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Catatonia and BD-I
Case Study: Catatonia and Bipolar 1 Disorder
Sara Jane Morton
College of Nursing, Auburn University
NURS 3730
Dr. Stuart Pope and Ms. Pamela Short
November 19, 2022
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Catatonia and BD-I
Abstract
Bipolar I Disorder is a psychiatric illness characterized by recurrent manic episodes, occasionally
fluctuating with depressive episodes, resulting in psychological distress and impairment of
everyday functioning. Individuals with Bipolar I Disorder are often diagnosed with both Bipolar
I Disorder and catatonia, resulting in altered motor function of speech, posture, and behavior.
There are numerous factors that can attribute to these diagnoses, including past trauma, role
crises, and stressful life events. Treatment includes both pharmacological and nonpharmacological options. Integrating drug therapy with behavioral modifications and coping
mechanisms is the ideal treatment method for these individuals. This paper reviews a case study
of an adult with Bipolar I Disorder and catatonia, a summary of the diagnosis, relevant treatment
options, and nursing interventions.
Keywords: bipolar I disorder, catatonia, behavior
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Catatonia and BD-I
Catatonia and Bipolar I Disorder
This case study discusses a 52-year-old African American male patient. For
confidentiality reasons, this patient will be referred to as James Brown. Brown was admitted to
the mental health unit following a psychosis court order. He presented with acute mania, extreme
agitation, and catatonic behavior upon arrival. Brown was initially diagnosed with psychosis and
catatonia. However, after psychiatric evaluation, he was diagnosed with Bipolar I Disorder (BDI) and catatonia (Patient chart). Catatonia, specifically periodic catatonia, often accompanies BDI as a comorbidity in the disease process. Periodic catatonia is characterized by recurrent
fluctuations in the patient’s mood, shifting between stupor and excitement (Yasgur, 2018). No
other medical diagnoses were documented.
Brown was unaccompanied and severely agitated upon arrival to the unit (Patient chart).
Adults between the ages of 40 to 65 are considered to be in the seventh stage, Generativity vs.
Stagnation, of Erikson’s Psychosocial Stages of Development (Cherry, 2022). Brown is in this
stage of development. During this stage, middle-aged adults strive to create and grow things that
will outlast them as an individual (McLeod, 2018). These adults often make a conscious effort to
foster relationships with their children and grandchildren, become more involved in their
communities, and contribute to society in ways that will promote future generations. Their
central focus during this time is on their contribution to the world (Cherry, 2022). Brown is
having difficulty at this stage of his life. He recently lost his job and went through a difficult
divorce with his wife (Patient chart). The patient stated he “has PTSD” from his divorce (J.
Brown, personal communication, September 29, 2022). These significant changes in the patient’s
life have negatively affected his contributive role in society as a middle-aged man. He no longer
achieves productivity within his occupation, and he has become distant from his family and ex-
Catatonia and BD-I
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wife since the divorce (Patient chart). Thus, the patient likely believes he is unable to benefit
society, causing him to feel unproductive and disconnected with loved ones and his community
as a whole (McLeod, 2018).
The patient’s worsening behavior and mental health status could be due to his perception
of his inability to contribute knowledge and value to society. Since admission to the unit, Brown
has become increasingly irritable and catatonic. He is nonverbal and self-isolates throughout
most of the day. The patient closes his eyes and tightens his lips when spoken to, or he ignores
the person speaking to him (Patient chart). These clinical manifestations are known to be caused
by stuporous behavior resulting from periodic catatonia (Purse, 2020). According to recent
studies, mutism is the most common characteristic symptom of catatonia in patients with BD-I
(Grover et al., 2019). The catatonic behavior that Brown exhibits, along with his new diagnosis
of BD-I, have likely developed from the recent life stressors and role crises he has experienced.
Research suggests that catatonia is triggered by past or current trauma that the individual has
experienced. This trauma invokes fear and distress in the patient. The patient’s catatonic
response to this stems from animals’ innate defense mechanism in danger: tonic immobility
(Ahmed et. al, 2021). Brown is considered to be using maladaptive behavior. This is defined as
an individual’s inappropriate and harmful actions, responses, and adjustments to external or
internal stimuli (Fields, 2022). The patient is not able to control how he adapts to his
environment and the difficulties he has faced. He is avoidant, angry, and withdrawn- common
behaviors that are considered maladaptive (Fields, 2022). In addition to maladaptive behavior,
Brown displays unhealthy coping mechanisms in managing his recent trauma. He refuses to
participate in group therapy and eats in solitude (Patient chart). Social relationships can have a
positive impact on individuals with BD-I and help reassure them that they are not alone,
Catatonia and BD-I
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therefore it is important for Brown to communicate with other patients while receiving treatment
(Tracy, 2022). Furthermore, the patient refuses to see his brother when he visits and will not read
the letters his brother sends him (Patient chart). This is another example of Brown’s unhealthy
coping strategies; having a support system is beneficial to individuals managing their symptoms
and coping with BD-I (Substance Abuse and Mental Health Services Administration, 2022).
