Catatonia is a neuropsychiatric syndrome characterized by a range of psychomotor disturbances, affecting an individual’s movement, speech, and behavior. It is often observed in those with underlying mood disorders or psychotic disorders, but can also stem from other medical conditions. Excitatory catatonia represents a distinct and severe form of this syndrome, marked by excessive motor activity and agitation. This condition warrants urgent medical attention due to its potential for serious complications if left unaddressed.
What Excitatory Catatonia Is
Excitatory catatonia involves heightened activity and restlessness, distinguishing it from other forms of catatonia which may involve reduced movement. Individuals may exhibit psychomotor agitation, a state of restless, unintentional movements, along with extreme talkativeness or frenzied behavior. This can manifest as repetitive, purposeless actions, such as picking at clothes or making odd, repeated gestures, known as stereotypies. Grimacing, or contorted facial movements, is also a common sign.
Patients might display impulsivity and combativeness, or even automatic obedience, where they perform actions without conscious thought or at inappropriate times, like saluting. Speech patterns can include echolalia, the meaningless repetition of another person’s words, or echopraxia, the imitation of another’s movements. The severity of these symptoms can fluctuate, with individuals experiencing periods of heightened excitation. Excitatory catatonia is a specific syndrome requiring careful differentiation from general agitation or psychosis.
Underlying Causes
Excitatory catatonia is not a standalone disorder but rather a symptom arising from an underlying medical or psychiatric condition. Psychiatric conditions frequently associated with catatonia include mood disorders such as bipolar disorder and severe depression, as well as psychotic disorders like schizophrenia.
Medical conditions can also trigger excitatory catatonia, encompassing neurological disorders, infections, and autoimmune diseases. Metabolic imbalances, where the body uses too much or too little of essential chemicals, are another potential cause. Additionally, substance intoxication or withdrawal, and medication side effects or withdrawal from certain drugs like clozapine, can induce catatonic symptoms. Identifying and treating the root cause is a primary focus in managing this complex condition.
Diagnosis Process
Diagnosing excitatory catatonia involves careful clinical observation and assessment of specific motor and behavioral signs. Healthcare professionals look for a cluster of at least three symptoms from a recognized list of 12 criteria, which include agitation, stereotypy, grimacing, echolalia, and echopraxia. A thorough medical history is collected to understand the patient’s background and recent changes.
A physical examination is conducted to rule out other medical conditions that might mimic catatonia, such as neuroleptic malignant syndrome, encephalitis, or certain seizure types. Laboratory tests, including blood work to check for electrolyte imbalances, are often performed to identify any underlying medical causes. The Bush-Francis Catatonia Rating Scale (BFCRS) is a commonly used tool to screen for and monitor catatonia symptoms.
Treatment Options
The primary treatment for excitatory catatonia often begins with benzodiazepines, such as lorazepam, due to their rapid effectiveness in reducing symptoms. Patients with catatonia can tolerate higher doses of benzodiazepines without excessive sedation.
Electroconvulsive Therapy (ECT) is an effective treatment option, particularly for severe or treatment-resistant cases. ECT involves brief electrical brain stimulations under anesthesia and can be a definitive treatment even when benzodiazepines have not been successful. Supportive care, including ensuring adequate hydration and nutrition, is also provided. Addressing the identified underlying medical or psychiatric condition is also an important part of the overall treatment strategy once the acute catatonia is managed.