Catatonic agitation: symptoms, causes, treatment

The term “catatonic arousal” refers to a condition characterized by the occurrence of attacks of psychomotor anxiety. A person’s behavior becomes inadequate, he commits a number of unmotivated and meaningless actions. Some time ago, doctors considered the state of catatonic arousal to be one of the clinical manifestations of schizophrenia. In modern medicine, it is isolated in a separate pathology, which has a number of specific symptoms. According to statistics, catatonic symptoms are detected in 15% of people registered with a psychiatrist about their autism.

Etiology

An attack always occurs unexpectedly. Even a person with a disorder cannot predict in advance when it will begin.

Triggers for the development of the disorder are the following diseases and conditions:

• Schizophrenia.
• Oligophrenia.
• Hysteria.
• Psychoses.
• Autism.
• Epilepsy.
• Stroke.
• Tourette's syndrome.
• Traumatic brain injuries.
• Postencephalic syndrome.
• The presence of neoplasms in the brain.
• Endocrinopathy.
• Wilson's disease (genetic pathology).
• Vasculitis
• Addiction.
• Body contact with harmful chemical compounds (e.g. carbon monoxide poisoning).
• Taking certain medications, in particular antibiotics, hormones and antipsychotics.
• Bipolar depression.
• Post-traumatic stress.
• Behavioral disorders in women in the postpartum period.
• Werlhof's disease.
• Pathologies of an infectious nature.
• Acute intestinal diseases.

There is also a hypothesis that catatonic behavior is characteristic of individuals whose body has a deficiency of gamma-aminobutyric acid. Some doctors are of the opinion that the “culprit” is dopamine deficiency. Often the state of catatonic excitement is a kind of reaction of the body to a long stay in fear.

Clinical manifestations

Catatonic disorder involves two conditions. This is excitement and stupor. Their change also occurs suddenly.

Catatonic manifestations are a whole symptom complex. It is quite complex and includes more than two dozen clinical manifestations.

The main symptoms of catatonic agitation:

• Inversion. This term refers to the deliberate rotation of the whole body from the interlocutor.
• Complete submission. The patient automatically carries out all the orders that the doctor gives him.
• Ambitance. This is a condition in which a person simultaneously tries to follow all the instructions and fiercely resists them.
• Blocking. At some point, a person abruptly ceases to move or engage in any activity.
• Verbigeration. The patient periodically pronounces words, phrases or syllables that are devoid of any meaning.
• Excitation. In other words, this is excessive psychomotor activity.
• Syndrome "air cushion." The patient, who lies on the bed, raises his head and stays in this position for quite a long time.
• Wax flexibility. This phenomenon, the essence of which is as follows: the doctor consciously gives the patient an uncomfortable position, while the latter does not make any attempts to change the pose.
• Grimacing. It is characterized by the presence of artsy facial expressions, which does not correspond to the circumstances and the internal state of the patient.
• Closure. A person does not want to make contact with other people.
• Catalepsy. The patient's body ceases to respond to external stimuli.
• Logorea. Human speech becomes continuous, monotonous and incoherent.
• Mannerism. The patient repeats the same uniform movements several times in which there is no sense.
• Mutism. Sometimes patients completely refuse to communicate using speech.
• Instead of wax flexibility, negativity sometimes occurs. In other words, the patient resists the actions of the doctor and returns to the starting position.
• Immobility. This is the complete absence of any motor activity.
• Perseveration. The patient stubbornly repeats any movements that are meaningless.
• Rigidity. It is characterized by a sharp increase in the tone of the anatomical structures.
• Stupor. The patient does not make any movements, does not respond to external stimuli, does not make contact.
• Grasping reflex.
• Bulging eyes.
• Echolalia. The patient repeats the words spoken by another person.
• Echopraxia. The patient imitates other people.

In addition, the catatonic state is accompanied by an increase in body temperature.

Forms

In patients, pathology can manifest itself in different ways. The following forms of catatonic arousal exist:

• Pathetic. It is characterized by a slow formation of psychomotor disorders. Over time, their strengthening occurs. A person’s speech becomes pathos, he begins to repeat words and sentences after other people. The mood in the patient is usually good. Periodically, laughter arises for no reason. All actions are impulsive. The behavior clearly shows foolishness, childishness.
• Impulsive. Symptoms of catatonic excitement in this case develop rapidly. The patient is a danger to others. His speech consists of a set of meaningless phrases. Human movements are chaotic.
• Speechless. A dangerous form of the disease. In this case, catatonic excitation is characterized by the presence of senseless and chaotic activity in a person. He shows aggression towards other people, gives them all kinds of resistance. Often the patient does physical harm to himself.

As mentioned above, the violation includes the state of stupor. When it occurs, motor activity ceases. In addition, a person does not perceive the world around him and does not enter into conversations with other people. The condition of a catatonic stupor can last several months.

Kinds

Pathology can be pure, lucid or oneiric. In the first case, a person is diagnosed with either stupor or arousal. The lucid form of the disease is characterized by the fact that a person has a clear consciousness against the background of the existing symptoms.

Oneiric catatonic excitement is a condition in which the patient has incoherent thinking, he is disoriented not only in time but also in space. The patient may lose memory, consciousness. Often he experiences emotional outbursts.

Stages

Catatonic disruption, as it develops, goes through several stages:

• Confused condition. The patient is eloquent. His statements have unnatural pathos. An incoherent not only speech, but also thinking.
• Hebephrenic arousal. At this stage, pronounced foolishness appears. The patient arranges clowning, grimaces and mimics other people.
• Impulsiveness. The patient's behavior becomes aggressive.
• Fury is characteristic of the final stage. The patient can direct destructive power both on himself and on others.

