obsolete catatonic schizophrenia in remission

Catatonic schizophrenia, also known as catatonia, was previously considered a subtype of schizophrenia. However, it is now recognized as a distinct syndrome that can be associated with various psychiatric conditions, including schizophrenia.

In the past, catatonic schizophrenia referred to a specific subtype of schizophrenia characterized by stereotypies, mannerisms, automatic movements, and bizarre postures [5]. People with this condition may exhibit unusual behaviors, such as agitation, mutism, or abnormal reactions to their environment [14].

Some cases of catatonic schizophrenia can go into remission, meaning that the symptoms subside and do not return. However, because the symptoms can recur unpredictably, experts still consider this a lifelong condition [1]. The exact causes of catatonia are not fully understood, but it is believed to be related to changes in brain function during puberty in susceptible individuals [7].

It's worth noting that the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) previously divided schizophrenia into five subtypes, including catatonic schizophrenia. However, in 2013, the American Psychiatric Association combined all the subtypes under the general category of schizophrenia [10]. Today, catatonia is recognized as a specifier for schizophrenia, indicating that it can be associated with this condition but is not a separate subtype [9].

References:

[1] Some cases can go into remission, which means a person's symptoms go away and don't return. However, because the symptoms can return unpredictably, experts still consider this a lifelong condition.

[5] Catatonic schizophrenia refers to a subtype of schizophrenia characterized by stereotypies, mannerisms, automatic movements, and bizarre postures.

[7] Nov 16, 2024 — Schizophrenia or other forms of psychosis may be triggered by changes to the brain during puberty in those who are susceptible due to genetics, ...

[9] by FJ Appiani · 2018 · Cited by 28 — Instead catatonia is a specifier for schizophrenia as it is for mood disorders. DSM 5 also added catatonia as a specifier for brief psychotic disorder, ...

[10] Schizophrenia was divided into five subtypes, including disorganized schizophrenia, paranoid schizophrenia, residual schizophrenia, undifferentiated schizophrenia, and catatonic schizophrenia per the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). In 2013 the American Psychiatric Association (APA) combined all the subtypes under the general category of schizophrenia.

Remission of Catatonic Schizophrenia: What to Expect

Catatonic schizophrenia, a condition characterized by abnormal behavior and immobility, is no longer considered a standalone diagnosis. However, understanding its signs and symptoms can provide valuable insights into the complexities of this psychiatric disorder.

When catatonic schizophrenia goes into remission, individuals may exhibit a range of physical and behavioral changes. Some common signs and symptoms include:

• Immobilization: People in remission from catatonic schizophrenia may still experience periods of immobility, where they appear rigid or unresponsive.
• Repetitive movements: Individuals may repeat words or phrases, or perform strange movements, such as pacing back and forth or exhibiting erratic body language.
• Changes in movement patterns: Remitted individuals may exhibit unusual styles and levels of physical movement, including immobility, posturing, or erratic movements.

It's essential to note that these symptoms can be controlled with appropriate treatment. People suffering from catatonic symptoms as part of schizophrenia and other psychiatric conditions can find significant relief from their symptoms with proper care.

Key Points:

• Catatonic schizophrenia is no longer a standalone diagnosis.
• Remission of catatonic schizophrenia can lead to changes in physical and behavioral patterns.
• Immobilization, repetitive movements, and changes in movement patterns are common signs and symptoms.
• Appropriate treatment can control these symptoms and provide significant relief.

References:

• [3] Catatonia is a complex syndrome, most commonly seen in people with underlying mood (e.g major depressive disorder) or psychotic disorders (e.g schizophrenia).
• [11] Catatonic schizophrenia is no longer a stand-alone diagnosis. Catatonic symptoms can happen not only with schizophrenia, but in mood disorders, autism, and other conditions.
• [12] Signs of catatonia often include an inability to move or speak. People experiencing it may appear rigid, repeat words, or perform strange movements.
• [14] Catatonia affects an individual’s movements and may involve immobility and posturing.

Diagnostic Tests for Obsolete Catatonic Schizophrenia in Remission

Catatonic schizophrenia, a subtype of schizophrenia, was previously diagnosed and treated as a distinct entity. However, with the removal of catatonic schizophrenia from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013 and the International Classification of Diseases (ICD-11) in 2019, its diagnosis and treatment have become obsolete.

