Treatments and drugs

By Mayo Clinic Staff

Catatonic schizophrenia is a chronic condition that requires lifelong treatment, even during periods when you feel better and your symptoms have lifted. You may feel as if you don't need treatment, and you may be tempted to ignore treatment recommendations. But effective treatment can help you take control of your condition and enjoy a happier and healthier life.

Treatment options are similar for all types of schizophrenia. But the specific treatment approach that's best for you depends on your particular situation and the severity of your symptoms.

Treatment teams

Schizophrenia treatment is usually guided by a psychiatrist skilled in treating the condition. But you may have others on your treatment team as well because the condition can affect so many areas of your life. Your treatment team can help make sure that you're getting all of the treatment you need and that your care is coordinated among all of your health care providers.

The team involved in treatment of catatonic schizophrenia may include your:

  • Family or primary care doctor
  • Psychiatrist
  • Psychotherapist
  • Pharmacist
  • Family members
  • Case worker
  • Psychiatric nurse
  • Social worker

Main treatment options

The main treatments for catatonic schizophrenia are:

  • Medications
  • Electroconvulsive therapy (ECT)
  • Hospitalization
  • Psychotherapy
  • Vocational skills training

Medications for catatonic schizophrenia

Medications, together with electroconvulsive therapy (ECT), are key catatonic schizophrenia treatments. Medications most commonly prescribed for catatonic schizophrenia include:

  • Benzodiazepines. These medications, also called anti-anxiety medications, are sedatives. They are generally the medication of choice to treat catatonic schizophrenia. Benzodiazepines, which may be injected in a vein — especially if you're in a state of catatonia — are typically fast acting, helping relieve catatonic symptoms quickly. They may cause dependency with long-term use. These medications may also help if you have anxiety along with catatonic schizophrenia. You may need to take benzodiazepines for a period of days or weeks to relieve your catatonic symptoms.
  • Other medications. It's common to have other mental health issues along with catatonic schizophrenia. Antidepressants can be helpful if you have symptoms of depression. And mood-stabilizing medications may help with aggression or hostility.
  • Antipsychotic medications. These are generally the medication of choice for schizophrenia. However, they aren't used as often for the catatonic type of schizophrenia because they can actually worsen catatonic symptoms.

Choosing a medication

In general, the goal of treatment with medications is to effectively control signs and symptoms at the lowest possible dosage. Which medication is best for you depends on your individual situation. Benzodiazepines may help quickly relieve your catatonic state and may be used on an emergency basis in the hospital. But it can take several weeks after first starting other medications to notice an improvement in your other symptoms, such as depression or anxiety.

If one medication doesn't work well for you or has intolerable side effects, your doctor may recommend combining medications, switching to a different medication or adjusting your dosage. Don't stop taking your medication without talking to your doctor, even if you're feeling better. You may have a relapse of psychotic symptoms if you stop taking your medication. In addition, some medications need to be tapered off, rather than stopped abruptly, to avoid withdrawal symptoms.

Electroconvulsive therapy (ECT) for catatonic schizophrenia

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through your brain to trigger a brief seizure. This seems to cause changes in brain chemistry that can reduce symptoms of certain mental illnesses. Electroconvulsive therapy is used to treat all types of schizophrenia, but appears to most quickly improve signs and symptoms of catatonic schizophrenia.

Together with benzodiazepine medications, ECT is the primary treatment for catatonic schizophrenia. Your doctor may recommend ECT after you finish a course of benzodiazepines, or you may be treated with both together.

Hospitalization for catatonic schizophrenia

During crisis periods or times of severe catatonic symptoms, hospitalization may be necessary. This can help ensure your own safety and that of others, and make sure that you're getting proper treatment, nutrition, sleep and hygiene. Partial hospitalization and residential care also may be options.

Psychotherapy for catatonic schizophrenia

Although medications and ECT are important catatonic schizophrenia treatments, counseling (psychotherapy) also is essential. Psychotherapy may include:

  • Individual therapy. Psychotherapy with a skilled mental health provider can help you learn ways to cope with the distress and daily life challenges brought on by catatonic schizophrenia. One approach, called cognitive behavioral therapy, has proved to be especially helpful in the treatment of catatonic schizophrenia. In cognitive behavioral therapy, a mental health provider helps you recognize — and change — harmful ideas and behaviors. As part of this process, your therapist will help you look back on your personal history. Together you're likely to gain insights into when, and why, you may have started to form those ideas and behaviors. Then, building from this new understanding, your therapist can help you start to change those patterns.

    Psychotherapy can help reduce the severity of your symptoms and improve communication skills, relationships, your ability to work and your motivation to stick to your treatment plan. Learning about catatonic schizophrenia can help you understand it better, cope with lingering symptoms and understand how medications could be helpful. Therapy can also help you cope with stigma surrounding catatonic schizophrenia.

  • Family therapy. Both you and your family may benefit from therapy that provides support and education to families. Your symptoms have a better chance of improving if your family members understand your illness, can recognize stressful situations that might trigger a relapse, and can help you stick to your treatment plan. Family therapy can also help you and your family communicate better with each other and understand family conflicts. Family therapy can also help family members cope and reduce their distress about your condition.

Social and vocational skills training for catatonic schizophrenia

Training in social and vocational skills to live independently is an important part of recovery from catatonic schizophrenia. With the help of a therapist, you can learn such skills as good hygiene, cooking and better communication. Many communities have programs that can help you with jobs, housing, self-help groups and crisis situations. If you don't have a case manager to help you with these services, ask your doctors about getting one.

Treatment challenges in catatonic schizophrenia

When you have appropriate treatment and stick to your treatment plan, you have a good chance of leading a productive life and functioning well in daily activities. But be prepared for challenges that can interfere with treatment.

For one thing, you, like many others with schizophrenia, may find it hard to follow your treatment plan. You may believe that you don't need medications or other treatment. Also, if you're not thinking clearly, you may forget to take your medications or to go to therapy appointments. Talk to your doctors about tips to stick to your treatment plan, such as taking an antipsychotic medication that's available in a long-lasting injectable form. Even with good treatment, you may have a relapse. Have a plan in place to deal with a relapse.

Smoking, often heavy smoking, is common when you have schizophrenia. If you smoke, you may need a higher dose of antipsychotic medication because nicotine interferes with these medications. Be honest with your doctors about your smoking habits. And be sure you understand the serious health risks of smoking.

Using alcohol and drugs can make catatonic schizophrenia symptoms worse. If you have a problem with alcohol or substance abuse, you may benefit from treatment programs that include care for both schizophrenia and substance abuse.

Dec. 17, 2010