Overview
Catatonia is a psychomotor syndrome characterized by a range of motor abnormalities, including immobility, stupor, mutism, and excitement. While often associated with schizophrenia, it can also occur in other psychiatric and medical conditions. This summary focuses on catatonia in the context of schizophrenia, particularly during remission.Diagnosis
Diagnosis requires the presence of at least three of the following signs: stupor, mutism, negativism, posturing, stereotypy, mannerisms, excitement, echolalia, or echopraxia 1.
Clinical assessment includes a thorough history, physical examination, and relevant investigations to rule out underlying medical causes 1.
Specific subtypes like periodic catatonia, malignant catatonia, neuroleptic malignant syndrome, and antipsychotic-induced catatonia require careful consideration 1.Management
First-line treatment: Benzodiazepines are considered a first-line treatment for catatonia 1.
* Lorazepam is often used, with initial doses typically ranging from 1-2 mg, titrated upwards as needed 1.
Second-line treatment: Electroconvulsive therapy (ECT) is a highly effective treatment, particularly for severe or treatment-resistant catatonia 1.
Other therapies: Other pharmacological and neuromodulatory therapies may be considered 1.Special Populations
Considerations for children and adolescents, older adults, women in the perinatal period, individuals with autism spectrum disorder, and those with certain medical conditions are addressed 1.Key Recommendations
Benzodiazepines are recommended as a first-line treatment for catatonia 1. (Evidence: Expert opinion)
Electroconvulsive therapy (ECT) is a highly effective treatment option, especially for severe or refractory catatonia 1. (Evidence: Expert opinion)
A thorough clinical assessment, including history, physical examination, and investigations, is crucial for diagnosis and to exclude medical causes 1. (Evidence: Expert opinion)References
1 Rogers JP, Oldham MA, Fricchione G, Northoff G, Ellen Wilson J, Mann SC et al.. Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology. Journal of psychopharmacology (Oxford, England) 2023. link