Presentations of Catatonia
What are the different presentations of catatonia?
Stuporous (Akinetic) Catatonia
Stuporous catatonia is the most recognized form of the condition.
A person may appear immobile, unresponsive, or disconnected from their surroundings and may hold a bizarre or fixed body position for extended periods.
Muscle rigidity, mutism (little or no speech), and failure to respond to pain or touch are common.
Some individuals may show repetitive movements, such as rocking, sniffing, or chewing.
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When stupor is severe—marked by extreme immobility and minimal responsiveness—patients may require intravenous fluids, feeding support, and extended nursing care to prevent complications.
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For scholarly articles, books, and other resources on Stuporous Catatonia, click here.
Catatonia can present in different ways—or expressions—that vary in severity and appearance.
While some individuals become immobile or unresponsive, others may appear restless, agitated, or confused.
Symptoms can shift or overlap, and a person may show features from more than one form over time.
Recognizing these presentations helps ensure accurate diagnosis and timely treatment.
Excited (Hyperkinetic) Catatonia
Excited catatonia is characterized by restless, impulsive, or agitated behavior, often with a sudden onset.
A person may become extremely talkative or frenzied, show disorganized or racing thoughts, and appear confused, disoriented, or unable to think clearly.
Movements are typically purposeless or repetitive, and sleep is often greatly reduced.
Psychotic symptoms—such as distorted perception of reality—may also occur.
In some cases—particularly among individuals with autism or other neurodevelopmental conditions—this pattern of intense motor agitation, unprovoked aggression, and self-injurious behavior is described as “agitated catatonia.” It falls within the excited form and is often misinterpreted as behavioral dysregulation.
It is important to distinguish excited catatonia from delirious mania, as treatment approaches differ significantly. While delirious mania may improve with antipsychotic medication, individuals with excited catatonia often worsen if these medications are given. In some cases, antipsychotics can precipitate malignant catatonia, a potentially life-threatening condition requiring immediate medical attention.
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For scholarly articles, books, and other resources on Excited Catatonia, click here.
Mixed Catatonia
Mixed catatonia describes cases in which a person shows features of both stuporous and excited catatonia—sometimes at the same time and sometimes in rapid alternation.
They may appear partly unresponsive or slowed, yet also restless, talkative, or impulsive.
These paradoxical or fluctuating symptoms can be confusing for families and clinicians, and may lead to delays in recognition or treatment.
Careful observation and medical assessment are essential to distinguish mixed catatonia from other conditions with overlapping features.​
Periodic Catatonia
Periodic catatonia is when catatonic symptoms recur in cycles.
A person may alternate between stuporous and excited phases, often with periods of full or near-full recovery in between.
During these intervals, the individual may appear completely well, making the condition difficult to recognize and diagnose.
Tracking the pattern and frequency of episodes can help clinicians identify periodic catatonia and guide appropriate treatment.
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For scholarly articles, books, and other resources on Periodic Catatonia, click here.
Malignant Catatonia
Malignant catatonia is a severe, life-threatening form of catatonia that develops suddenly and acutely.
It is characterized by stupor (extreme immobility and minimal responsiveness), mutism (little or no speech), catalepsy (holding postures for long periods without reaction), waxy flexibility (initial resistance followed by passive repositioning), and negativism (resisting movement or instruction).
Serious medical complications may include fever, muscle rigidity, abnormal blood pressure, rapid heart rate and breathing, and elevated CPK levels, indicating muscle injury. These signs reflect autonomic instability and require immediate medical attention.
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Malignant catatonia can be fatal if not treated urgently.
In some cases, it may be triggered by medications, including certain antipsychotic or serotonergic drugs.
Prompt recognition and treatment—often involving benzodiazepines, electroconvulsive therapy (ECT), and supportive care—are critical to recovery.
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NOTE: Malignant catatonia shares features with neuroleptic malignant syndrome (NMS), and distinguishing between them can be critical for treatment decisions.
Without prompt recognition and intervention, stuporous or excited catatonia can progress to malignant catatonia, which is a medical emergency.
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For scholarly articles, books, and other resources on Malignant Catatonia, click here.
Catatonia can also present differently across the lifespan and in specific clinical contexts, where symptoms may be subtle, atypical, or easily mistaken for other conditions.
Broad Clinical Presentations and Vulnerable Groups
Catatonia occurs across a wide range of populations and circumstances—including children and adolescents, individuals with autism or other neurodevelopmental disorders, and older adults or those with complex medical illness.
Recognizing catatonia in these groups is especially important, as symptoms may be subtle or misinterpreted.
Catatonia in Autism and Other Neurodevelopmental Disorders
In individuals with autism or related conditions, catatonia may appear with slowed movement, loss of skills, reduced speech, or episodes of agitation, unprovoked aggression, and self-injury.
These changes represent a departure from the individual’s baseline and are often mistaken for behavioral or psychiatric issues rather than an underlying medical condition.
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For an in-depth look at Catatonia in Autism and Other Neurodevelopmental Disorders, click here.
For scholarly articles, books, and other resources, click here.
Catatonia in Children and Adolescents
Catatonia also occurs in children and adolescents without autism, where it is frequently underrecognized or misdiagnosed as depression, psychosis, or oppositional behavior.
Early identification is vital, as treatment response is often excellent when catatonia is recognized promptly.
Catatonia in Older Adults and Medically Ill Populations
In older adults or individuals with complex medical conditions, catatonia may develop gradually or present subtly, sometimes overlapping with delirium, dementia, or medication side effects.
Awareness among hospitalists, neurologists, and geriatric clinicians is essential, as timely recognition and treatment can lead to recovery even in medically fragile patients.
Catatonia in Autoimmune and Medical Encephalitis
Anti–NMDA receptor encephalitis, first described in 2007, is now recognized as one of the most common forms of autoimmune encephalitis. Catatonia may occur during the course of this illness and can be severe or life-threatening if not recognized promptly.
The disorder typically begins with flu-like symptoms, followed by the sudden onset of psychiatric and neurological changes—including psychosis, agitation, delusions, hallucinations, anxiety, repetitive behaviors, echolalia, mutism, and insomnia.
As the illness progresses, patients may develop altered alertness, abnormal movements of the face or limbs, autonomic instability (fluctuations in heart rate or blood pressure), and seizures.
These features may overlap with those of excited or mixed catatonia, sometimes making diagnosis challenging.
Diagnosis is confirmed by detecting NMDA antibodies in the cerebrospinal fluid, often after EEG abnormalities or normal brain MRI findings.
Treatment involves immunotherapy and management of catatonia, often using benzodiazepines or ECT alongside treatment of the underlying autoimmune process.
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For scholarly articles, books, and other resources on Catatonia due to Anti-NMDA receptor encephalitis, click here.
COVID-19 Associated Catatonia
The COVID-19 virus may be responsible for the onset of Catatonia without a prior mental health condition. This has been explored in several articles addressing psychiatric disturbances in COVID-19.
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For scholarly articles, books, and other resources on COVID-19 associated Catatonia, click here.
With timely recognition and appropriate treatment, all forms of catatonia can improve—often dramatically.
This information is provided for educational purposes only and is not a substitute for professional medical evaluation or care.