Causes of Catatonia
Catatonia is caused by a wide range of psychiatric, neurological, and medical conditions, with the most common associations being mood disorders, psychotic disorders, and various medical conditions that affect central nervous system function. 1, 2
Primary Psychiatric Causes
- Mood Disorders: Catatonia frequently occurs in patients with primary mood disorders, including depression and bipolar disorder, and is recognized as an episode specifier in these conditions 3
- Schizophrenia and Psychotic Disorders: Historically associated with schizophrenia (coded as F20.2 - Catatonic schizophrenia), catatonia can occur as a subtype of schizophrenia and other psychotic disorders including schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder 4, 3
- Autism Spectrum Disorders: Catatonic symptoms can present in individuals with autism spectrum disorders 5
Medical and Neurological Causes
- Autoimmune Disorders: Anti-NMDA receptor encephalitis is a prominent cause of catatonia, with glutamatergic activity playing a key role in the pathophysiology 5, 2
- Metabolic Disturbances: Conditions such as hyponatremia can induce catatonic states 5
- Neurological Conditions: Cerebral venous sinus thrombosis and other neurological disorders can present with catatonia 5
- Infectious Processes: Neuroinfections, including viral encephalitis and meningitis, can manifest with catatonic features 6
- Neoplastic Conditions: Neoplastic meningoencephalitis and other brain tumors can present with catatonia and akinetic mutism 6
Medication-Related Causes
- Medication Withdrawal: Abrupt discontinuation of benzodiazepines or clozapine can precipitate catatonia, likely due to sudden changes in GABA activity 5
- Neuroleptic Malignant Syndrome: A severe reaction to antipsychotic medications that can present with catatonic features 5
Pathophysiological Mechanisms
Neurotransmitter Imbalance: Evidence points to an imbalance in neurotransmission involving GABA, dopamine, and glutamate systems 2
Neuroanatomical Pathways: Dysfunction in cortico-cortical and cortico-subcortical pathways appears central to catatonia, involving structures such as 2:
- Orbitofrontal and temporal cortex
- Basal ganglia
- Brainstem structures involved in motor processing
Genetic Factors: Research has identified genetic factors related to oligodendrocyte function that may contribute to catatonia susceptibility 2
Developmental and Environmental Factors
Prenatal Viral Exposure: There is evidence suggesting that prenatal exposure to viral infections may increase risk for later development of psychotic disorders with catatonic features 1
Pandysmaturation: Infants genetically at risk for schizophrenia may display a neurointegrative defect described as pandysmaturation, which could be a developmental precursor to later catatonic presentations 1
Clinical Subtypes
Inhibited (Retarded) Catatonia: Characterized by stupor, mutism, negativism, and waxy flexibility 2
Excited Catatonia: Characterized by psychomotor agitation, combativeness, and autonomic instability 2
Malignant Catatonia: A life-threatening form with hyperthermia, autonomic instability, and altered consciousness 7
Understanding the diverse causes of catatonia is essential for proper diagnosis and treatment, as early intervention is associated with better outcomes 5. The recognition that catatonia is not merely a subtype of schizophrenia but a syndrome that can occur across multiple conditions has important implications for clinical practice 3.