Catatonic schizophrenia is a rare but serious form of schizophrenia that deeply affects a person’s ability to move, respond, and engage with the world around them. Once considered its own subtype, the most recent guidelines from the American Psychiatric Association now identify it as schizophrenia with catatonia, a recognition that captures both the catatonic symptoms and the traditional symptoms of schizophrenia.
For individuals and families, this condition can feel overwhelming. Catatonia may leave someone frozen in place, caught in repetitive movements, or unable to communicate, while schizophrenia itself can add layers of intrusive thoughts, hallucinations, or disorganized behavior. Together, these challenges often require immediate, specialized support.
Understanding Schizophrenia
Schizophrenia is a complex mental health condition that affects how a person thinks, feels, and behaves. It is often marked by challenges such as hallucinations, delusions, disorganized thinking, and difficulties engaging in daily life. While schizophrenia looks different for each person, clinicians have historically described several main types.
Although modern diagnostic manuals now use a more unified approach, these categories can still provide helpful context for understanding the varied ways schizophrenia can present.
Schizophrenia with catatonia
In the past, catatonia was classified as its own type of schizophrenia. Today, it is recognized as schizophrenia with catatonia. This form is defined by catatonic symptoms, such as remaining in fixed postures, repeating movements, or showing little to no response to the environment. It may also include episodes of catatonic excitement, where energy becomes restless and hard to control.
Catatonic symptoms and schizophrenia symptoms
Catatonia refers to a cluster of symptoms that can appear in people living with schizophrenia, mood disorders, or other medical conditions. This psychiatric condition impacts a person’s movements, behavior, and ability to respond to external stimuli, often disrupting daily routines and quality of life.
For some, these catatonia symptoms occur alongside the negative symptoms of schizophrenia, making recovery even more complex. Recognizing these signs early is essential, as untreated catatonia can significantly affect a person’s life and may become dangerous if linked to substance use or other health complications.
Stuporous Catatonia
Stuporous catatonia, sometimes called catatonic stupor, occurs when a person remains in one position for long periods without moving or speaking. This state of unresponsiveness to external stimuli can make it appear as if the individual is completely withdrawn, creating challenges for both the person and their loved ones.
Waxy Flexibility
In this form, individuals maintain uncomfortable or unusual postures for extended periods, even when gently repositioned by someone else. This symptom is often a hallmark of schizophrenia with catatonia and reflects the profound effect of the disorder on voluntary control of movement.
Exaggerated or Excessive Movements
Rather than immobility, some people show bursts of purposeless motor activity. These sudden and excessive movements may be difficult to control and often seem disconnected from the environment.
Repetitive Movements
Repetitive behaviors, such as pacing, rocking, or repeating gestures, are also common catatonia symptoms. These patterns are often involuntary and highlight the disruption of normal behavioral responses in this psychiatric condition.
Catatonic Excitement
Some individuals experience catatonic excitement, characterized by restless or agitated activity. These bursts can feel overwhelming and may put the person at risk for harm without proper intervention.
Malignant Catatonia
In severe cases, malignant catatonia can develop, posing a serious health risk. Characterized by sudden changes in blood pressure, temperature, or nervous system function, malignant catatonia is considered a medical emergency that requires immediate treatment in an emergency department.
Risk factors for catatonic schizophrenia
While the exact cause is unknown, risk factors for developing catatonic schizophrenia include:
- Family history of mental illness or mental disorders
- Imbalances in brain chemicals, such as dopamine
- History of viral infections or infectious diseases affecting the nervous system
- Co-occurring mood disorders like bipolar disorder or major depressive disorder
- Certain medical conditions or autoimmune disorders
Most cases tend to emerge in young adulthood, although catatonic episodes can occur at any age.
Diagnosing catatonia and schizophrenia
Diagnosing catatonia requires a thorough psychiatric evaluation, physical exam, and sometimes medical testing to rule out other mental health conditions or medical conditions.
According to the Diagnostic and Statistical Manual, a diagnosis of schizophrenia with catatonia depends on identifying multiple catatonia symptoms over a sustained period. Clinicians also consider diagnostic criteria for schizophrenia, including disturbances in thought, perception, and psychomotor activity.
Treating and managing catatonic schizophrenia
When someone enters a catatonic state, prompt treatment is essential. Untreated or acute catatonia can lead to severe complications, including neuroleptic malignant syndrome, blood pressure changes, or life-threatening immobility. Because catatonia often overlaps with schizophrenia and other mood disorders, clinicians use a combination of medical and supportive therapies to stabilize symptoms and restore quality of life.
