What is Catatonia?
Catatonia can occur with neurological or mental health conditions like schizophrenia, bipolar disorder, depression, and certain medical illnesses. Up to 50% of cases are related to mood disorders. It can also arise from substance abuse or withdrawal. Catatonia affects an estimated 5% of psychiatric inpatients.
Symptoms and signs
Catatonia has a broad spectrum of motor abnormalities:
Stupor – little or no voluntary movement or speech
Rigidity – resistance to positioning by others
Posturing – maintaining awkward or bizarre positions
Waxy flexibility – limbs can be positioned but stay temporarily fixed
Agitation – repetitive, purposeless movements and gestures
Stereotypies – repetitive, ritualistic muscle contractions
Mutism – no or reduced speech
Grimacing and echopraxia – mimicking others’ facial expressions
Negativism – resisting instructions or attempts to be moved
There is debate whether catatonia represents a unified disease entity or a cluster of loosely related motor signs. In many cases, no underlying cause can be identified.
Treatments
The benzodiazepine medication lorazepam often leads to rapid improvement in catatonic signs within hours or days. Electroconvulsive therapy is also highly effective. When catatonia is caused by schizophrenia, antipsychotics should also be given. Identifying and treating any underlying psychiatric, neurological or medical illness is crucial. Permanent disability is possible if prolonged immobility leads to malnutrition, pneumonia, or blood clots. With proper treatment, the long-term outlook for catatonia can be good in many cases.
Much remains unknown about mechanisms regulating motor activity that go awry in catatonia. Further research should clarify the optimal diagnosis and management of this complex spectrum of motor abnormalities.