From the Guidelines
Catatonia is a syndrome of primarily psychomotor disturbances characterized by the occurrence of several different symptoms including stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypies, psychomotor agitation, grimacing, echolalia, and echopraxia. According to the most recent evidence from 1, catatonia is no longer regarded as a subtype of schizophrenia, but rather a distinct syndrome that can occur in various conditions. The symptoms of catatonia can vary widely, but typically include abnormal movements, behaviors, and withdrawal.
Some key features of catatonia include:
- Stupor or limited responsiveness
- Catalepsy or waxy flexibility
- Mutism or inability to speak
- Negativism or resistance to instructions
- Posturing or holding unusual positions
- Mannerisms or stereotypies
- Psychomotor agitation or excitement
- Grimacing or echolalia and echopraxia
It is essential to recognize and treat catatonia promptly, as untreated catatonia can progress to a life-threatening condition called malignant catatonia with fever, autonomic instability, and potentially death 1. The exact mechanism of catatonia involves dysregulation of GABA and glutamate neurotransmitter systems in the brain, explaining why GABA-enhancing medications like benzodiazepines are effective treatments.
In terms of treatment, benzodiazepines like lorazepam are typically used as first-line therapy, with most patients responding within days 1. For those who don't improve, electroconvulsive therapy (ECT) is highly effective, especially in cases where catatonia is present 1. The underlying cause of catatonia should also be addressed simultaneously to ensure the best possible outcome. Early recognition and treatment are crucial to prevent morbidity, mortality, and to improve the quality of life for patients with catatonia.
From the Research
Definition and Characteristics of Catatonia
- Catatonia is a psychomotor syndrome characterized by motor, affective, and cognitive-behavioral signs, lasting from hours to days 2
- It is recognizable by clinical signs such as immobility, mutism, staring, rigidity, and psychomotor agitation 3, 4
- Catatonia can be categorized into two subtypes: catatonia of the retarded type and excited catatonia 3
Prevalence and Diagnosis
- Catatonia is found in 5-18% of inpatients on psychiatric units and 3.3% of inpatients on medical units 2
- The incidence of catatonia is between 5 and 20% 5
- A comprehensive workup is required to rule out organic causes and diagnose catatonia 5
- The Bush-Francis Catatonia Rating Scale can be used to screen for catatonia 4
Treatment and Management
- Benzodiazepines, such as lorazepam and diazepam, are the most preferred pharmacotherapy for catatonia 3, 4, 2, 6
- Electroconvulsive therapy is also an effective treatment option 3, 2, 6
- N-methyl-D-aspartate antagonists, such as amantadine and memantine, and dopamine-modulating second-generation antipsychotics, such as clozapine and aripiprazole, can be used in some patient populations 2
- Early and appropriate treatment is crucial to achieve a favorable outcome and reduce morbidity and mortality associated with catatonia 2