Catatonia

I sit on the ground, my breath rhythmic and steady. My breath is my sole attention, as I watch the world go by around me. My thoughts go by immeasurably slow. My breath is the only thing I can focus on. I am aware that there is a world outside myself, but it does not feel like a real world, I am withdrawn into myself like a hermit crab into its shell. My limbs are statues. All I am is breath.

The above describes my first catatonic stupor. A state of immobility or repetitive movements that can last anywhere from hours to years. I do not know how long it lasted, but based on the length of my other episodes I would suspect it was at least an hour. I would later be officially diagnosed with psychosis NOS, an inherently varying disease that includes many symptoms of schizophrenia. I have experienced auditory and visual hallucinations, depersonalization and derealization, and lack of focus to the point where I could not read a book, but the catatonia is still what frightens me the most.

What is Catatonia?

As mentioned previously, catatonia is an elongated period of immobility or repetitive movement. While catatonia is extremely debilitating, it is not, in itself, a disorder, rather, it is a symptom of an overlying disorder, often schizophrenia. People in a catatonic state may not react to external stimuli, or may suddenly become agitated or react to no stimuli at all. They may also maintain positions that they are put in, a trait called waxy flexibility, while others resist all efforts to be moved, called rigidity.

Catatonic Schizophrenia

Although removed as a diagnosis in the DSM V, the “Bible” of mental health, some people with schizophrenia acutely display catatonic symptoms. Formerly, these people were diagnosed not just with schizophrenia, but with catatonic schizophrenia. Note that not only do these people qualify for a diagnosis of schizophrenia (hallucinations, delusions, etc.), but they also have catatonic symptoms as described above.

Treatments

Catatonia can usually be treated successfully with anti-psychotics, and in some cases benzodiazepines. Most people respond well to these drugs and will quickly come out of a catatonic state within a few days. Some people may require ECT (Electro-Convulsive Therapy), and may even require regular rounds of ECT to stay out of catatonia. It is to be noted that ECT is not the horrible torture that movies often make it out to be. It is painless, and the movements seen during old time ECT is simply due to involuntary movements. During current ECT procedures, the patient is given a muscle relaxant to cease the movements.

Prognosis

Unfortunately, the prognosis for people with catatonia, in general, is not a good one. This is why I fear it most out of all my symptoms. According to one study, 14 of the 36 participants were in need of “continuous psychiatric care”, take from that what you will.

Conclusion

While I may have catatonic symptoms, which studies show makes my prognosis rather poor, and while my symptoms, as we speak, may be getting worse, I have not given up hope, and neither, I believe, should anyone else who has psychotic and/or catatonic symptoms. Life isn’t over till it’s over, and every life is worth living all the way through, even if the part of the path you’re on right now is in a scary forest with wolves all around you. One day after walking (or running) down that path for long enough you’ll come out to a field full of bright tulips, and the sun will shine.

 

 

Relapse

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Sometimes, despite our best efforts, things do not work out. Sometimes it’s something small, like not getting through that light coming up. Sometimes it’s something big, like breaking up with a long-time partner. Sometimes, despite taking medicine and going to therapy religiously, our mental health continues to deteriorate.

In the past week, symptoms have slowly begun creeping back into my life. The auditory hallucinations are worsening, and I’m now starting to see things as well. My cognitive symptoms are also returning, and I’m having small bouts of catatonia. So far, it is not as bad as my initial breakdown, but I fear it may become worse as time goes on.

My fear stems from two corners. In one corner, I am terrified of becoming sick again, and, more specifically, staying sick. In the other corner, I’m scared of going to the hospital. So great is my fear that I am planning to  suicide if it gets to that point.

I don’t want to write about this, and I’m sure most of you don’t want to read it, but this is my week to write an article and dammit I’m going to write one. I’d like to write about something nice, something to educate you or make you feel better about yourself, but I can’t do that this week. This is the only thing I can think about, and hence, it’s what this article must be about.

