Catatonia
The term for a psychiatric patient who appears catatonic is simply "catatonia"—a distinct neuropsychiatric syndrome of primarily psychomotor disturbances that is no longer regarded as a subtype of schizophrenia but rather as an independent syndrome that can occur across multiple psychiatric and medical conditions. 1
Definition and Core Features
Catatonia is a syndrome of primarily psychomotor disturbances characterized by the occurrence of several different symptoms including:
- Stupor 1
- Catalepsy 1
- Waxy flexibility 1
- Mutism 1
- Negativism 1
- Posturing 1
- Mannerisms 1
- Stereotypies 1
- Psychomotor agitation 1
- Grimacing 1
- Echolalia 1
- Echopraxia 1
Clinical Recognition
Catatonia occurs in more than 10% of patients with acute psychiatric illnesses and is found in 10% or more of acute psychiatric admissions when actively looked for. 2, 3
Two main subtypes exist:
- Retarded catatonia: characterized by immobility, mutism, staring, rigidity, and related signs 2
- Excited catatonia: less common presentation with prolonged periods of psychomotor agitation 2
Critical Diagnostic Context
Catatonia is no longer considered a subtype of schizophrenia as it was historically classified, but rather an independent syndrome that occurs with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders. 1, 2, 3 This represents a major shift from ICD-10 to ICD-11 classification. 1
The syndrome can occur in patients with mania (where psychotic symptoms including catatonic behavior may be present), depression, toxic responses, neurological illnesses, metabolic disorders, and immunological disorders. 4, 2, 5
Important Clinical Pitfall
Awareness and level of consciousness remain intact in catatonia, unlike delirium—this is a key differentiator. 4 Psychomotor slowing is common in catatonia but may not be captured by all screening tools, potentially leading to missed diagnoses. 6