Catatonia is a neuropsychiatric condition with varying presentations that involve behavioral, motoric, cognitive, affective, and, occasionally, autonomic disturbances. Underlying causes of the syndrome include:
- mood disorders
- psychotic disorders
- neurologic disease
- general medical conditions
- metabolic abnormalities
- drug intoxication or withdrawal.
- deep vein thrombosis and pulmonary embolism
- pressure sores or ulcers
- muscle contractures
- nutritional deficiencies and dehydration from decreased oral intake.1
Prompt recognition, assessment, and treatment are vital.
We recommend the following systematic approach to evaluate and treat catatonia (Table).
Assess
Appropriate assessment of catatonia requires recognition of the array of potential underlying causes of the syndrome.
Obtain a complete history, including:
- recent changes in behavior
- past psychiatric illness and hospitalization
- past or current neurologic or medical disease
- prescription and illicit drug use.
Collateral informants, such as family members and caregivers, could provide valuable information. This history could reveal causative factors and identify appropriate targets for treatment.
Physical and mental status examinations can help characterize the type and severity of motoric and behavioral symptoms, such as rigidity, waxy flexibility, negativism, automatic obedience, ambitendency, and perseveration. Monitoring vital signs is crucial because of the risk of medical complications and malignant catatonia, which can be lethal if not treated.
Laboratory testing and imaging might be indicated to rule out medical causes, such as infection, metabolic disturbances, drug intoxication and withdrawal, and acute neurologic etiologies.