catatonic

Catatonia is a neuropsychiatric syndrome characterized by abnormalities of movement, behavior, and responsiveness. It can occur in the context of psychiatric disorders such as schizophrenia and mood disorders, as well as medical or neurological illnesses and certain drug exposures. The adjective catatonic describes features or states associated with this syndrome.

Core signs include stupor or immobility, mutism, waxy flexibility or catalepsy, negativism, posturing, echolalia or echopraxia, grimacing, and stereotyped or bizarre movements. Marked variability may occur, with periods of withdrawal and periods of agitation or excitement. In severe cases, individuals may be unable to speak or maintain hydration; dysphagia may occur. Malignant catatonia is a life-threatening form marked by fever, autonomic instability, and delirium.

Causes are diverse: primary psychiatric disorders (schizophrenia spectrum, bipolar disorder, major depressive disorder with catatonia), medical conditions (encephalitis, metabolic disturbances, autoimmune or neurologic diseases), and substances or medication effects (antipsychotics, sedative withdrawal, stimulants).

Diagnosis relies on clinical observation. Tools such as the Bush-Francis Catatonia Rating Scale aid assessment. A diagnosis typically requires multiple signs and duration sufficient to distinguish catatonia from other movement or behavioral disorders, with exclusion of reversible medical explanations. A psychiatric or medical evaluation is recommended.

Treatment centers on addressing the underlying cause and reducing catatonic symptoms. Benzodiazepines, especially lorazepam, are commonly used first-line therapy and can produce rapid improvement. If there is insufficient response or malignant catatonia is suspected, electroconvulsive therapy is highly effective. Supportive care, nutrition, hydration, and prevention of complications are essential.

Prognosis varies; with prompt recognition and treatment, most patients improve, though delays can lead to complications or poorer outcomes. The concept has a long history in medical literature and remains a focal point of contemporary psychiatry and neurology.