Bipolar Disorder and Catatonic Behavior: What You Need to Know

The symptoms and complications of catatonia for bipolar disorder

Catatonic Rigidity
Catatonic Rigidity. Credit: Wikimedia Commons

Catatonic behavior is scary for bipolar disorder sufferers to experience. For those witnessing an episode, it's important to understand what catatonia is, and how to respond to catatonic symptoms. Catatonia is a psychomotor disturbance - since it involves psychiatric and physical or motor manifestations. It may be characterized by a marked decrease in, increase in, or peculiar motor activity. Mentally, its expression can range from unresponsiveness to agitation.

Catatonia Diagnosis and Prevalence

Catatonic features occur most often in schizophrenia, schizoaffective disorder and similar conditions, but can occur with bipolar spectrum disorders and major depressive disorder. In some cases, catatonia may also be an extreme side effect of a medication or manifestation of another medical condition. Research shows over 50% of people who experience catatonic episodes have bipolar disorder, and about 28% of bipolar patients experiencing catatonia had them in a mixed mood states of depression and mania at the same time. For this reason, scientists believe anywhere from 20 to 30% of bipolar patients will experience catatonia during their illness. There are no lab or clinical tests to diagnose catatonia. Instead behavior rating scales are used. These include: Bräunig-Catatonia Rating Scale, Bush-Francis Catatonia Screening Instrument, Bush-Francis Catatonia Rating Scale, Rogers Scale, Northroff Scale and Catatonia Rating Scale.

Additionally, patients being screened for catatonia may be asked about their family medical history, have their vital signs checked, and be subject to a neurological exam.

Two Types of Catatonic Episodes

Catatonia presents in two forms: one of excited delirium and one of stuporous behavior marked by unresponsive behavior that renders the sufferer mute, immobile and responsive only to pain or visual stimuli.

Possible symptoms of Catatonia

  • Stupor - lack of response to external stimuli - e.g., no response to being spoken to or prodded.
  • Catalepsy - muscular rigidity, so that the limbs remain in whatever position they are placed.
  • Excessive motor activity with no purpose.
  • Extreme negativism - resistance to movement or instruction.
  • Mutism - being unable or unwilling to speak.
  • Inappropriate postures and grimacing.
  • Echolalia - parrotlike repetition of a word or phrase just spoken by another person.
  • Echopraxia - repetitive imitation of the movements of another person.

Possible complications of catatonia

  • Malnutrition
  • Exhaustion
  • Blood clots
  • Muscle breakdown
  • Self-inflicted injury

Catatonia Treatment

There is no cure for catatonia, however pharmaceuticals and electroconvulsive treatment(ECT) may be employed to treat symptoms of catatonia. Drugs such as benzodiazepines, muscle relaxants, anti-depressants and neuroleptics have all been used to treat catatonic symptoms. People who experience catatonic symptoms may also be admitted to psychiatric, medical, or neurological inpatient observation and treatment.

Regular follow-up visits may be urged to stay ahead of catatonic episodes or to ensure re-admittance is not warranted for the patient. In severe cases, catatonia patients may be placed in an intensive care unit. Untreated severe catatonia can be fatal. Lack of communication and responsive, as well as not eating paired with the possibility of physical violence, the ICU is a restrictive environment that may be suggested for the patient and others' safety as well as intravenous nutrition during a catatonic episode. If you are bipolar, be sure you educate your close friends and loved ones about how catatonia may affect you.

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