Catatonia or catatonic syndrome is a condition in which a person becomes unresponsive to external stimuli and loses the ability to move and speak normally. In the early 20th century, catatonia was primarily viewed as a subtype of schizophrenia. Within professional circles, it has been suggested that the prevalence of this condition has declined over recent decades. However, it is now clear that catatonia can be part of a complex of symptoms associated with a variety of psychiatric, neurological, and somatic disorders.

What is Catatonia?

Catatonia presents with a range of symptoms and is diagnosed when at least three of the following are observed:

• Prolonged immobility in a natural posture
   

• Maintaining a fixed body position for an extended period (catalepsy)
   

• Extended periods of silence (mutism)
   

• Retaining limb positions given by another person (waxy flexibility)
   

• Passive but strong resistance to attempts at repositioning the limbs or body (negativism)
   

• Holding awkward or unusual postures
   

• Exaggerated or overly formal movements (mannerism)
   

• Repetitive, purposeless movements (stereotypy)
   

• Excessive agitation or aggression
   

• Involuntary facial movements, such as lip or eyebrow twitching
   

• Repeating others' speech (echolalia)
   

• Mimicking others’ movements (echopraxia)
   

Additional physical signs may include elevated body temperature, thirst, drooling, high blood pressure, and rapid heartbeat.

The risks associated with catatonia include malnutrition, exhaustion, muscle contractions, thromboembolism, and the development of pressure sores.

Catatonia may be caused by a range of psychiatric disorders, most commonly mood disorders, schizophrenia, post-traumatic stress disorder (PTSD), and postpartum psychiatric conditions. Another group of causes includes neurological diseases such as brain tumors, head trauma, temporal lobe epilepsy, and stroke. Catatonia can also develop in the context of certain somatic illnesses, toxic exposures, or the use of specific medications and substances.

Treatment

Timely treatment in the early stages of catatonic states is essential for achieving sustained symptom relief. Any treatable underlying conditions should be identified and addressed without delay.

The treatment of catatonia should include specific treatment of catatonia, treatment of any underlying disorder and prevention and management of complications associated with catatonia.
 

Specific treatment primarily involves medication and electroconvulsive therapy (ECT).

Since catatonia can arise in the context of an underlying disorder, treatment may require modification of current medications. For instance, it may be necessary to discontinue antipsychotic drugs. The most commonly prescribed medications for catatonia are benzodiazepines.