Index
It consists of maintaining the limbs of the body in forced postures.
Waxy flexibility is a psychomotor symptom of catatonia associated with schizophrenia, bipolar disorder, or other mental disorders that leads to a decreased response to stimuli and a tendency to remain immobile.
Attempts to change the patient’s position are resolved with “even slight resistance,” and after repositioning, the patient will generally remain in the new position. Waxy flexibility rarely occurs in delirium.
Causes of waxy flexibility
This term refers to when another person can move a catatonic person to other positions. Once moved, they will generally remain in a new position and will not return to their previous posture or movements.
The term waxy flexibility refers to the person being flexible enough to move, but the person moving them feels like wax.
It is a symptom of catatonia, catatonia is a state of apparent lack of response to external stimuli and apparent inability to move normally in a person who is apparently awake.
There are 3 types:
- Catatonia associated with another mental disorder (catatonia specifier).
- Catatonic disorder due to another medical condition.
- Unspecified catatonia.
Catatonia is a syndrome, typically episodic, with periods of remission, characterized by the presence of a variety of behavioral and motor features.
Accurate and rapid diagnosis of waxy flexibility from catatonia is crucial to prevent morbidity and death in a variety of settings (including emergency medical, psychiatric, neurological, medical, obstetric, and surgical) and to institute effective interventions.
This symptom is the complete opposite of stiffness. In these cases, the person is in the descending phase of the activity, and the waxy flexibility is similar to the positioning of a doll or mannequin.
While it is not known exactly what causes catatonia and consequently waxy flexibility, several theories have been put forward, including the following:
- Gamma-aminobutyric acid deficiency.
- Glutamate dysregulation.
- Dysregulation in dopamine.
- Metabolism abnormalities in the thalamus and frontal lobes.
Perhaps the most interesting theory, however, is one that suggests that waxy flexibility from catatonia may be due to an exaggerated primary fear response.
It is possible, these scientists suggest, that our prehistoric ancestors, who frequently had to deal with predators, developed the ability to stay very still for long periods of time to avoid detection by dangerous animals.
Catatonia, they say, may be this ancient defense mechanism that is triggered into action by strong feelings of fear.
Symptoms of waxy flexibility
Waxy flexibility manifests retention of any position in which the body has been placed. Somatic delusions involve a false belief about how the body works.
Neologisms are made up nonsense words. Nihilistic delusions are misconceptions about oneself, others, or the world.
The presence of waxy flexibility along with at least two other catatonic symptoms such as stupor or negativity are sufficient to justify the diagnosis of catatonia.
For example, if you moved someone’s arm with waxy flexibility, you would keep the arm where you moved it until it moved again, as if it were made of wax. Further alteration of an individual’s posture is similar to folding a candle.
Stupor is actually a symptom of Catatonia. The person does not respond but is awake. It is psychological or neurological. Catatonia is quite rare. They can have waxy flexibility, which is when the person will stay in whatever position someone else places them in.
Someone raises the other person’s arm and their arm will remain elevated. That is just one example of a symptom. There is more. It is found in some people with disorders such as schizophrenia and Parkinson’s disease.
Someone who suffers from Catatonia has no concept of time and, although you are aware of your environment, which you see through your own eyes, it may be different.
They said they couldn’t move and when they were in that state they visually hallucinated. They said it was like an uncontrollable trip.
Catatonic symptoms can be divided into two categories : positive symptoms and negative symptoms. Most notable of the symptoms not covered above is disorganized speech along with command automatism.
Schizophrenia patients repeat the same words and phrases for no other purpose than to repeat them. In command automatism cases, there is an almost robotic nature of how patients follow instructions.
In addition to the above, the patient may also have the following symptoms of schizophrenia:
Delusions : the patient may believe that they are being persecuted. Alternatively, they may think that they have extraordinary powers and gifts.
Hallucinations : particularly hearing voices (auditory hallucination), but hallucinations can include visual (seeing things that are not there) or hallucinations that involve any other sensory system.
Thought disorder : when speaking, the person may jump from one topic to another without a logical reason. The patient’s speech can be confusing and impossible to understand.
Poor expression of emotions : They may not respond to happy or sad events, or they may react inappropriately.
Not being aware of the illness : Also known as “misperception,” because hallucinations and delusions seem so real to the patient, many do not believe they are ill.
Patients with the symptoms of waxy flexibility are generally unable to obtain medical help on their own. Often times, it is a family member or friend seeking medical help.
Associated disorders
Although waxy flexibility has historically been linked to schizophrenia, there are also other disorders with which it can be associated, such as mood disorder with catatonic behavior, for example.
