The psychological and subjective experience of catatonia: a qualitative study

Abstract

Background Catatonia is a severe psychomotor disorder that presents as abnormality of movement which may also be excessive or severely slowed. It often inhibits communication when protracted or severe. In this study we investigated the emotive and cognitive experience of patients with catatonia during a prevalence study in an acute mental health unit from August 2020 to September 2021. The value of this study is the addition of the inner and often unexplored cognitive and emotive experience of patients in the description of the catatonic state, which lends an additional dimension to complement the medical and psychopathological descriptors that have been the focus of most studies on catatonia. Methods Ethical approval was received from the Nelson Mandela University Human Research Committee and convenience sampling was undertaken to recruit participants admitted into an acute mental health unit with catatonia, four to eight weeks after discharge, following admission. The BFCSI and BFCRS and a pre-designed data collection sheet were used to assess n = 241 participants, and collect data on descriptions of thoughts, feelings, and behaviours they experienced during the catatonic episode. Results Forty-four (18.3%) of the total 241 participants who were assessed had catatonia. Thirty (68.2%) of the 44 participants with catatonia provided data on their experience of catatonia. Twenty-three were males (76.7% of 30) and seven were females (23.3% of 30). All were within the age range of 17 to 65 years. The dominant themes of thoughts, feelings, and behaviors described centered around yearning for or missing loved ones, heightened fear, intense anxiety, negative affect, aggression, obedience, and withdrawal. Conclusions The common themes that emerged from this study were overwhelming anxiety, fear, and depression. These were found to occur frequently in patients with catatonia when describing their psychological experience. These experiences may possibly relate to the flight, fight, freeze and fawn response, as described in prior studies on the subjective experience of catatonia. Trial registration: Not applicable.

Investigating suicidality across the autistic-catatonic continuum in a clinical sample of subjects with major depressive disorder and borderline personality disorder

“…Clinically, catatonia is not just petrifying paralysis, but a complex condition in which psychomotor activity is reduced, excessive or abnormal, in a so-called psychomotor alternation. Following the theory proposed by Fink ( 69 ) for which catatonia is often linked to and can be driven by fear ( 70 ), and that the signs of catatonia may be adaptations to persistent fear, similar to a tonic immobilization, the manifestation of stupor and impulsivity could easily be compared to the animal behavior in front of danger where the freeze reaction is the catatonic extreme form of total psychomotor block and the flight one would correspond to agitation and impulsive behaviors ( 71 ). In this view, the two extreme and opposite manifestations are the main indicators of the gravity of the catatonic manifestation, explaining also the raised suicidal risk and the specific link with suicidal behavior.…”

German version of the Northoff scale for subjective experience in catatonia (NSSC-dv)

“…[ 11 ] wurde lediglich in einer neueren Studie von Zingela et al. [ 30 ] das subjektive Erleben bei Katatonie in einem qualitativen Ansatz untersucht. Zingela et al.…”

“…Zingela et al. [ 30 ] zeigten, dass das subjektive Erleben von PatientInnen mit Katatonie hauptsächlich durch überwältigende Ängste und depressive Symptome gekennzeichnet ist. Die AutorInnen konnten die früheren Ergebnisse von Northoff et al.…”

Management and outcomes of catatonia: A prospective study in urban South Africa

“…6,7 The main signs and symptoms of catatonia are psychological or motor, with motor signs presenting as excessive slowing down or motor agitation to the point of excitement. 8–14 Autonomic instability may also occur with changes in pulse rate, blood pressure, and body temperature. 10–12,14–21…”