What is the most common cause of catatonia?

Most Common Cause of Catatonia

The most common cause of catatonia is mood disorders (particularly bipolar disorder and major depression), followed by schizophrenia and other psychotic disorders. 1, 2

Primary Psychiatric Causes

Mood Disorders (Most Common)

• Affective disorders represent the most frequent underlying etiology of catatonia, with bipolar disorder and major depressive disorder being the predominant associations 2
• Severe depressive episodes in bipolar disorder are particularly prone to progressing to catatonia, especially when characterized by psychomotor retardation, hypersomnia, and psychotic features 1
• Approximately 10% or more of patients with acute psychiatric illnesses develop catatonia, with mood disorders accounting for the largest proportion 2

Schizophrenia and Psychotic Disorders

• While historically catatonia was considered exclusively a subtype of schizophrenia, it is now recognized that schizophrenia accounts for a smaller proportion of catatonia cases compared to mood disorders 3, 2, 4
• Catatonia can occur as a specifier across the psychotic disorder spectrum, including schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder 4
• Patients with schizophrenia who develop catatonia may be less likely to respond to first-line benzodiazepine treatment compared to those with mood disorders 3, 2

Secondary Medical Causes

Neurological Conditions

• Viral encephalitis and meningitis are among the most common organic causes, particularly in children and adolescents 5
• Seizure disorders including epilepsy can precipitate catatonia 5
• CNS lesions such as brain tumors, congenital malformations, and cerebral venous sinus thrombosis have been reported as causes 5, 6

Metabolic and Systemic Conditions

• Endocrinopathies, particularly thyroid disorders, can induce catatonia 5
• Hyponatremia and other electrolyte disturbances are recognized triggers 6
• HIV-related syndromes represent a common infectious etiology 5

Iatrogenic Causes

• Neuroleptic malignant syndrome is a serious iatrogenic cause associated with antipsychotic medication use 1, 6
• Withdrawal from benzodiazepines or clozapine can precipitate catatonia due to sudden changes in GABA activity and increased excitatory neurotransmission 6
• Stimulant medications, corticosteroids, and substances of abuse (amphetamines, cocaine) can induce catatonia 5

Genetic and Metabolic Disorders

• Wilson's disease, velocardiofacial syndrome, and lipid storage disorders (such as Gaucher's disease) are associated with catatonia in youth 5
• Chorea, including Huntington's disease, can present with catatonic features 5

Clinical Recognition Pitfalls

• Catatonia remains significantly under-diagnosed despite its prevalence and treatability, with significant morbidity and mortality when left untreated 3, 2
• The syndrome can be confused with various other diagnoses due to its diverse presentations (retarded vs. excited subtypes) and multiple potential etiologies 3
• Clinicians should maintain a high index of suspicion when patients present with rapid onset of psychomotor symptoms, particularly in the context of known mood disorders 3, 2
• Diagnostic scales such as the Bush-Francis Catatonia Rating Scale should be utilized to avoid delayed diagnosis 3