Catatonic stupor, causes, types and treatment

Catatonic stupor

The most common type of pathology, characterized by the patient's numbness in a position with awkwardly bent limbs. That is, the position of the body is not entirely characteristic of a person. The patient stops contacting others, does not pay attention to what is happening around him, as if under hypnosis, even if the situation poses a clear threat to life.

The most striking examples characterizing catatonic stupor and what it is are, for example, cases when the patient remained lying in an unnatural position in a room engulfed in fire, without showing any signs of anxiety and without reacting to pain. Anyone can fall into a stupor under stress.

This manifestation of catatonic syndrome begins, as a rule, with the masticatory muscles, later descending to the cervical region, and ends with numbness of the limbs. Such nervous paralysis can be caused by any stressful situation, for example, fear, shock, fright.

How to help a person get out of a stupor

Naturally, in case of extreme manifestations, immediate hospitalization is necessary, where a specialist will prescribe the necessary drug treatment. But if you witness a situation where a person has fallen into a stuporous state, you can immediately try to take the following actions:

• In an even, calm voice, clearly and quietly tell the person things that can evoke strong emotions, any, even negative ones.
• Give the person several slaps, and hit him hard.
• Press the person's fingers firmly into the palm, keeping the thumbs straight.

Even if your efforts are crowned with success, the person subsequently needs to consult a specialist.

Types of stupor and its symptoms

In severe cases, a person experiences total immobility, accompanied by the absence of any reaction to any external stimuli, even painful ones. Muscle tone in such patients is increased or, conversely, decreased. In some types of stupor, waxy flexibility may develop.

Depending on the reasons that caused the disorder, a different combination of symptoms may be observed: reduction and distortion of motor and volitional functions.

Stupor is sometimes a symptom of reactive psychoses, schizophrenia and organic damage to the central nervous system.

Stupor with waxy flexibility is caused by the patient having mutism, immobility, and the ability to maintain a certain position for a long time. Patients do not want to communicate, but at night they can eat, answer questions, or take care of themselves.

Negativistic stupor is manifested by the fact that a person refuses to eat, talk, and attempts to change the position of his body cause sharp resistance.

Stupor with muscle numbness is manifested by the fact that the patient assumes a fetal position, the muscles of such patients are tense, the lips are slightly elongated, and the eyes are closed. Such patients may refuse to eat, so they receive feeding through a feeding tube.

Depressive stupor is caused by complete immobility; such patients have a pained expression on their face; if you manage to come into contact with them, they give monosyllabic answers. Sometimes this type of stupor is replaced by sudden excitement or melancholic raptus, in which case patients tend to cause serious harm to themselves.

Apathetic stupor is expressed by the fact that patients lie on their backs, they are detached from the outside world, answering all questions in monosyllables with some delay. This type of stupor occurs during psychosis or Wernicke's disease.

Catatonic stupor is associated with freezing in fear or numbness in fear, freezing in fear. Such patients refuse to talk and eat and tend to freeze in one position for a long time.

Before moving on, let's take a quick look at the types of stupor and give them a very brief description. So, there is a stupor:

• Akinetic. This condition is characterized by maintaining the body position in one position for a long time and resisting its change.
• Apathetic. It is characterized by a lack of motivation for any activity, both motor and mental, disorientation, and paucity of experiences.
• Affective, depressive, melancholic stupor. It is observed with deep depression and is usually accompanied by a mournful expression on the face and posture.
• Hallucinatory or hallucinatory-paranoid stupor is accompanied by hallucinations, either auditory or visual.
• Catatonic. It is a manifestation of catatonic syndrome and is characterized by passive negativism or waxy flexibility, and in the most extreme manifestation – muscle numbness in the fetal position.
• Manic. Combined with the patient's extremely agitated mood.
• Negativistic. In this state, the patient is in a daze, but resists attempts at external influence.
• Effective or empty. There are no other psychopathological disorders.

Reasons for the development of catatonic syndrome

The catatonic state most often occurs in patients aged 17 to 30 years. After 50 years, catatonic syndrome is recorded in isolated cases.

The main cause of catatonia is mental disorders.