Tomorrow I see my therapist. After much deliberation, I have decided to tell her about my plans to kill myself. I’m not sure what’s going to happen after that, but I have a strong suspicion. That suspicion is the reason I am posting this on today rather than the usual Friday, before I go to my therapy appointment. If I don’t post my article week after next, you’ll know where I am.

I know I’m not the only one in this boat. I know there are more of you out there who are terrified of reaching out for help, or deathly afraid of the hospital like I am. I wish I could give you some uplifting pep talk, but I know from experience that there are no magical words that make everything better.

All I can tell you is that right now you are pulling a heavy wagon up a steep hill. The only way to get to the top is to get help pulling. Getting  down  that mountain won’t be a cakewalk either, with rocks and pitfalls along the way, but as long as someone’s next to you pulling, you have a chance.

I want to sincerely thank all of you who have, and continue, to read my articles. It really means a lot to me that you find it worth your time. I hope to write many more for you in the future. Thank you.

 

Joy

To begin this article, I would like to wish everyone that celebrates it a merry Christmas, and to everyone else, happy Holidays. This time of year is one filled with joy, wonder, and wishes. December itself is enveloped by this sentiment. I believe joy is something that is vital to all of our lives, and for not just one month, but for all of them. Joy is unbridled happiness, it is not hindered by logic or reality, in that moment, when you are joyous, nothing else but that emotion matters. Joy is pure.

I had an early Christmas present this year. It came in the form of a 37 pound black, white, and brown, bundle of energy named Jack. Jack was a shelter dog and had been there, much to our surprise (because of how sweet he is) for over 3 months. We immediately fell in love and brought him home. I bring up the story of Jack, which I’m sure must strike most of you as completely unrelated, because, as all dog owners know, there is nary a purer, more unadulterated source of joy than a dog. As a favorite show of mine (Limmy’s Show for those interested) said in one episode, a dog does not overthink things, he does not sit in a car going 70 miles an hour thinking “how is this possible?”, he just sticks his head out the window and enjoys the wind blowing in his face. That is joy.

Jack does not think about the 3 months he spent at the Humane society, in what surely must have been a terrifying experience. He does not think about the time he spent in a high kill out-of-state shelter, which I’m sure was much worse. He doesn’t think of the heartbreak he had to have experienced when he was adopted out for a week and then brought back because the owner “didn’t have time”. No, Jack does not think about any of that, Jack just runs around our half acre yard at full speed, trips, sending him somersaulted across the yard, gets back up, and keeps running like nothing happened with a huge grin on his face.

Jack is joy, and I think we could all learn something from him.

 

Understanding Psychosis

The word “psychotic” is perhaps one of the most misunderstood words in the mental health repertoire. To the public, who are used to hearing it in movies and other media to refer to a violent, remorseless, person, attribute it’s meaning to just that. Someone who is psychotic, by this definition, may be violent, violently “crazy”, or simply lacking empathy and remorse, capable of any wrong and evil doing. But, as so often is the case, Hollywood and the media have gotten it wrong, and in the case of psychosis, they’ve gotten it completely and dangerously wrong. This incorrect usage has led to irreparable stigma for those suffering from actual psychosis, the sufferers of which are far more likely to be victims than perpetrators of violent crime. In this article I will tell you, dear reader, about the real story of psychosis.

According to NAMI, psychosis occurs in about 3% of the population. Psychosis is a debilitating mental condition that affects the way we perceive reality. In a way, people undergoing a psychotic episode live in an “alternate reality”, different from what healthy people experience. They may believe, perceive, and understand things that are not actually in existence, to the sufferer however, this “alternate reality” is as real as the ground beneath our feet.

What is Psychosis?

Psychosis is often called a “break from reality” due to the reasons I described above. There are hallmark symptoms of psychosis that healthcare providers look for when diagnosing a person, such as…

Hallucinations: Seeing, feeling, tasting, and especially hearing things that are not actually there. The most common hallucination is auditory hallucinations, or “voices”. The voices may tell a person to harm themselves and say other negative things.

