Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Dec 22, 2016; 6(4): 391-398
Published online Dec 22, 2016. doi: 10.5498/wjp.v6.i4.391
Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology
Sean A Rasmussen, Michael F Mazurek, Patricia I Rosebush
Sean A Rasmussen, MINDS Program, McMaster University, Hamilton L8S 4K1, Ontario, Canada
Michael F Mazurek, Department of Medicine (Neurology), McMaster University, Health Sciences Centre, Hamilton L8N 3Z5, Ontario, Canada
Patricia I Rosebush, Department of Psychiatry & Behavioural Neurosciences, McMaster University, St. Joseph’s Healthcare, Hamilton L8N 3K7, Ontario, Canada
Author contributions: All authors contributed to the literature review, data analysis, and manuscript preparation; Mazurek MF and Rosebush PI conducted the patient assessments.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sean A Rasmussen, PhD, MINDS Program, McMaster University, 1280 Main Street West, Hamilton L8S 4K1, Ontario, Canada.
Telephone: +1-289-9256176
Received: June 22, 2016
Peer-review started: June 27, 2016
First decision: August 11, 2016
Revised: August 29, 2016
Accepted: October 25, 2016
Article in press: October 27, 2016
Published online: December 22, 2016

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.