Katatoniaan

Katatoniaan, also known as catatonia, is a neuropsychiatric syndrome characterized by disturbances in movement, behavior, and responsiveness. Classic features include stupor or immobility, mutism, negativism, waxy flexibility, catalepsy, posturing, echolalia, and echopraxia. Affected individuals may be unresponsive to stimuli or display motor activity that serves no clear purpose. Symptoms can fluctuate and may be accompanied by agitation or autonomic changes, with risks of malnutrition or dehydration if prolonged.

Katatoniaan occurs in a range of contexts. It is most commonly associated with schizophrenia spectrum and mood disorders, but can also arise from medical conditions such as infections or autoimmune encephalitis, metabolic derangements, and neurological diseases. It may be induced by substances or medications, including antipsychotics or withdrawal from benzodiazepines. Because of overlapping features with other conditions, identifying the underlying cause is essential for effective treatment.

Diagnosis is primarily clinical, based on observation of signs. Rating scales such as the Bush-Francis Catatonia Rating Scale (BFCRS) can aid assessment. A lorazepam challenge test (1–2 mg IV or oral, with observation for improvement within hours) can support the diagnosis. The DSM-5 recognizes catatonia as a specifier for mood or psychotic disorders, reinforcing the need to evaluate for medical or substance-related contributors.

Treatment focuses on both symptom relief and addressing the underlying cause. First-line pharmacotherapy is benzodiazepines, typically lorazepam 1–2 mg daily with titration. If there is inadequate response or in severe cases, electroconvulsive therapy (ECT) is recommended. Supportive care, including nutrition, hydration, and prevention of complications, is important. With prompt recognition and appropriate management, prognosis improves; delayed treatment is associated with worse outcomes.