- 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).
- Ruling out other possible causes of the patient’s symptoms.
- Meeting the DSM-IV-TR criteria.
- 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).
- Spend time with the patient even if he’s mute and unresponsive, to promote reassurance and support.
- 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.
- 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”)
- Verbalize for the patient the message that his behavior seems to convey, encourage him to do the same.
- 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.”)
- 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.
- Remember that if he’s in bizarre posture, he may be at risk for pressure ulcers or decreased circulation.
- Provide range-of-motion exercises.
- Encourage to ambulate every 2 hours.
- During periods of hyperactivity, try to prevent him from experiencing physical exhaustion and injury.
- As appropriate, meet his needs for adequate food, fluid, exercise, and elimination; follow orders with respect to nutrition, urinary catheterization, and enema use.
- Stay alert for violent outbursts; if these occur, get help promptly to intervene safely for yourself, the patient, and others.