Catatonia Associated With

Another Mental Disorder

(Schizophrenia)
By: Casey Gatto and
Nicole Garancsi
 Catatonia Definition

A pronounced increase or decrease in the rate and amount of movement. Excessive motor

activity is purposeless. The most common form of catatonia is when the person moves little

or not at all. Muscle rigidity, or catalepsy, may be so severe that the limbs remain in

whatever position they are placed. Persistent catatonia may contribute to exhaustion,

pneumonia, blood clotting, malnutrition, or dehydration.

(Herzog, 2022)
 The History of Catatonia
Karl Ludwig Kahlbaum discussed Catatonia during a lecture in 1868 about patients from his

practice in a sanitorium. He concentrated on describing the motor symptoms and how this

syndrome was co-occurring with the most common disorders including depression and

schizophrenia. Many researchers and psychiatrists after this mainly thought of this disorder as

one originating from schizophrenia but it was later discovered in a variety of other conditions.

Treatment before the 1920’s only included supportive care.

(Wilcox & Reid Duffy, 2015)

 DSM-5 Criterion
➢ Must exhibit 3 or more of the following symptoms:
■ Stupor ■ Posturing
● No psychomotor activity, not actively relating to the ● Spontaneous and active maintenance of a posture
environment against gravity
■ Catalepsy ■ Mannerism
● Passive induction of a posture held against gravity or muscle ● Odd circumstantial caricature of normal actions
rigidity and fixity of posture regardless of external stimuli ■ Stereotypy
■ Waxy Flexibility ● repetitive, abnormally frequent, non-goal-directed
● Slight even resistance to positioning by examiner, the limb can movements
be placed in different postures and remain fixed in that ■ Agitation
position for a long period of time despite asking the individual ● Not influenced by external stimuli
to relax ■ Grimacing
■ Mutism ■ Echolalia
● No or very little verbal response ● Mimicking another's speech
■ Negativism ■ Echopraxia
● opposition or no response to instructions or external stimuli ● Mimicking another's movements

(Catatonia, 2023)
 Prevalence of
Risk Factors Comorbidities
Catatonia in the US
- Prior episodes of - Psychotic disorders
- Found in about 35% catatonia - Depressive disorders
of people with - Current or past
- Bipolar disorder
schizophrenia extrapyramidal syndrome
- Autism Spectrum - Neurodevelopmental
disorder disorders
- Found in an - Mood disorders - Other medical
estimated 15-31% of - Psychotropic conditions (ie. TBIs)
people with mood medications
disorders - Substances
- Electrolyte disturbances
(Catatonia, 2023)
 Pharmacotherapeutics
○ 1st line Treatment - Electroconvulsive therapy + Lorazepam (IV)
■ Lorazepam
● Patients with catatonia will usually respond within 30 minutes
● Around 70% of patients with catatonia will respond to Lorazepam
■ ECT
● Definitive treatment for patients whose catatonia persists for more than 2-3 days or if there are
malignant features
● Bitemporal ECT is recommended 3 times per week for at least a total of 6 sessions
○ Treatment of the underlying condition is indicated which may require antipsychotics, benzodiazepines, and
mood stabilizers. However, the use of antipsychotics can cause an increase in motor symptoms.
Clinical Problem
Patient J present to Emergency Department
from home in a catatonic state. Patient is
brought in by father (caregiver) stating the
patient has become nonverbal and stares off
without “snapping back into reality.” The
patient has not ate or drank anything in the
last two days. The catatonic state first started
with slow movements followed by little
verbal response, however the patient is now
nonverbal and is not cooperative.
 Demographics

Age Gender Marital Status

54 Female Single
 Admitting Diagnosis
Mutism Grimacing
No use of verbal response for 1 Constant grimace facial
week. expression for the last few
days

Catalepsy Negatism
Very little movement, stays No response to painful stimuli
seated and only moves to get (pinching), however patient
out/in bed. did have all reflexes
 Patient Medical History

❏ Stage 2 pressure ulcer on 1998

coccyx (current) Schizophrenia
❏ Former substance abuse
(Meth)
❏ GERD (2009) 2003
Depression

2005
Type 2 diabetes
 Medication Profile

Fluoxetine (Prozac) Metformin

Trazodone (Desyrel) Ozempic

Haldol Methadone

Cogentin
 Priority Nursing Assessments
Medication
Adherence
Determine whether
the patient's drug or
alcohol usage, or
noncompliance with
treatment, is a
contributing factor
to the psychotic
episode.
Contents of Monitor for
Hallucinations Agitation/Anxiety
It is important for the Keep a close eye on
nurse to clarify that the patient's
they are not hearing thoughts and actions
or seeing what the to see any signs of
patient is increasing agitation
experiencing and not or anxiety, and act
to support the swiftly to protect the
hallucination. patient and other
people from harm.
Problem
The key problem in this particular
situation, with the patient not getting up
or giving oneself nutrition or water. This
will lead to malnutrition and dehydration.
The patient has not been cooperative with
staff, is now incontitent, and nonverbal.
 Nursing Interventions for the Problem
❖ Nutrition

