Catatonic Schizophrenia

• Is a rare disease form in which the patient tends to remain in a fixed stupor or position for long periods, periodically yielding to brief spurts of extreme excitement.
• Many catatonic schizophrenia have an increased potential for destructive, violent behavior when agitated.

Signs and Symptoms

• Remaining mute; refusal to move about or tend to personal needs.
• Exhibiting bizarre mannerisms, such as facial grimacing and sucking mouth movements.
• Rapid swing between stupor and excitement (extreme psychomotor agitation with excessive, senseless, or incoherent shouting or talking).
• Bizarre posture such as holding the body (especially the arms and legs) rigidly in one position for a long time.
• Diminished sensitivity to painful stimuli.
• Echolalia (repeating words or phrases spoken by others).
• Echopraxia (imitating other’s movements).

Diagnosis

• Ruling out other possible causes of the patient’s symptoms.
• Meeting the DSM-IV-TR criteria.

Treatment

• ECT and benzodiazepines (such as diazepam or lorazepam) for catatonic schizophrenia.
• Avoiding conventional antipsychotic drugs (they may worsen catatonic symptoms).
• Investigating atypical antipsychotic drugs to treat catatonic schizophrenia (requires further evaluation).

Nursing Interventions

1. Spend time with the patient even if he’s mute and unresponsive, to promote reassurance and support.
2. Remember that, despite appearances, the patient is acutely aware of his environment, assume the patient can hear – speak to him directly and don’t talk about him in his presence.
3. Emphasize reality during all patient contacts, to reduce distorted perceptions (for example, say, “The leaves on the trees are turning colors and the air is cooler, It’s fall”)
4. Verbalize for the patient the message that his behavior seems to convey, encourage him to do the same.
5. Tell the patient directly, specifically, and concisely what needs to be done; don’t give him choice (for example, say, “It’s time to go for a walk, lets go.”)
6. Assess for signs and symptoms of physical illness; keep in mind that if he’s mute he won’t complain of pain or physical symptoms.
7. Remember that if he’s in bizarre posture, he may be at risk for pressure ulcers or decreased circulation.
8. Provide range-of-motion exercises.
9. Encourage to ambulate every 2 hours.
10. During periods of hyperactivity, try to prevent him from experiencing physical exhaustion and injury.
11. As appropriate, meet his needs for adequate food, fluid, exercise, and elimination; follow orders with respect to nutrition, urinary catheterization, and enema use.
12. Stay alert for violent outbursts; if these occur, get help promptly to intervene safely for yourself, the patient, and others.

Paranoid Schizophrenia
Disorganized Schizophrenia

Schizophrenia Case Study

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