"Catatonia is a severe neuropsychiatric disorder affecting movement, speech and complex behavior often involving disturbances in automatic [involuntary] functions or affect [moods, feeling and attitudes]. It has been associated with excess morbidity and, sometime, mortality compared to other serious mental illnesses." Rogers, JP et al. (2023) Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

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Unfortunately, recognition by healthcare professionals is often poor and knowledge about Catatonia and it's treatments is often limited among providers. The mission of The Catatonia Foundation is to raise awareness and educate healthcare providers and the public about Catatonia, including identification, diagnosis, and effective treatment options. 

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Catatonia typically comes on suddenly with behaviors and/or activity that are out of character compared to the person's baseline. It may take family members some time to realize how significant the changes are. In many cases, family members may not realize the changes to baseline are not volitional, as the person may appear to be belligerent, stubborn, depressed, anxious, or just acting strange. Patients with catatonia are frequently overwhelmed by fear, dread, and anxiety. 

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Catatonia is NOT Schizophrenia

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While Catatonia used to be associated with schizophrenia, it is now more commonly known that Catatonia is NOT schizophrenia.

 

The DSM-5-TR no longer puts catatonia with the subtype of schizophrenia. It creates a category for catatonia under Schizophrenia Spectrum and other Psychotic Disorders section. Within the category of catatonia, the DSM-5-TR splits catatonia into (1) catatonia due to general medical condition, (2) catatonia due to another mental disorder, and (3) catatonia not otherwise specified.

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ICD-11 codes for catatonia in the following ways: (1) catatonia, unspecified, (2) catatonia induced by substances or medications, (3)catatonia associated with another mental disorder, and (4) secondary catatonia syndrome.

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Signs and Symptoms of Catatonia

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There may be overlap between the signs and symptoms of other diagnoses and catatonia, including delirium, cognitive decline, suicidal ideation, delusion of poverty, self-stimulatory behavior, echolalia, impulsivity, belligerence, or aggression. The lorazepam challenge and an evaluation using a Catatonia rating scale (described below) may help to make a proper diagnosis of Catatonia. 

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Catatonia is typically diagnosed by observing specific signs that may indicate the presence of Catatonia. Many signs have been identified as significant and they fall within several categories — focal motor activity, generalized motor activity, speech, affect, complex behavior, and autonomic activity.

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Focal motor activity includes catalepsy (spontaneous maintenance of postures including mundane — sitting or standing for long periods without reacting), mannerisms (odd purposeful movements — hopping or walking tiptoe, saluting passers by or exaggerated caricatures of mundane movements), stereotypy (repetitive non-goal-directed motor activity — finger-play, repeated touching, patting or rubbing self), grimacing (odd facial expressions), and echopraxia (mimicking movements).

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Generalized motor activity includes stupor (extreme hypoactivity, immobile, and minimally responsive to stimuli) and agitation (extreme hyperactivity, constant motor unrest which is apparently non-purposeful).

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Speech includes mutism (verbally unresponsive or minimally unresponsive), verbigeration (repetition of phrases or sentences — like a scratched record), and echolalia (mimicking speech).

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Affect includes affective blunting, anxiety, and ambivalence.

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Complex behavior includes negativism (refusal to comply with requests, expectations, or suggestions), reduced oral intake, and withdrawal. 

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Autonomic activity includes tachycardia and hypertension. 

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A diagnosis of Catatonia does not require that all of the symptoms are exhibited by the patient. In fact, a diagnosis is typically made if three or more diagnostic symptoms are identified. The symptoms may wax and wane, making a diagnosis difficult. 

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Click here for a description of the symptoms of Catatonia and how to diagnose it.

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“Catatonia is more than a movement disorder. It entails negativistic behavior [refusal to comply with requests] and psychotic ideation [perceiving or interpreting things differently from reality] as well as rigidity, immobility, posturing [spontaneous adoption of positions that are held for an abnormal length of time], muscle tension, stupor, agitation, tics, echolalia [repeating other's words], echopraxia [imitating other's movements] and mannerisms [exaggerated example of normal action.]” (Fink and Shorter, 2018, page 2)​​

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Expressions

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It's important to recognize that Catatonia has many expressions with certain symptoms commonly associated with each expression. Stuporous or Akinetic Catatonia involves immobility and stupor. Excited Catatonia involves delirium, disorientation and confusion. Agitated Catatonia (a form of excited catatonia) is typically seen in patients with autism or developmental disorders and may involve self-injurious or unprovoked aggressive behavior.​​

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Click here for a description of the different expressions of Catatonia. 

Catatonia typically responds to the benzodiazepine Lorazepam (Ativan) and electroconvulsive therapy (ECT). It is important to note that the symptoms of patients with Catatonia who are treated with antipsychotic medication may worsen.  

Click here for more information about treatment options.