Catatonic stupor or agitation may occur in patients with:

• affective disorders (mania, bipolar disorder);
• schizophrenia;
• psychoses of various origins (intoxication, withdrawal, infectious, somatic);
• PTSD (post-traumatic stress disorder);
• postpartum psychosis;
• autism and autism spectrum disorders (according to statistics, catatonic states are observed in almost 17% of patients with autistic disorders);
• dissociative (conversion) disorders (hysteria);
• mental retardation.

Catatonic states can also be observed in neurological disorders.

For reference. Patients most likely to experience stupor are those with Tourette's syndrome , temporal lobe epilepsy (also called ictal catatonia), or lesions of the globus whites, thalamus, parietal and frontal lobes of the brain. In addition to catatonic stupor, such patients may also experience catatonic agitation.

Patients with a brain tumor, brain metastases, strokes , TBI (traumatic brain injury) or postencephalitis syndrome can also fall into a catatonic stupor.

Less commonly, catatonic states are observed in patients with:

• cerebrovascular diseases;
• thrombocytopenic purpura;
• typhoid fever;
• previous rheumatic attacks;
• viral infections (including HIV infection);
• paraneoplastic syndromes;
• autoimmune pathologies (including various vasculitis).

Also, severe oxygen deprivation of the brain, heat stroke, poisoning with salts of heavy metals, and carbon monoxide can lead to the development of catatonic stupor.

Metabolic disorders less often lead to catatonic stupor, but this condition can still occur against the background of severe hyponatremia, Tay-Sachs disease, vitamin B12 deficiency, hypercalcemia, homocystinuria.

In isolated cases, the development of catatonic stupor is possible against the background of hypothyroidism or hyperthyroidism, hypo- and hyperadrenalism, diabetic ketoacidosis, as well as hepatic encephalopathies.

What medications can lead to the development of catatonic stupor?

In addition to diseases, the use of certain medications can lead to the development of catatonic stupor.

Stupor causes, methods of diagnosis and treatment

Stupor is a physical and mental disorder expressed in the form of numbness, as well as partial or complete immobility. Most often accompanied by mutism - the inability or unwillingness to contact others with complete preservation of thinking and speech abilities. A symptom is a person’s condition in which he does not react to external stimuli, does not experience hunger, temperature changes, pain or other sensations.

When diagnosing stupor, the presence or absence of a state of immobility in the patient, a decrease or absence of reaction to external stimuli is taken into account. Also, when making a diagnosis, it is necessary to take into account whether the patient has recently suffered a stressful event.

Types and symptoms of catatonia

The catatonic state may manifest as catatonic stupor, agitation, or catatonic schizophrenia.

There may also be an alternation of catatonic stupor and agitation (can be observed in catatonic schizophrenia).

For reference. Classic catatonic syndrome is most often manifested by the appearance of stupor or pathological agitation, mutism, as well as negativism (the patient’s resistance to any influence on him).

Repetition of other people's words (echolalia), copying of facial expressions (echomimia), and other people's movements and postures (echopraxia) may also be observed.

Some patients may experience a hood symptom (unconsciously pulling a shirt, robe, or sheet over the head).

Quite typical symptoms of catatonia include the syndrome of passive submission in combination with waxy flexibility of the body.

Stupor: causes of the disease, main symptoms, treatment and prevention

Emotional disorders

29.11.2017

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6 min.

Stupor is a condition in which a person does not move and does not respond to external stimuli. This is a psychiatric pathology that occurs with severe shock.

There are many types of stupor, differing in symptoms and causes. To get out of this state, a person needs the help of relatives.

In some (especially severe) cases, consultation with a psychiatrist and even medication are required.

Stupor in medicine is a dissociative disorder that is accompanied by a state of numbness.

It is characterized by immobility combined with a quality such as mutism (muteness or refusal of all kinds of communications), a weak reaction to irritating stimuli.

The individual does not pay attention to events around him, including pain, noise or cold. A person goes without food for a long time, does not speak, and often freezes in one position.

Stupor becomes the outcome of depression, mental disorders, and stress.

Many patients may lie down, not change their position, refuse to eat, or not answer questions for several days or even weeks. Patients are able to stand in one unnatural position.

The main factors causing the condition:

• severe traumatic event;
• stressful situation;
• mental disorder;
• emotional negatively colored situation;
• organically determined damage to the brain structure;
• intoxication;
• bruise or concussion;
• infectious diseases.

According to some experts, a deficiency of gamma-aminobutyric acid, located in the brain, causes disorders of the musculoskeletal system, which is the main symptom of catatonic stupor.

