Depression with Catatonic Features (Catatonic Depression)


Overview

Catatonic depression is a subset of the diagnosis "major depression" and is characterized by severe disturbances in motor function. In the past century, the field of psychology has allowed its views concerning depression and its subsets to evolve from existential perspectives to cognitive-behavioral and biological understandings. Today, modern interventions draw upon a broad range of both mental and physical treatments.

History

Existentialist Soren Kierkegaard believed that persons failing to grasp a personal sense of freedom and responsibility were more susceptible to depression. Later, the behaviorist B.F. Skinner contended that depression stemmed from persons having an "external locus of control," meaning they learned to be helpless and vulnerable by modeling their environment. From this, the teachings of cognitive therapist Aaron Beck evolved. He asserted that both cognitions (thoughts) and the environment caused depression. More specifically, a person's negative mental perceptions of their environment generated a depressive cycle that reinforced their faulty beliefs. Modern research focuses on the biological components of depression by highlighting the influence imbalanced neurotransmitters such as serotonin, norepinephrine and dopamine have on mood disorders.

What is the Symptoms of Depression with Catatonic Features (Catatonic Depression)?

According to the Encyclopedia of Mental Disorders, "Catatonic disorders are a group of symptoms characterized by disturbances in motor (muscular movement) behavior that may have either a psychological or a physiological basis." Catatonic depression is a subtype of the DSM-IV diagnosis "major depression." It is characterized by at least two of the following:

  • Loss of voluntary movement and inability to react to one's environment.
  • Excessive movement (purposeless and not in response to one's environment).
  • Extreme resistance to instructions/suggestions or unable/unwilling to speak.
  • Odd or inappropriate voluntary movements or postures (e.g. repetitive movements, bizarre mannerisms or facial expressions).
  • Involuntarily repeating someone’s words or movements in a meaningless way.

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Elective Mutism

The symptoms of this type of depression vary from patient to patient. Some will express extreme negativism, while others will choose not to speak (elective mutism). Some will move in a strange fashion, while others will imitate the movements of others (echopraxia). There may also be echolalia, in which the patient echoes another's thoughts and words. In some cases, the symptoms are so severe that the patient requires constant supervision to protect both the patient and others. At other times, catatonia is expressed in a less extreme manner, through slowed motor activity.

Random Movement

Catatonic behavior may also pop up from time to time in people with other types of mood disorders. For instance, those with bipolar syndrome may sometimes exhibit immobility or agitated random movement. When depression is severe, just moving a finger may cause intense emotional pain. In some, the depression is so deep that getting out of a chair may take hours and be quite painful. As the depression lifts, the catatonic symptoms decline.

It is believed that mood disorders may be due in part to irregular production of the brain's neurotransmitters. These chemicals are responsible for conducting impulses from one nerve cell to the next. The main neurotransmitters linked to depression are serotonin and norepinephrine. Research in animal subjects shows that nearly all the antidepressant medications change the way the receptors of these neurotransmitters operate. Another neurotransmitter that is implicated in depressive disorders is dopamine.

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Repeating Words

Catatonic symptoms are seen most often in patients suffering from bipolar I disorder. In this mood disorder, the patient wavers between periods of mania and depressive episodes. During the manic phase, catatonic excitement is expressed through random movement that seems to be unrelated to the patient's environment. There may also be repetition of movements, words, and phrases.

During the depressive episodes, there may be catatonic immobility. These symptoms include long periods of immobility, during which the body may remain in a rigid position. The patient may hold his body position for hours or days. The positions may be quite odd or even inappropriate. While someone suffers from these catatonic symptoms, you may be able to position his body for him, in which case, he may hold the position at length.

Association

Catatonic depression is often associated with bipolar I disorder. Bipolar I disorder refers to a mood disorder that involves alternating periods of mania and depression. Catatonic stupor is more likely to occur during the more severe depression phases; catatonic excitement is most likely to occur during the manic phases.

Treatment

The most effective form of psychotherapy for depression is Beck's cognitive-behavioral therapy, which seeks to break a person's negative perceptions about themselves, their world and their future. Following the Monoamine theory, most medicines prescribed for depression seek to increase levels of imbalanced neurotransmitters in the brain. Commonly prescribed antidepressants include selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). In cases of extreme debilitating depression, psychiatrists may opt for the treatment of electroconvulsive therapy (ECT), wherein electrical current is passed through the patient, causing seizures that temporarily diminish depressive symptoms.

Some of the other ways of treating catatonic depression are: Light therapy, as most of the depressive symptoms can be curtailed to a large extent when exposed to the ultra violet rays and acupressure.

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Suicide

Patients with catatonic depression are at high risk for committing suicide. In general, the lifetime suicide risks patients suffering from major depression is 3 to 4 percent. Men are five times more likely to commit suicide than women. Depression also increases the risk of cardiovascular diseases. Research showed that the mortality rate of people diagnosed with depression is 50 to 80 percent higher than that of people of the same age who are not depressed.



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