Catatonia

Definition

Catatonia is an abnormal neuropsychiatric condition that affects both behavior and motor function, and results in unresponsiveness in someone who otherwise appears to be awake. For the purpose of diagnosis, there are three types of catatonia, including catatonia associated with another mental disorder, catatonia disorder due to another medical condition, and unspecified catatonia. Although often associated with schizophrenia and other affective disorders, catatonia may be a result of, or due to, any number of psychotic disorders, mood disorders or general medical conditions. Catatonia is sometimes referred to as catatonic syndrome, because there is not just one identifying sign or symptom associated with this condition or symptoms that appear separately from one another, but rather a collection of several symptoms that appear together at the same time. These specific signs and symptoms do not vary, regardless of the nature of the condition.

Symptoms

At least three out of twelve symptoms must be present for a diagnosis of catatonia. These symptoms include: 

  • Stupor (oblivious inability to move or respond to stimuli), catalepsy (rigid body posture)
  • Mutism (little to no verbal communication)
  • Waxy flexibility (body remains in whatever position it is placed by another)
  • Negativism (lack of verbal response)
  • Posturing (holding a posture or position that goes against gravity)
  • Mannerisms (extreme or odd movements and mannerisms)
  • Stereotypy (frequent repetitive movements for no reason)
  • Agitation (for no reason), grimacing (distorted facial expressions)
  • Echolalia (repeating others’ words)
  • Echopraxia (repeating others’ movements).

Other common symptoms include rigidity and automatic obedience. When catatonia is associated with schizophrenia, stupor may continue for long periods of time as compared to schizophrenia associated with other psychiatric conditions, where there are likely to be long remissions.

Causes

Catatonia is generally associated with, or due to, other medical conditions, especially brain disorders such as neurodegenerative disease and encephalitis. A severe vitamin B12 deficiency; infection; exposure to toxins; or conditions such as schizophrenia and other psychotic disorders, autism, extreme trauma, and mood disorders are also associated with catatonia. Catatonia can also be idiopathic, arising from an unknown cause. Any general medical patient who displays obvious related symptoms may be catatonic. The link between catatonia due to or associated with general medical conditions is unclear and the condition often goes unrecognized, but when identified, responds to standard catatonia treatments.

Treatments

Benzodiazepines (tranquilizers), antidepressants, muscle relaxers, and antipsychotic medications, with extreme caution, are commonly used to treat catatonia. Brain stimulation therapy, such as electroconvulsive therapy, and NMDA antagonists (anesthetic pain medications) are used in some cases. Medical treatment may vary for someone who is catatonic, depending on co-existing conditions. In the case of a vitamin deficiency, catatonia can easily be treated with supplemental nutrients.

References

Wilcox JA and Duffy PR. The Syndrome of Catatonia. Behavioral Sciences. December 2015;5(4):576-588.

Proenca M, Marques F, Cardoso D, Fonseca C. Catatonia as an Internal Medicine Disease: Infrequent or Still Underdiagnosed? BMJ Case Reports. 2016. doi:10.1136/bcr-2015-214233.

Tandon R, Heckers S, Bustillo J, et al. Catatonia in DSM-5. Schizophrenia Research. 2013;150:26-30.

Last reviewed 10/05/2017