Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology

Abstract

Catatonia is a psychomotor syndrome that has been reported to occur in more than 10% of patients with acute psychiatric illnesses. Two subtypes of the syndrome have been identified. Catatonia of the retarded type is characterized by immobility, mutism, staring, rigidity, and a host of other clinical signs. Excited catatonia is a less common presentation in which patients develop prolonged periods of psychomotor agitation. Once thought to be a subtype of schizophrenia, catatonia is now recognized to occur with a broad spectrum of medical and psychiatric illnesses, particularly affective disorders. In many cases, the catatonia must be treated before any underlying conditions can be accurately diagnosed. Most patients with the syndrome respond rapidly to low-dose benzodiazepines, but electroconvulsive therapy is occasionally required. Patients with longstanding catatonia or a diagnosis of schizophrenia may be less likely to respond. The pathobiology of catatonia is poorly understood, although abnormalities in gamma-aminobutyric acid and glutamate signaling have been suggested as causative factors. Because catatonia is common, highly treatable, and associated with significant morbidity and mortality if left untreated, physicians should maintain a high level of suspicion for this complex clinical syndrome. Since 1989, we have systematically assessed patients presenting to our psychiatry service with signs of retarded catatonia. In this paper, we present a review of the current literature on catatonia along with findings from the 220 cases we have assessed and treated.

Keywords: Catatonia, Schizophrenia, Benzodiazepines, Electroconvulsive therapy, Extrapyramidal disorders

Core tip: Catatonia is a complex clinical syndrome occurring in more than 10% of patients with acute psychiatric illnesses, and it is associated with multiple life-threatening complications. In the last several decades, renewed interest in this syndrome has led to a great deal of research and debate regarding its diagnosis and treatment. In this paper, we present a review of the current literature on catatonia along with findings from the 220 cases we have assessed and treated since 1989. Catatonia itself is readily treated using low-dose lorazepam, and it also has important implications for how other underlying psychiatric conditions should be treated.