Diagnostic Criteria

Prior to its removal, catatonic schizophrenia was diagnosed based on specific criteria, including:

• Presence of catatonic symptoms, such as immobility, mutism, or rigidity
• Duration of symptoms for at least a week
• Significant distress or impairment in social, occupational, or other areas of functioning

Diagnostic Tests

While catatonic schizophrenia is no longer a distinct diagnosis, some diagnostic tests and criteria may still be relevant for assessing remission or treatment response in individuals with underlying mood or psychotic disorders. These include:

• Lorazepam challenge test: This test involves administering lorazepam to assess the presence of catatonia. A positive response (i.e., improvement) can validate the diagnosis.
• Electroconvulsive Therapy (ECT): ECT has been shown to be effective in treating catatonic symptoms, particularly in individuals with long-standing catatonia or schizophrenia.

Remission Criteria

The Remission in Schizophrenia Working Group (RSWG) criteria define remission as a level of core schizophrenia symptoms that does not interfere with an individual's behavior and is below that required for a diagnosis. These criteria may still be relevant for assessing remission in individuals with underlying mood or psychotic disorders.

Limitations

The lack of precise psychopathological consensus on defining catatonic symptoms remains a methodological problem, making it challenging to diagnose and treat catatonia accurately.

References:

• [1] The American Psychiatric Association removed catatonic schizophrenia from its list of official diagnoses when updating to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013.
• [2] Tanskanen (2021) described a drop in incidence of catatonic schizophrenia between the 1950s and 1970s in Finnish registry data.
• [9] Some patients, particularly those with long-standing catatonia or schizophrenia, may respond more gradually or not at all to lorazepam, and may require ECT or other treatments.
• [10] The Remission in Schizophrenia Working Group (RSWG) criteria define remission as a level of core schizophrenia symptoms that does not interfere with an individual's behavior and is below that required for a diagnosis.

Catatonic schizophrenia, although considered an obsolete term, was once a recognized subtype of schizophrenia characterized by pronounced psychomotor symptoms, including immobility and rigidity.

Treatment Options

In the past, treatment for catatonic schizophrenia focused on medications that could help alleviate these symptoms. While antipsychotic drugs were not typically used due to their potential to worsen catatonia [10], other classes of medication were explored.

• Benzodiazepines: These anti-anxiety drugs were often the first line of treatment for catatonic schizophrenia, with lorazepam being a commonly used option. However, studies have shown that benzodiazepines may not be effective in treating chronic catatonia [2].
• Clozapine: This atypical antipsychotic has been found to be effective in treating catatonia associated with schizophrenia, with a remission rate of over 80% reported in some clinical studies [4].

Current Understanding

While the term "catatonic schizophrenia" is no longer used in modern psychiatric classification systems, the concept of catatonia as a symptom complex remains relevant. Treatment for catatonia typically involves benzodiazepines or electroconvulsive therapy (ECT), with a focus on addressing the underlying cause of the condition.

References

• [1] Beckmann and colleagues' 5-year follow-up study found benzodiazepines ineffective in treating chronic catatonic schizophrenia.
• [2] Lorazepam is generally accepted as a first-choice drug for treating catatonia, with a remission rate of 79% reported in some studies.
• [3] Benzodiazepines are often the first option for treating catatonic symptoms.
• [4] Clozapine has been found to be effective in treating catatonia associated with schizophrenia.

Understanding Differential Diagnosis

When considering the differential diagnosis of catatonic schizophrenia, it's essential to explore other conditions that may present with similar symptoms. In this case, we're looking at obsolete catatonic schizophrenia, which is no longer a recognized subtype.

• Catatonia as a symptom: Catatonia can be a symptom of various mental health disorders, including schizophrenia, but also other medical and psychiatric illnesses (1). This complexity makes differential diagnosis challenging.
• Differential diagnosis: The process involves ruling out other conditions that may present with similar symptoms. In the case of catatonic schizophrenia, this might include delirium, psychosis, stroke, dementia, or coma (6).
• Remission: Catatonic schizophrenia can go into remission, but the unpredictability of symptom return makes it a lifelong condition (1).

Key Considerations

When considering differential diagnosis for obsolete catatonic schizophrenia in remission:

• Catatonia as a symptom: Recognize that catatonia can be associated with various mental health disorders and other medical conditions.
• Differential diagnosis: Be aware of the potential for misdiagnosis, particularly with conditions like delirium, psychosis, stroke, dementia, or coma (6).
• Remission: Understand that remission does not necessarily mean a complete absence of symptoms, as they can return unpredictably.

References

1. Catatonia is a syndrome that has been associated with several mental illness disorders but that has also presented as a result of other medical conditions.
2. Differential diagnosis can be challenging and misdiagnosis of catatonia as delirium, psychosis, stroke, dementia or coma have been reported (6).
3. Catatonic schizophrenia was divided into five subtypes, including disorganized schizophrenia, paranoid schizophrenia, residual schizophrenia, undifferentiated schizophrenia, and catatonic schizophrenia per the Diagnostic and Statistical Manual of Mental Disorders (DSM IV).