Delusions: Strong beliefs that do not change despite opposing evidence. For example, a person may believe that someone is stealing their thoughts, that they are being watched or followed, or that they are God.

Causes

Psychosis, like so many things having to do with the mind, is  hard to pin down to a single cause. There are several, intermingling factors that affect someone’s likelihood of developing psychosis.

Drugs: Psychedelic drugs, or even lighter drugs like marijuana, have been shown to trigger or worsen psychotic episodes.

Genetics: Many studies have been carried out that link psychosis and other mental illnesses to genetics. If your parents, family, or siblings have experienced psychosis, you are more likely to experience it.

Illness: Some illnesses and diseases, such as brain cancer, can cause psychosis, or what appears to be psychosis, in a person.

Stress: Stress and trauma can bring on or worsen psychosis.

Warning Signs

There are several early warning signs for psychosis which can be noticed by others, they include the following…

  • Difficulty in school or work
  • Isolation from others
  • Decline in personal hygiene
  • Lack of clear or coherent thoughts

Psychosis and Mental Illness

Psychosis itself is not a mental illness. It is, however, a component, or possible component, of many mental illnesses. It should then, be seen as a symptom rather than an illness. Many illnesses can include psychosis, including post traumatic stress disorder, depression, bipolar disorder, and schizophrenia, the last of which has psychosis as a hallmark symptom.

Treatments

Treatment is paramount for those suffering from an acute psychotic episode. There are a variety of treatments for psychosis, some of which I shall list  below.

Hospitalization: For someone undergoing an acute psychotic episode, the hospital may be the best option. The goal of any psychiatric hospital is to stabilize and rehabilitate enough so that a person may undergo further treatment after discharge.

Cognitive Behavioral Therapy (CBT): CBT is used in a variety of disorders to identify and change thought patterns. In psychosis, CBT can help a person identify triggers, manage symptoms, and identify strategies for getting through it all.

Medication: Medication for psychosis is referred to as antipsychotics, these drugs work by reducing dopamine (a neurotransmitter involved in psychosis) in the brain. While often effective, they can have detrimental side effects. Newer antipsychotics however, called atypical, have less side effects and are more tolerable to take than older drugs.

To Wrap it Up…

Psychosis is a serious mental condition that requires care as soon as possible. Unfortunately, it is also one of the most misunderstood mental conditions in our society today. This makes reaching out for help difficult for those who suffer, the stigma is real and is felt by sufferers every time they turn on the TV to a headline of “psychotic killer”. As someone who has experienced psychosis first-hand, I can tell you that getting help is possible, and it does help…it saved my life.

If you believe you or someone you know is undergoing a psychotic episode, please reach out for professional help, it will improve your life tenfold, and may just save it. Some crisis numbers can be found here.

Exploring the Science of Schizophrenia

Blanket Embroidered by Someone with Schizophrenia
Too often the general public relegates mental illnesses like depression, bipolar disorder, and schizophrenia to just that, mental illness, diseases of the mind. However, with modern science, we are beginning to see more and more the folly of this simplistic viewpoint. We are now seeing the science behind these illnesses;  the changes in brain form, function, and chemical balance that alter how our brain functions and perceives the world around us.  In the “Exploring the Science of…” mini series, I will be talking about how what happens in our brain impacts what happens in our mind.

In this, the last of the “Exploring the Science of…” miniseries, I will be talking about schizophrenia, perhaps the most studied and scrutinized of all mental illnesses.


What is Schizophrenia?

Schizophrenia is a complex brain disorder that affects everything from perception to cognition. Symptoms vary, but include positive, negative, and cognitive symptoms. Positive symptoms are things added on by the disease, such as hallucinations and delusions. Negative symptoms are characters or traits removed by the disease, such as facial expression and enjoyment of activities, both of which can be hindered by schizophrenia. Finally, cognitive symptoms affect the persons ability to think, for example, people with schizophrenia may be unable to concentrate or organize their thoughts the way healthy people can. For more on schizophrenia itself, feel free to check out my post “Understanding Schizphrenia” here.

