What are the causes of catatonia?

From the Guidelines

Catatonia is primarily caused by psychiatric conditions, including severe major depression, mania, schizoaffective disorder, schizophrenia, and neuroleptic malignant syndrome.

Causes of Catatonia

• Psychiatric conditions:
  • Severe major depression
  • Mania with or without psychotic features
  • Schizoaffective disorder
  • Schizophrenia, especially when affective symptoms are prominent 1
  • Neuroleptic malignant syndrome, a serious iatrogenic condition associated with the use of antipsychotic medication 1
• Other conditions:
  • Catatonia can also be a feature of other psychiatric conditions, but the provided evidence does not specify these conditions in detail.

According to the evidence, catatonia is characterized by psychomotor disturbances, including stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypies, psychomotor agitation, grimacing, echolalia, and echopraxia 1. The use of electroconvulsive therapy (ECT) may be considered for adolescents with catatonia who meet certain criteria, including a diagnosis of a severe and persistent condition, significant disability, and lack of response to at least two adequate trials of psychopharmacological agents 1.

From the Research

Causes of Catatonia

The causes of catatonia are diverse and can be categorized into primary psychiatric conditions and secondary medical illnesses. Some of the established predisposing and precipitating factors for catatonia include:

• Exposure to neuroleptic medications or withdrawal states 2
• Primary psychiatric conditions such as bipolar disorder, schizophrenia, and affective disorders 2, 3, 4
• General medical illnesses like autoimmune encephalitis, hyponatremia, cerebral venous sinus thrombosis, and liver transplantation 2, 4
• Neuroleptic Malignant Syndrome and anti-NMDA receptor encephalitis 4
• Withdrawal from benzodiazepines or clozapine 4
• Delirium or coma 2

Pathophysiology of Catatonia

The pathophysiology of catatonia is not fully understood, but several factors have been suggested to contribute to its development, including:

• Abnormalities in gamma-aminobutyric acid and glutamate signaling 3
• Defective neurotransmitter regulation and impaired oligodendrocyte function 4
• Aberrant neuronal activity in different motor pathways 4
• Neuroinflammation and immunoactivation, which may be triggered by infectious or inflammatory etiologies, neuromedical illnesses, or psychiatric entities 5
• Dysfunction in the anterior cingulate cortex (ACC)/mid-cingulate cortex (MCC)/medial prefrontal cortex (mPFC)/paralimbic cortico-striato-thalamo-cortical (CSTC) circuit, involved in motivation and movement 5