Due to the abrupt onset and the presence of unmotivated aggression, catatonic arousal is considered a dangerous condition. If its symptoms occur, the patient must be taken to a medical facility as soon as possible.

Diagnostics

When a person has catatonic symptoms, he needs to be shown to a neurologist. If the patient is in contact with others, the doctor will conduct a conversation with him. Otherwise, a history should be collected with the help of relatives. The purpose of the survey is to identify the root cause, that is, the provoking factor that became the impetus for the development of the disorder.

The next stage is a comprehensive neurological examination. It includes:

• Haemogram.
• Blood tests (general and biochemical).
• Study of fluid connective tissue for hormones.
• The immunogram.
• Clinical analysis of urine.
• Microbiological studies of urine and blood.
• CT and MRI of the brain.
• Encephalography.
• ECG.
• Lumbar puncture.
• Ultrasound of the kidneys and thyroid gland.
• Test for the detection of heavy metals in the body.

Based on the results of the diagnosis, the doctor chooses the patient management tactics.

Drug treatment

All therapeutic measures are carried out exclusively in a psychiatric clinic. In severe cases, the patient is tied to a bed. This measure is necessary to ensure the safety of both others and the person suffering from the disorder.

The main goal of the treatment of catatonic arousal is to relieve symptoms. All drugs are prescribed by the doctor individually. The specialist takes into account even the smallest features of the patient’s health when choosing treatment tactics.

The classic treatment regimen for the disorder involves the use of benzodiazepine tranquilizers. Currently, the maximum effectiveness against the disease is shown by the anxiolyticlorazepam component. It is the active substance of the drug "Lorazepam". In addition, the medication has an undeniable advantage over other similar drugs - low toxicity.

Several years ago, treatment of catatonic arousal implied the administration of antipsychotics to the patient. In modern psychiatry, this group of drugs is not used. This is due to the fact that they can lead to the development of malignant antipsychotic syndrome. This is a condition that poses a danger to the life of patients.

Currently, the treatment of catatonic arousal involves the use of the following groups of drugs:

• Normotimikov. These are medicines whose active components help stabilize mood in patients. An example is Carbamazepine.
• Antagonists of n-methyl d-aspartate receptor. As a rule, doctors prescribe Amantadine.
• Dopamine receptor agonists. Example: Bromocriptine.
• Sleeping pills. Most often, doctors prescribe Zolpidem.
• Muscle relaxants. Example: Dantrolene.

Immediately after stopping the acute phase, patients are shown a course of treatment by a psychotherapist.

Contrary to popular belief, catatonic disorder is not a sentence. With a competent approach to the disease in most patients, a stable period of remission sets in.

Electroconvulsive therapy

Its implementation is shown only if drug treatment has not led to a positive trend. The essence of the method is as follows: the doctor, using a special device, delivers an electric current to the brain. In this case, the latter passes through all the structures of the organ. Against the background of electroconvulsive therapy, medications are continued to be administered to the patient.

Treatment is also carried out exclusively in a hospital setting. Patients are constantly monitored by medical personnel who are ready at any second to provide emergency care.

Electroconvulsive therapy should be carried out exclusively by highly qualified specialists. This is due to the fact that any incorrect action can lead to irreversible consequences and even death of the patient.

This method of treatment has been used in psychiatry for many years. However, he has a number of contraindications. These include: pregnancy, lactation, pathologies of the cardiovascular system, diseases of the musculoskeletal system, impaired functioning of the digestive and respiratory organs, infections in the acute stage.

Effects

Catatonic arousal is a condition that is recognized by doctors as extremely dangerous. This is due to the fact that the slightest delay threatens the development of serious complications in the patient.

First of all, all undesirable consequences can be triggered by the following factors:

• Mutism. This term refers to a disorder of speech initiation.
• Long stays stationary.
• Inadequate or illiterate care for patients hospitalized in a hospital.
• Lack of emotions due to lack of contact with the environment.
• Pessimism of doctors. Many experts still believe that catatonic disorder is incurable and accompanies a person for the rest of his life. As a rule, patients feel the mood of doctors very subtly.
• Illiteracy when choosing an approach to the patient. All medicines should be prescribed taking into account individual characteristics.
• Lack of preventive measures.

Due to this, all patients suffering from catatonic disorder are susceptible to the development of somatic pathologies.

Possible complications:

• Pneumonia. It occurs against the background of aspiration into the respiratory tract of the contents of the stomach.
• Venous thrombosis of an acute nature. It develops against the background of excessive blood coagulation in the lumen of blood vessels.
• Pulmonary embolism. Large branches become clotted with blood clots.
• Pneumothorax. This is a pathology in which an accumulation of gases occurs in the pleural cavity.
• The formation of fistulas between the lungs and bronchi.
• The occurrence of various violations of the digestive tract. Most often diagnosed: diarrhea, constipation, bowel obstruction.
• Metabolic disorders. They arise due to the fact that the patient eats through a special tube. The blood glucose concentration decreases and the amount of oxygen increases.
• Carious tooth damage.
• Fungal and bacterial infections of the oral cavity.
• Pressure sores. In other words, it is soft tissue necrosis.
• Retention or, on the contrary, urinary incontinence.
• Genital infections.
• Nervous paralysis.

The risk of complications increases significantly with untimely hospitalization of the patient in a psychiatric dispensary.

Finally

The term "catatonic arousal" refers to a pathological condition characterized by the occurrence of psychomotor disorders. The patient's behavior becomes inadequate, it often poses a danger to others, since one of the symptoms of the disorder is unmotivated aggression. Treatment of the disease is carried out in a psychiatric clinic.