Overview Of Catatonia

Catatonia is a psychomotor syndrome that has historically been associated with schizophrenia. Many clinicians have thought that the prevalence of this condition has been decreasing over the past few decades. This review reminds clinicians that catatonia is not exclusively associated with schizophrenia, and is still common in clinical practice. Many cases are related to affective disorders or are of an idiopathic nature. The illusion of reduced prevalence has been due to evolving diagnostic systems that failed to capture catatonic syndromes. This systemic error has remained unchallenged and potentiated by the failure to perform adequate neurological evaluations and catatonia screening exams on psychiatric patients. We find that current data support catatonic syndromes are still common, often severe, and of modern clinical importance. Effective treatment is relatively easy and can greatly reduce organ failure associated with prolonged psychomotor symptoms. Prompt identification and treatment can produce a robust improvement in most cases. The ongoing prevalence of this syndrome requires that psychiatrists recognize catatonia and its presentations, the range of associated etiologies, and the import of timely treatment.

Causes Of Catatonia

Historically, catatonia is related to schizophrenia and other mental illnesses, such as severe depression, bipolar disorder, and psychosis.4 However, the causes of catatonia are numerous, ranging from psychiatric to medical illnesses. Therefore, it is not surprising that there are several proposed underlying mechanisms of catatonia—including top-down modulation, cholinergic and serotoninergic rebound hyperactivity, sudden and massive blockade of dopamine, and hyperactivity of glutamate.

Symptoms Of Catatonia

A patient will often present with worsening depression, mania, or psychosis antecedent to catatonia symptoms beginning. These symptoms can present as excited, withdrawn, or a mixture. A patient presenting with excited catatonia will often have odd mannerisms such as performing actions without purpose or at inappropriate times (e.g., saluting). They may be agitated, hold odd positions against gravity, or have stereotypic and repetitive movements such as picking at their clothes or making odd gestures repeatedly. Their speech may be repetitive or mimic the interviewer’s speech or actions. A patient with withdrawn catatonia will likely be stuporous, hold an odd position, have no response or opposition to outside stimuli, and have very little speech. These symptoms may be present at some times and not at others, may be present in a combination, and vary in intensity throughout the hospital course. If these symptoms begin because of a secondary medical illness that illness may also cause other psychiatric symptoms such as mania or psychosis.

The physical exam for a patient with suspected catatonia can help to diagnose and differentiate it between other conditions such as neuroleptic malignant syndrome. Passive movement of limbs and the type of resistance encountered can reveal what the underlying condition is. If the patient has waxy flexibility and catalepsy (holds a posture against gravity when passively moved into a posture,) catatonia is high on the differential. If there is lead-pipe rigidity, the neuroleptic malignant syndrome should be suspected. Spastic rigidity would indicate potential serotonin syndrome



Catatonia is a rare side effect of some medications used to treat mental illnesses. If you suspect that a medication is causing catatonia, seek immediate medical attention. This is considered a medical emergency.

Withdrawal from some medications, such as clozapine (Clozaril), can cause catatonia.