Considering the syndrome in animals in stressful situations (the victim is afraid of the predator), the researchers noted that under the influence of fear the body is tuned to imminent death. This is the reaction that persists in people. Based on this assumption, catatonic syndrome can manifest itself in patients with schizophrenia who are in a state of irresistible fear.

Treatment for stupor

In a hospital setting, thanks to barbamyl-caffeine disinhibition, it is possible to identify the characteristics of the patient’s experiences and thereby determine the nature of the stupor. It also serves as a method of treatment and helps with persistent refusal to eat. At the beginning, 1-2 ml of a 20% caffeine solution is administered, and after 3-5 minutes, 5-10 ml of a 510% barbamyl solution is administered slowly intravenously, monitoring the patient’s condition, and at the first signs of disinhibition, the infusion is stopped so as not to exceed the individual disinhibition dose for this patient and do not induce normal sleep. The administration of barbamyl is stopped at the moment when the patient opens his eyes or when facial, motor or vegetative reactions (in the form of paleness or redness of the face, sweating, etc.) begin to appear; in this case, it is necessary to stimulate the patient’s disinhibition in every possible way: contact him with questions, slow him down, lightly pat on the cheek, etc.

In a psychiatric hospital, catatonic stupor is treated with intramuscular administration of frenolone at a dose of 5-15 mg/day; for lucid stupor, mazeptil is prescribed orally up to 60 mg/day; Barbamilcaffeine disinhibition is also effective. The psychostimulant sydnocarb up to 30-50 mg/day orally is also effective. For stupor with delusions and hallucinations, stelazine (triftazine), haloperidol, and trisedal are used according to the same principles as the treatment of delusional and hallucinatory states.

For depressive stupor, barbamyl-caffeine disinhibition is carried out, melipramine is used up to 200-300 mg/day orally or intramuscularly. For psychogenic stupor, use diazepam (Seduxen, Relanium) up to 30 mg/day orally, preferably intramuscularly; elennium up to 50 mg/day orally, preferably intramuscularly; phenazepam - 3-5 mg/day orally. Stupor in severe somatic diseases requires intensive treatment of the underlying disease. Hospitalization is necessary in a psychiatric hospital for all types of stupor, except for somatogenic stupor, the treatment of which is carried out in the same department where the patient is diagnosed with a somatic disease.

Depressive stupor

Depressive stupor - what is it? Another condition that psychiatry history knows very well. Depressive stupor is a consequence of severe endogenous depressive disorders. In addition to numbness, it is characterized by a pained or melancholic expression on the patient’s face.

However, he continues to take care of himself, to carry out everything

functions and sometimes even makes contact. Often, numbness and detachment are replaced by unexpected bouts of activity and bursts of energy. Suffice it to remember how grief or depression is depicted in films: the hero, sitting by the window, looks at one point. At the same time, he can drink tea or smoke, seeking salvation and peace in this.

Causes of stupor

Women are much more likely than men to fall into emotional stupor. This condition usually occurs due to intense mental shocks (fear, horror, grief, disappointment). In this case, motor activity and affective activity are blocked, and mental activity also slows down. This condition can go away without treatment and without any special consequences, or it can lead to a panic state, during which the sick person will rush to perform chaotic actions (run, scream). The consequence of this may be depression. A state of stupor of this type can appear in a woman who has witnessed a catastrophe, an accident, or someone else's suffering. It can occur in soldiers during combat, and also in children, for example, during exams.

Treatment of catatonic syndrome

As a rule, treatment of catatonic stupor and agitation is carried out in a psychiatric or neurological hospital. The treatment regimen depends on the underlying disease that caused catatonia.

For reference. Benzodiazepines (eg, lorazepam) are most often used for initial therapy. If there is no effect, ECT (electroconvulsive therapy) is used.

For resistant catatonic stupor, a combination of lithium drugs (normotimic) and antipsychotics (for example, amantadine) can be used.

Additionally, muscle relaxant drugs (for example, dantrolene sodium) can be used. This can also be supplemented with dopamine receptor agonists (for example, bromocriptine).

Please note that the use of neuroleptics is not recommended - the risk of transition to neuroleptic malignant syndrome with subsequent death increases. Although in some cases of catatonia (if it is therapeutically insensitive), antipsychotics may be effective. But still the risks from use are great.