Mind Matters

Ventricles of a healthy individual (left) and an individual with schizophrenia (right) showing difference in ventricle size.
One very noticeable difference between healthy individuals and those with schizophrenia occurs in the region of the brain called the ventriclesVentricles are fluid filled cavities in our brain where no actual brain matter is found. However, in some people with schizophrenia, these ventricles are not of a normal size. Instead, they are enlarged. Scientists are not quite sure what that means in terms of cause yet, but are in the midst of studying the phenomena to learn more about what it could mean.

Brain Drain

Perhaps the most stark change that happens in schizophrenia occurs in our grey matter, the stuff we use to think. In some individuals with schizophrenia, there are subtle, yet concrete, differences in the amount of grey matter in the brain. Loss can be extreme, in some cases up to 25% of grey matter is lost. Furthermore, the more grey matter is lost, the more severe the schizophrenia. Scientists believe that some symptoms, such as some individual’s lack of awareness of their illness, may be caused by this loss of brain matter and the effect that loss has on cognition. Untreated schizophrenia can result in loss of grey matter, but the good news is that there may be a solution. Some scientists now believe that the loss of grey matter may be reversible with treatment, and that is great news for those with the disease.

Just Think About It

It doesn’t stop at grey matter and ventricles either, that’s just the beginning. Individuals with schizophrenia also show differences in activity levels in different regions of the brain. One of these regions is the prefrontal cortex, a part of the brain reserved for organization and self evaluation, both areas of deficit in schizophrenia. The prefrontal cortex in those with schizophrenia is less active than in healthy subjects. This difference helps to explain why we see some of the symptoms we do.

Listen

Auditory hallucinations, or “voices” and other noises, are by far the most common form of hallucination found in schizophrenia, and are experienced by approximately 75% of those with the illness.  As someone who suffers from prodromal schizophrenia, the early stage of the disease, the voices were always the most interesting and horrifying part of my symptoms. But far more interesting are the mechanics behind those “voices”, or auditory hallucinations.

When we hear a sound, a region in our brain called the temporal gyrus activates. The temporal gyrus is responsible for handling external audio, makes sense right? That’s not interesting though; here’s what is. When someone experiences auditory hallucinations, that same region of the brain activates, just as if the person were hearing a real voice. More than that, scientists have found that people with schizophrenia also lose brain matter in the temporal gyrus, and the more brain matter lost, the worse the hallucinations.

Transmitter Troubles

Like the other diseases we’ve talked about in the “Exploring the Science of…” series, neurotransmitters are again implicated in this disorder. Like most disorders it’s difficult to know exactly what is going wrong with these transmitters; we just know they are causing a problem. Two of the neurotransmitters involved in schizophrenia are dopamine and glutamate.

Dopamine is a very important neurotransmitter which has a variety of functions, the most prominent of which is its role as a “reward” neurotransmitter. You know that feeling you get when you win a game or get something you’ve always wanted? Dopamine. Most all antipsychotics work by blocking dopamine receptors to effectively reduce dopamine levels in the brain, which more often than not helps to alleviate symptoms.

Glutamate is more boring, but also extremely important. It is involved in just about every aspect of our brain and central nervous system, so it’s not to be overlooked. We don’t know why or in what exact way these neurotransmitters are related to schizophrenia, all that we know is that they are.

The Takeaway

This article is very near and dear to my heart, since I myself suffer from prodromal schizophrenia, the early stage of the disease. Given my diagnosis, I have about a 50/50 chance of developing the disease that I’ve already shown you can have such disastrous effects on the brain and mind. The good news for myself and so many others is that treatments and drugs for schizophrenia are constantly improving, in no small part because of research such as that which I’ve shown you in this article. As for the causes, effects, and treatments of schizophrenia, for all we know there is much more still to be discovered…


Sources:

PsychCentral

Schizophrenia.com

BrainBlogger

Matsumoto, H. et al

The Psychiatric Times

The Neurotransporter Group

Psychology Today