Catatonia in Bipolar: What You Need To Know
Catatonia is a disorder that disrupts a person’s awareness of their surroundings. Those who are afflicted may have minimal reactions to their surroundings. This is what's known as being "catatonic." As one of the somewhat common bipolar disorder symptoms, catatonia can sometimes be dismissed as being purely psychiatric. However, an escalated form of this condition, called malignant catatonia, can be lethal. Here are the facts about catatonia.
Understanding Catatonia
Catatonia is often a presentation of extreme anxiety and depression. Researchers aren’t exactly sure of the catatonia causes, but it’s believed to be disturbances with chemicals in the brain.
While catatonia has historically been associated with schizophrenia, it's now understood that it can be present with primary mood disorder, bipolar type 1, neurological diseases, and other medical conditions. However, catatonia is most commonly seen in people with bipolar 1 disorder (43% in studies), and schizophrenia (30%).
Symptoms of Catatonia
To be diagnosed with catatonia, a person must have three of the officially recognized symptoms below:
Agitation or irritability
Grimacing - Or making unusual facial expressions
Catalepsy - Holding the body in the same position for a long period of time
Echopraxia - Mimicking other people’s movement
Echolalia - Repeating what others say
Mutism - Being unusually quiet or even unable to speak
Negativism - Not responding to the environment
Posturing - Disturbances in motor activity
Stereotypy - Repetitive movements that lack purpose
Stupor - Non-responsive although awake
Waxy Flexibility - Resistance to changing body positions
It's common for people who are catatonic to hold themselves in a single posture for an uncomfortably long amount of time. Most people think of someone who is catatonic as being in a still, coma-like state. However, that is not true. Catatonia can be:
Excited (hyperkinetic) - In this case, a person might pace, appear agitated, or act out aggressive or violent behaviors. They may even attempt to harm themself or others.
Withdrawn (hypokinetic) - A person may not respond to anything happening around them even though they are clearly wide awake. They are typically silent and expressionless.
Catatonia usually isn't considered a life-threatening condition. However, a subset of this condition called malignant catatonia can quickly turn deadly without proper interventions. It's important to understand malignant catatonia if you are prone to this condition.
What Is Malignant Catatonia?
Once called lethal catatonia, malignant catatonia is considered the most extreme manifestation within the catatonic spectrum. Malignant catatonia has a high mortality and morbidity rate.
Malignant catatonia (MC) is a diagnosis that doesn’t occur too often. However, the obscurity of this potentially life-threatening neuropsychiatric condition is one of the things making it so dangerous. A person experiencing an episode of malignant catatonia is experiencing dysautonomia. Their nervous system is in an acute state of dysfunction. Symptoms of malignant catatonia are:
Dangerously high body temperature and fever (hyperthermia)
Unstable blood pressure
Rapid heart rate (tachycardia)
Excessive sweating
Tremor
Unstable blood pressure
Low blood oxygen (cyanosis)
These symptoms come in addition to the symptoms of general catatonia. As a condition that involves suppression or deregulation of the nervous system, malignant catatonia has the potential to disrupt brain messaging and automatic bodily processes. This is what makes it such a dangerous and life-threatening condition. For this reason, immediate and acute medical care is required when a person presents with a suspected case of malignant catatonia.
Life-threatening catatonia is often misdiagnosed or diagnosed late in a patient's hospital course. This is mostly due to the fact that its nuanced cause or set of causes can allow it to easily slip through standard screening tools. The average delay in treatment for malignant catatonia is believed to be around 15 days. Delayed treatment for this condition is associated with worse outcomes.
Poor diagnosis contributes to why malignant catatonia has a mortality rate of up to 20 percent. A long-held association with purely psychiatric symptoms is one of the reasons why malignant catatonia treatments are often delayed.
How Is Catatonia Diagnosed?
Both catatonia and malignant catatonia are often diagnosed based on the presentation of symptoms and health history. Healthcare providers will often use electroencephalogram (EEG) brain-activity testing to potentially rule out a seizure or epileptic episode. Additionally, CT scans and MRI testing may sometimes be used. Chemical changes in bodily fluids indicating catatonia can be detected using blood, urine, and fluid tests.
How Is Catatonia Treated?
Since it can be fatal if it progresses, it’s imperative to seek treatment for catatonia early. The disorder is highly treatable. But. treatment depends on the severity and the person's medical history.
Pharmacologically, benzodiazepines are usually the first-line treatment for both regular and malignant catatonia. A clinical review of treatment for catatonia found that benzodiazepines created the most dramatic and immediate effects compared to other pharmacological agents. In this review, lorazepam and zolpidem were specifically named. Other research shows benzodiazepines as being effective in 70% of malignant catatonia cases.
Another treatment for catatonia is electroconvulsive therapy or ECT. Electroconvulsive therapy has been found to be quite effective for catatonia. However, ECT treatment can be limited in certain settings.
