In the course of catatonia, a tendency towards passivity to the point of catalepsy may also manifest itself.

Similar signs of passivity and other symptoms are:

ecopraxia: the automatic imitation of acts that are seen to be performed;
echolalia: the echo-like repetition of the last words heard uttered by others;
waxen flexibility: the forcing of the subject to assume even uncomfortable physical positions for a certain period of time, as if they were wax statues;
automatic obedience to even nonsensical, absurd and/or humiliating commands (e.g. a catatonic could drink his own urine if asked to do so);
hypokinesia: marked decrease in movements;
akinesia: total blockage of movements;
stupor: lack of critical cognitive function combined with a level of consciousness that leads to the patient’s partial or total inability to respond to basic stimuli, such as pain;
mannerism: the use of hyperbolic, overloaded and unnatural facial and body mimicry;
mutacism: difficulty on the part of the sufferer in pronouncing labial consonants;
uninterrupted repetition of sentences (‘broken record’).

In some cases, immobility is suddenly interrupted by strong tremors, shaking and sometimes running away.

Interruption of immobility

As just mentioned, even the most rigid catatonia can be abruptly interrupted, for a more or less brief time, sometimes for no apparent reason, sometimes due to visible psychic influences, or to give rise to sudden outbursts, to impulses that take on infinite forms, from the most futile to the most serious and dangerous.

Immobility can also be interrupted for hours and days at a time and give rise to fits of violent agitation, to vociferation of an ever-changing phrase. Movement may cease for no apparent reason or for an external influence that the patient considers relevant.

In what pathologies does catatonia occur?

Although the precise causes of catatonia are not yet fully understood, there are many pathologies that increase the risk of developing this syndrome.

The picture of catatonia is very frequent, in more or less severe forms, especially in dissociative psychoses that are ascribed to so-called early dementia or schizophrenia.

This manifestation can also be induced by drug use/abuse (overdose), alcohol withdrawal and abrupt discontinuation of benzodiazepine treatment.

Pictures of catatonia may also occur episodically in many other pathologies of neurological and psychiatric interest, both organic and psychic, such as:

brain tumours
subarachnoid haemorrhage;
hydrocephalus;
progressive paralysis;
cerebral angio-syphilis;
sleep disorders;
melancholia;
dementia;
autism;
dipolar disorder;
stroke on an ischaemic or haemorrhagic basis;
hysteria;
metabolic disorders;
multiple sclerosis;
Parkinson’s disease;
encephalitis.

Therapy in the catatonic patient

The treatment of this syndrome depends on the pathology that caused it, e.g. if the cause is a brain tumour, the patient may improve or come out of his catatonic state when the tumour is eradicated.

Therefore, not for all pathologies is a definitive cure possible, and not for all catatonic states is an effective cure always possible.

Regardless of the causes, catatonic states tend to improve after administration of drugs belonging to the benzodiazepine family.

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