What are the symptoms of catatonia?

From the Guidelines

Catatonia is a syndrome characterized by a range of psychomotor symptoms, including stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypies, psychomotor agitation, grimacing, echolalia, and echopraxia, as defined in the ICD-11 classification system 1. The symptoms of catatonia can vary widely, but key features include:

• Stupor: a state of near-unconsciousness or insensibility
• Catalepsy: maintaining unusual postures
• Waxy flexibility: limbs can be positioned by others and remain in place
• Mutism: inability or unwillingness to speak
• Negativism: resistance to instructions
• Posturing: maintaining an unusual or uncomfortable posture
• Mannerisms: repetitive, purposeless movements
• Stereotypies: repetitive, non-goal-directed movements
• Psychomotor agitation: excessive, purposeless motor activity
• Grimacing: making facial expressions that are not consistent with the current emotional state
• Echolalia: repeating others' words
• Echopraxia: mimicking others' movements These symptoms result from dysregulation in brain circuits involving the prefrontal cortex, basal ganglia, and thalamus, with abnormalities in neurotransmitters like GABA and glutamate 1. Catatonia can occur in various psychiatric conditions, including schizophrenia, mood disorders, and medical conditions like autoimmune encephalitis 1. Prompt recognition is crucial, as treatment with benzodiazepines (particularly lorazepam 1-2mg every 4-6 hours) or electroconvulsive therapy is often effective 1. If left untreated, catatonia can progress to a life-threatening condition called malignant catatonia, characterized by fever, autonomic instability, and delirium. Some of the key points to consider when diagnosing and treating catatonia include:
• Severity of symptoms: the patient’s symptoms must be severe, persistent, and significantly disabling 1
• Lack of treatment response: failure to respond to at least two adequate trials of appropriate psychopharmacological agents accompanied by other appropriate treatment modalities 1
• Diagnosis: severe, persistent major depression or mania with or without psychotic features, schizoaffective disorder, or, less often, schizophrenia 1

From the Research

Symptoms of Catatonia

The symptoms of catatonia can be categorized into two subtypes: catatonia of the retarded type and excited catatonia.

• Catatonia of the retarded type is characterized by:
  • Immobility
  • Mutism
  • Staring
  • Rigidity
  • Other clinical signs 2
• Excited catatonia is a less common presentation, marked by prolonged periods of psychomotor agitation 2

Clinical Features

Catatonia can occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders 2, 3.

• It may be associated with:
  • Schizophrenia
  • Mania
  • Depression
  • Neuroleptic Malignant Syndrome
  • Anti-NMDA receptor encephalitis
  • Certain medical conditions, such as hyponatremia, cerebral venous sinus thrombosis, and liver transplantation 3
• The pathobiology of catatonia is poorly understood, but abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors 2, 3

Diagnosis and Treatment

Catatonia is highly treatable, and most patients respond rapidly to low-dose benzodiazepines 2, 4, 5.

• Electroconvulsive therapy is occasionally required, especially for patients with longstanding catatonia or a diagnosis of schizophrenia 2, 5
• The treatment of catatonia often involves the use of benzodiazepines, such as lorazepam, which can be used in combination therapy with antipsychotics 3