Although catatonia is not identified as a separate disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it is increasingly being recognized as a syndrome with many aspects. Catatonia is associated with several psychiatric conditions, including:
- Schizophrenia
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Autistic spectrum disorders
- Depression
- Drug abuse/overdose
Catatonia is also associated with several medical conditions, including:
- Encephalitis (infection that causes acute inflammation of the brain) and other infections
- Autoimmune disorders
- Stroke and other focal neurologic lesions
- Metabolic disturbances
- Typhoid fever
- Overly rapid withdrawal from benzodiazepines (depressants commonly used to treat anxiety, agitation, insomnia, seizures, muscle spasms, and alcohol withdrawal)
- Adverse reaction to a drug, including antipsychotic, dopaminergic, opiate, and illicit recreational drugs
There are different subtypes of catatonia, including stupor and catatonic excitement, with markedly differing clinical features. Without regard to the different subtypes of catatonia, clinical features of a patient with catatonia may include:
- Loss of motor ability
- Purposeless hyperactive motor activity
- Holding rigid poses for extensive periods
- Resisting movement in proportion to force applied
- Ignoring external stimuli
- Repetitive, stereotyped movements
- Repetition of meaningless phrases
- Repeating back of what is said to the patient
Initially, the aim of treatment is to provide relief from the catatonic state. Patients in a state of catatonic excitement can literally die of exhaustion if not treated. To provide relief, high doses of benzodiazepines are often prescribed. And while a test dose of intramuscular lorazepam or zolpidem may show improvement and additional diagnostic feedback within half an hour, the underlying cause will ultimately need to be treated.
Antipsychotics should be used with caution since they can worsen the condition or even cause neuroleptic malignant syndrome, which can mimic catatonia. Electroconvulsive therapy often proves to be effective.