BD-I is a psychiatric illness characterized by recurrent manic episodes, often alternating
with depressive episodes, resulting in mental distress and impairment of everyday functioning
(Haddad et al., 2022). To be diagnosed with BD-I, the individual’s manic episodes must last at
least seven days or be so extreme that hospitalization is necessary (National Alliance on Mental
Illness [NAMI], 2017). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
states that to be diagnosed with BD-I, an individual must meet manic episode criteria by having
three out of the seven DSM-5 symptoms (BetterHelp Editorial Team, 2022). Brown exhibits
decreased need for sleep, increased irritability, and decreased attention span, therefore he meets
the criteria for a manic episode diagnostic of BD-I. The patient also portrays heightened selfesteem; he refuses to take medications by mouth and states he does not need medication (Patient
chart). This behavior is known as grandiosity, which is another DSM-5 diagnostic criteria for
manic episodes caused by BD-I (BetterHelp Editorial Team, 2022). Since admission, the patient
has become increasingly non-cooperative, irritable, and refuses to speak or listen when being
spoken to (Patient chart). In an individual with BD-I, mood progressively becomes more
irascible, behavior more unpredictable, and decision-making more impaired (NAMI, 2017). This
progression is evident in this case study, as the patient’s manic behavior has rapidly evolved
since his arrival to the unit (Patient chart).
Catatonia and BD-I
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Catatonia is a condition of altered motor conduct accompanying different behavioral and
neurological disorders, including drastic changes in speech, posture, and behavior. The DSM-5
states that the presence of three out of the twelve criteria is diagnostic for catatonia (Yasgur,
2018). The patient exhibits many of these symptoms, including stupor (no psychomotor activity
or responsiveness to environment (Yasgur, 2018)), agitation, mutism (no verbal response), and
negativism (opposing or ignoring external stimuli (Yasgur, 2018)). Brown’s posture is extremely
poor and stiff, with his head, neck, and spine constantly rigid. As mentioned previously, the
patient is nonverbal, resists and ignores surrounding stimuli, and has minimal to absent
psychomotor activity. His behavior often fluctuates from stupor to irritable excitement. This is
evidenced by the patient shifting from ignoring stimuli to responding with anger (Patient chart).
These symptoms are characteristic of periodic catatonia, which is often seen in patients with BDI (Yasgur, 2018).
There are multiple treatment options for individuals diagnosed with BD-I and catatonia.
Non-pharmacological methods for treating BD-I include Cognitive Behavioral Therapy (CBT)
and self-management strategies (NAMI, 2017). During CBT, the individual learns how to shift
his or her thoughts and behaviors, while implementing effective coping strategies (BetterHelp
Editorial Team, 2022). Additionally, self-management strategies, like meditating and seeking
support groups, have proven to benefit individuals diagnosed with BD-I (NAMI, 2017). BD-I
can also be managed pharmacologically with medication. The patient is prescribed clonazepam,
an anticonvulsant often used to treat BD-I due to its mood-stabilizing affects (BetterHealth
Editorial Team, 2022). Anticonvulsants have also proven to be effective in managing catatonia,
which is why clonazepam is currently the treatment of choice for Brown (M. Davis, personal
communication, September 30, 2022). The patient also takes haloperidol, an antipsychotic which
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research has proven to be effective in reducing acute mania symptoms in patients with BD-I
(Neuroscience Research Australia, 2021). Haloperidol rebalances dopamine levels in the brain,
improving the patient’s thinking, behavior, and speech (NAMI, 2022). The patient also takes
Benadryl as needed for insomnia (Patient chart).
Nursing implications for adults with BD-I and catatonia include encouraging patients to
express their feelings and re-establish their self-esteem (Wang & Yu, 2021). The nurse can
achieve this by providing a therapeutic environment where the patient feels safe to communicate
their emotions. Nurses can also help patients recognize their self-worth through positive
reinforcement, patient-centered care, and encouragement of decision-making.
This case study assignment was particularly helpful to meet the course learning
objectives. It provided specific insight and knowledge retaining to patients diagnosed with BD-I
and accompanying catatonia. The course objectives that are most relevant to this case study
include designing evidence-based BD-I interventions in the delivery of safe, high-quality nursing
practice for mentally ill individuals, incorporating critical thinking and clinical judgement in the
care of patients with BD-I and catatonia, and effectively communicating and collaborating with
BD-I patients, their families, and their health care professionals.
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Catatonia and BD-I
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Catatonia and BD-I
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