Examples of waxy flexibility
The physician examining a patient with waxy flexibility may place the patient in what would normally be a very uncomfortable position that the patient will continue to hold for an extended period of time.
If an examiner places the patient’s arm in one position, they will hold this position until it is moved again.
Suppose you walk into a room on the way to a meeting and see a man standing with his left hand pointing skyward and his right hand in his pocket. At first, you don’t think about anything and go about your day.
Two hours later, when he heads towards the exit of the building, he walks through the same room and notices that the man’s position has not changed.
Curious, you ask someone close if the man has been standing like this for a long time. You discover that the man has been in this same position for the past five hours.
At first glance, many of us would probably think that this man is pointing skyward. However, we would be concerned if we find a man standing in this same position for more than a few minutes.
Eventually, the building’s owners call 911, fearing the man is injured.
Despite numerous attempts to get the man to respond or move, he remains in the same position until emergency medical technicians move his arms and legs so they can tie him to the stretcher. The immobility of man is an example of waxy flexibility.
Risk factor’s
Risk factors for waxy flexibility are the same as for other subtypes of schizophrenia, including:
Genetics : People with a family history of schizophrenia are at a higher risk of developing themselves.
Viral infection : Some recent studies suggest that viral infections may predispose the child to the development of schizophrenia.
Diagnosis of waxy flexibility
A physician who suspects that a patient may have catatonic schizophrenia will recommend a series of medical and psychological tests to help with the diagnosis; these may include:
- Physical exam : The patient’s height, weight, heart rate, blood pressure, and temperature are checked.
- Complete blood count (CBC) : to detect alcohol and drugs, as well as thyroid function.
- MRI or CT scan : the goal is to look for any abnormalities in the structure of the brain.
- Electroencephalogram (ECG) – to check brain function.
- Psychological evaluation : A psychiatrist will ask the patient (if possible) about his thoughts, feelings, and behavior patterns.
They will discuss the symptoms, when they started, how severe they are, and how they affect the patient’s life. They will also ask if the patient has thoughts of harming himself or others.
It can take a long time to accurately diagnose waxy flexibility caused by catatonic schizophrenia.
Other conditions, such as mania, seizure disorders, substance abuse, and severe depression, share symptoms with catatonic schizophrenia and should be ruled out first.
Treatment options for waxy flexibility
Waxy flexibility is a lifelong condition, although catatonic symptoms may not persist.
Patients with schizophrenia and waxy flexibility require permanent treatment; even when the symptoms seem to have disappeared and the patient thinks they are better.
Methods vary depending on a number of factors, including the severity and types of symptoms, the patient’s health, and their age.
Medication for waxy flexibility
Benzodiazepines and electroconvulsive therapy are the two main treatments for catatonia, although other treatments, such as some atypical antipsychotics, may also be used.
Benzodiazepines : This class of drugs acts as a tranquilizer and is most often used for catatonic schizophrenia. The patient may have to take this medicine for several days or weeks.
Benzodiazepines are the first line option for treating catatonia. They work by increasing the effects of the neurotransmitter Gamma-Aminobutyric Acid (GABA).
This type of medication is also capable of quickly providing relief for symptoms such as anxiety, insomnia, restlessness, and muscle spasms.
About 70 percent of people with catatonia do well on a benzodiazepine called lorazepam.
Barbiturates : These drugs are known as depressants or sedatives. Its effects range from mild sedation to total anesthesia. Barbiturates quickly relieve catatonia symptoms.
If used for a long time, there is a risk of dependency. This drug is used to treat catatonic schizophrenia less often than barbiturates.
Other treatments
Waxy flexibility from untreated catatonic schizophrenia can cause health, financial, behavioral, and legal problems; These problems can affect every part of the patient’s life.
Electroconvulsive Therapy (ECT) : Electroconvulsive therapy is often used as a treatment for catatonia, the therapy is the most effective treatment available for catatonia.
One study found that catatonic patients with waxy flexibility responded faster to electroconvulsive therapy, compared to patients with different catatonic symptoms.
Electroconvulsive therapy is used for catatonic patients who have not responded to medications or other treatments. Side effects can include short-term memory loss.
It works for about 85 percent of patients. Benzodiazepines are usually tried first. The two therapies can be combined.
Prompt recognition and treatment early in the catatonic state are essential for best results.
Hospitalization : This may be necessary during severe episodes. Patients are safer in a hospital setting; they are more likely to get proper nutrition, sleep, and hygiene, as well as proper treatment.
Compliance (adherence) : Compliance or adherence in medicine means taking the medicine at the right time and the correct doses.
Unfortunately, non-compliance is a major problem for patients with schizophrenia. Patients can stop taking their medications for long periods of time, significantly interfering with their lives and those of the people around them.
