Catatonia
Catatonia is a complex neuropsychiatric behavioral syndrome that is characterized by abnormal movements, immobility, abnormal behaviors, and withdrawal. The onset of catatonia can be acute or subtle and symptoms can wax, wane, or change during episodes. It has historically been related to schizophrenia (catatonic schizophrenia), but catatonia is most often seen in mood disorders. It is now known that catatonic symptoms are nonspecific and may be observed in other mental, neurological, and medical conditions. Catatonia is now a stand-alone diagnosis (although some experts disagree), and the term is used to describe a feature of the underlying disorder.
| Catatonia | |
|---|---|
| Other names | Catatonic syndrome |
| A patient in catatonic stupor | |
| Specialty | Psychiatry, neurology |
| Symptoms | Immobility, mutism, staring, posturing, rigidity, low consciousness, etc. |
| Complications | Physical trauma, malignant catatonia (autonomic instability, life-threatening), dehydration, pneumonia, pressure ulcers due to immobility, muscle contractions, deep vein thrombosis (DVT) and pulmonary embolism (PE) |
| Causes | Underlying illness (psychiatric, neurologic, or medical), brain injury/damage, certain drugs/medications |
| Diagnostic method | Clinical, Lorazepam challenge |
| Treatment | Benzodiazepines (lorazepam challenge), electroconvulsive therapy (ECT) |
There are several subtypes of catatonia: akinetic catatonia, excited catatonia, malignant catatonia, and delirious mania.
Failure to recognize and treat catatonia may lead to poor outcomes and can be potentially fatal. Treatment with benzodiazepines or ECT can lead to remission of catatonia. There is growing evidence of the effectiveness of the NMDA receptor antagonists amantadine and memantine for benzodiazepine-resistant catatonia. Antipsychotics are sometimes employed, but they can worsen symptoms and have serious adverse effects.