➢ Place patient on strict intake and output observations

■ Document everything going in and out of the patient to
ensure they are receiving the appropriate nuritishment and
fluid intake. May have to catheterize the patient to obtain
accurate amount of output.
➢ Prepare for IV fluids
■ Keep the patient hydrated without the patient having to
physically drink water
➢ Educate patient on importance of eating/drinking in order to
maintain health
■ Even though the patient is nonverbal, they can still hear us.
The patient has rights like everyone else. We need to
sympathize and ensure the proper education is being given
to the patient.
 Nursing Interventions for All Patients
○ Establish trust ○ Nutrition
■ Don’t touch the patient without the patients knowledge or ■ Monitor the patient's nutritional status
consent ■ Strict intake and output (catheterization if
■ Use short calm sentences when communicating with the patient needed)
■ Talk to them through the entirety of your interaction (verbalize ■ The nurse may need to administer fluids or
what you are doing) parenteral feedings
■ Announce yourself when approaching the patient and when ○ Hygiene
leaving them ■ Skin care
○ Safety ■ Turning and repositioning
■ Maintain a safe environment with minimal stimuli ■ Bed baths
■ Ensure path is cleared of objects if the patient were to exhibit
movement symptoms
■ Posey beds if the patient is an elopement risk
■ Advocate for patient
 Goals
Get patient of medication
profile that will benefit the
Long term patient and will continue
to work for their medical
needs.
Ensure appropriate
nutrition and hydration has
been reached for the Short term
patient within 1 week of
stay.
The use of ECT is effective
in the patient and they will
Long term begin to go back to
routine.
The patient will begin to
make voluntary
movements for oneself Short term
within 1 week on
benzodiazepines.
Creating a Safe Environment

01
Provide an environment free of distractions
and possible triggers for agitation.

Keep one tone with patient, do not raise your

02 voice or make any sudden movements. Still

make sure to explain to the patient everything
you are doing even if they are not responding,

Promote an encouraging and uplifting

03 environment. By establishing therapeutic

communication the patient will likely begin to
know and trust you.

(APNA, 2022)
Question 1. The nurse walks into a patient's room that has schizophrenia. The patient is
standing in the corner of the room with his hand raised upright. The nurse engages with the
patient but the patient does not respond. The nurse returns in 30 minutes and notes that
the patient has not moved. Which symptom of catatonia is this an example of?

A. Catalepsy
B. Waxy Flexibility
C. Posturing
D. Stereotypy
 Question 1. Answer
Answer - C
Catalepsy occurs when the examiner moves the patient's arm into a position and it
is held while in a catatonic state. Waxy Flexibility is when the examiner tries to
reposition a patient in a catatonic state but the patient shows slight resistance to
the position change. Posturing is when a spontaneous position exhibited by the
patient. Stereotypy can be defined as non goal directed movements exhibited from
the patient.
Question 2. A patient has a diagnosis of catatonic schizophrenia. Which behavior(s) would
support this diagnosis? Select all that apply

A. The patient maintains an immobilized state for hours

B. Does not respond to the nurse when prompted
C. Mimics the speech of the nurse
D. The patient walks back and forth in his room waving his right
hand
 Question 2. Answer
Answer - A,B,C,D
All of the answers are symptoms from the DSM-5 criterion that would diagnose
the patient with catatonic schizophrenia. A is stupor, which is defined as no
reactivity to the environment. B is mutism, when the patient does not provide a
verbal response. C is echolalia, which is when the patient repeats words that the
examiner has spoken. D is stereotypy, this is considered to be repetitive and
non-goal directed movements.
 Question 3. A nurse is caring for a newly admitted patient that has been diagnosed with
catatonic schizophrenia. The doctor has prescribed Lorazepam for this patient. What other
treatment would the nurse expect the doctor to order because of its effectiveness when paired
with Lorazepam?
A. Antipsychotics
B. Electroconvulsive Therapy
C. Mood stabilizers
D. Family Therapy
 Question 3. Answer
Answer - B
A, Antipsychotics should not be taken when an individual is experiencing catatonia
because it can increase the movement effects of catatonia. B, electroconvulsive
therapy with the use of Lorazepam is the first line treatment for catatonia. It is
shown to be the most effective. C, mood stabilizers can be given and are indicated
if an individual is experiencing mania and/or has a diagnosis of bipolar. Family
therapy could be helpful but is not the first line treatment for an individual
experiencing catalonia.
 References
APNA. (2022, March 30). Key components of safety.

https://www.apna.org/key-components-of-safety/

Catatonia. PsychDB. (2023, June 2). https://www.psychdb.com/cl/0-catatonia#catatonia

Herzog, E. A. (2022). Schizophrenia Spectrum Disorders. In M.J. Halter’s Varcarolis’ (Ed.),
Foundations of Psychiatric-Mental Health Nursing: A Clinical Approach (9th ed). (Pp.
190 - 196). Elsevier.
Wilcox, J., & Reid Duffy, P. (2015). The syndrome of catatonia. Behavioral Sciences, 5(4),
576–588. https://doi.org/10.3390/bs5040576