Medication management
Medications play a critical role in addressing both catatonia symptoms and the underlying features of schizophrenia. Clinicians may use dopamine blockers (antipsychotics) to manage hallucinations, delusions, and disorganized thinking.
In cases where antipsychotics might worsen catatonia, benzodiazepines such as lorazepam are sometimes introduced first to calm the nervous system. Finding the right medication is highly individualized, as people with schizophrenia often present with positive, negative, and cognitive symptoms that respond differently to treatment.
Comprehensive treatment planning
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines criteria for diagnosing both schizophrenia and catatonia. Once a diagnosis is made, treatment planning typically includes a blend of medication, talk therapy, and skills training.
This holistic approach helps individuals not only manage immediate symptoms like exaggerated movements or repetitive behaviors, but also address the long-term challenges of living with schizophrenia.
Psychotherapy and skills training
Beyond medical stabilization, psychotherapy helps individuals process their experience and develop healthier coping strategies.
Cognitive behavioral therapy (CBT) can challenge thought patterns that fuel anxiety or delusions, while skills training teaches practical ways to manage daily stressors and prevent relapse. These therapies are especially valuable for individuals who may develop schizophrenia with catatonic features in early adulthood and need lifelong strategies for resilience.
Role of supportive therapies in recovery
While medication and ECT are often essential for stabilizing acute catatonic behavior, long-term recovery from schizophrenia with catatonia depends on more than medical intervention. Supportive therapies and structured treatment programs provide the bridge between stabilization and living a fulfilling life.
Here are some common supportive therapies in recovery:
Drug and alcohol detox
For clients whose catatonic symptoms are complicated by substance use or withdrawal, a medically supervised detox program provides the safest first step. In a comfortable, supportive setting with 24/7 monitoring, individuals can safely withdraw from substances and prepare for continued treatment.
Inpatient residential treatment
Our inpatient program offers a highly structured environment where individuals can focus fully on healing. Here, clients receive individual counseling, group therapy, and skill-building sessions to manage symptoms, process trauma, and rebuild independence. Residential care also allows for round-the-clock support, which is critical for stabilizing severe psychiatric conditions.
Partial hospitalization program (PHP)
PHP provides intensive, daylong care without overnight stays. This level of care combines psychiatric services, trauma-informed therapy, and holistic approaches that target both catatonic behavior and co-occurring mental health concerns like depression, anxiety, or substance use disorder. PHP helps clients stabilize while maintaining some connection to home life.
Intensive outpatient program (IOP)
For individuals ready to step down from higher levels of care, IOP offers structured support with greater flexibility. Through group therapy, relapse prevention planning, and coping skills development, clients learn to manage triggers, reduce relapse risk, and strengthen resilience while re-engaging with daily responsibilities.
Outpatient treatment for catatonic behavior
Outpatient programs provide ongoing therapy, including individual counseling, group sessions, and relapse prevention tools. This level of care helps individuals continue working on long-term stability, while maintaining commitments to family, school, or work.
Dual diagnosis treatment
Because catatonia often co-occurs with schizophrenia, mood disorders, or substance use, dual diagnosis care is especially important. Red Ribbon Recovery Colorado specializes in treating both mental health conditions and substance use simultaneously, ensuring that neither condition is overlooked. By integrating medication management, therapy, and holistic support, we help clients build a strong foundation for recovery.
At Red Ribbon Recovery Colorado, supportive therapies aren’t just add-ons; they’re at the heart of how we help people regain independence, rebuild confidence, and restore hope. Whether through inpatient care, PHP, IOP, or dual diagnosis treatment, our compassionate team is here to provide the tools and support needed for long-term recovery.
Moving forward after a difficult diagnosis
Although catatonic schizophrenia can be a lifelong condition, early intervention, a strong therapeutic alliance, and continuous support from mental health professionals can help individuals manage schizophrenia and improve quality of life.
At Red Ribbon Recovery Colorado, we aim to restore hope and empower recovery. Ready to begin? Contact us today to get started.
Sources
- Substance Abuse and Mental Health Services Administration. (2016, June). Impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health (Table 3.22). SAMHSA. https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t22/
- Jain, A., & Mitra, P. (2023, July 24). Catatonic schizophrenia. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563222/
- [Authors not provided]. (2021). [Article on catatonia treatment]. Frontiers in Psychiatry. https://pmc.ncbi.nlm.nih.gov/articles/PMC8628989/
