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Catatonia

Reviewed by Psychology Today Staff

Catatonia is a 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 underlying reason for the condition.

Symptoms

According to the DSM-5, 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 lengthy remissions.

What are the different types of catatonia?

Catatonia is sometimes categorized into three types. Akinetic Catatonia (also called retarded catatonia) involves a lack of movement and responsiveness; the person may stare blankly or not reply to others. Excited Catatonia involves excessive energy or uncontrolled movement; the individual may be agitated, restless, and sometimes engage in self-harm. Malignant Catatonia involves medical problems such as high blood pressure, rapid breathing, and a faster heart rate.

What is the history of catatonia?

Catatonia was previously considered a subtype of schizophrenia. Therefore patients diagnosed with catatonia were also diagnosed with schizophrenia. However, researchers and clinicians have since come to understand that catatonia has distinct features and actually occurs more frequently in patients with mood disorders than schizophrenia. It is now diagnosed as its own entity in the DSM-5, unspecified or associated with another mental disorder or medical condition.

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Causes

Catatonia is generally associated with, or due to, other mental disorders or medical conditions. Those include 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 associated with catatonia. Catatonia can also be idiopathic, arising from an unknown cause.

Any general medical patient who displays obvious 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.

How common is catatonia?

Although prevalence estimates vary, research suggests that catatonia occurs in 9 to 17 percent of patients with acute psychiatric illnesses, such as schizophrenia, bipolar disorder, and depression. Catatonia is more prevalent among those with mood disorders than schizophrenia.

What are the risk factors associated with catatonia?

Catatonia typically occurs in the context of other mental disorders and medical conditions. Therefore, disorders including developmental disorders, bipolar disorders, schizophrenia, and depression are risk factors for catatonia as are medical conditions including autoimmune disorders, encephalitis, and seizures, research suggests. Catatonia is also more common among women.

Treatment

Treatment depends on the underlying cause of the disorder, and often includes benzodiazepines (tranquilizers), as well as antidepressants, muscle relaxers, and antipsychotic medications. Brain stimulation therapy, such as electroconvulsive therapy, is used in some cases.

Medical treatment will also vary depending on co-existing conditions. In the case of a vitamin deficiency, catatonia can easily be treated with supplemental nutrients.

References
Burrow, J., Spurling, B., & R. Marwaha (2021). Catatonia. StatPearls Publishing.
Consoli, A., et al. (2012) Medical and developmental risk factors of catatonia in children and adolescents: a prospective case-control study. Schizophrenia Research.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 2013. 
Proenca M, Marques F, Cardoso D, Fonseca C. Catatonia as an Internal Medicine Disease: Infrequent or Still Under-diagnosed? BMJ Case Reports. 2016. doi:10.1136/bcr-2015-214233.  
Rasmusseh, S, Mazurek, M., & Rosebush, P. (2016). Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology. World Journal of Psychiatry.
Tandon R, Heckers S, Bustillo J, et al. Catatonia in DSM-5. Schizophrenia Research. 2013;150:26-30.
Usman D., et al. (2011). Comparison of Catatonia Presentation in Patients with Schizophrenia and Mood Disorders in Lagos, Nigeria. Iranian Journal of Psychiatry.
Walther, S. & Strik W. (2016). Catatonia. CNS Spectrums. Cambridge University Press.
Wilcox JA and Duffy PR. The Syndrome of Catatonia. Behavioral Sciences. December 2015;5(4):576-588.
Last updated: 07/07/2021