Catatonia is a disorder that disrupts how your brain works, disrupting how a person processes and reacts to the world around them. People with catatonia often don’t react to things happening nearby or may react in ways that seem unusual. Impaired communication, unusual movements or lack of movement, and behavior abnormalities are the most striking features of this condition.
Researchers have studied catatonia since German psychiatrist Karl Kahlbaum named and described it in 1874, but it remains highly underdiagnosed. Part of this is because, until recent decades, catatonia was mistakenly believed to only occur in people with schizophrenia. Further challenges to diagnosis include disagreement within psychiatry on how many criteria and which criteria are required to diagnose catatonia. In addition, some catatonic signs, such as agitation and mutism, overlap with other conditions.
Agitation. This means a person acts upset or irritable. It only counts as a symptom of catatonia if it happens and it isn’t a response to something around the person having it.
Catalepsy (pronounced “cat-ah-lep-see”). This is when a person holds a position in which someone places them (you can still move them around to make them take on a new pose).
Echolalia (pronounced “eck-oh-la-lee-ah”). This is when a person echoes sounds that someone else makes.
Echopraxia (pronounced “eck-oh-prax-ee-ah”). This is when a person mimics or mirrors someone else’s movements.
Grimacing. This is holding the same facial expression, usually with stiff or tense facial muscles. Sometimes, it can take the form of smiling in inappropriate contexts.
Mannerism. This is when a person acts out motions or movements that could be normal but does them in an unusual or exaggerated way.
Mutism (pronounced “mew-tizm”). This is when a person is either very or totally quiet (this is only a symptom if the person doesn’t have another condition, such as aphasia, to explain why they aren’t speaking).
Negativism (pronounced “neg-uh-tiv-ism”). This means a person doesn’t react to something happening around them or actively resists what’s happening around them for no rational reason.
Posturing. This is when a person holds a specific position, which would often be uncomfortable to people who aren’t catatonic. In contrast to catalepsy, this doesn’t involve being placed in the position by another person.
Stereotypy (pronounced “stair-ee-oh-type-ee”). These are repetitive movements that don’t seem to have a purpose. They can include finger-play and patting/rubbing one’s body.
Stupor (pronounced “stoop-er”). This is when a person is awake but doesn’t respond to what’s happening around them. People with catatonia often don’t respond to painful stimuli, such as being pinched.
Waxy flexibility. This is when a person puts up some slight even push-back or resistance to any attempt to change their position. Then their muscles slowly release and their limbs bend like a warm candle.
Catatonia activity levels
While most people think of catatonia as a disorder that involves moving very little or not at all, that’s not always the case. Catatonia can also involve sudden and unpredictable behavior changes, including excessive or even constant movement. The activity levels of catatonia are as follows:
Excited/hyperkinetic. This form usually involves behavior changes, such as pacing, agitation, aggression and violent behavior without any situations causing the behavior change. It can also include acting or speaking strangely, mimicking how others nearby move or talk or even acts of self-harm.
Withdrawn/hypokinetic. This form of catatonia is often what people think of when they talk or think about this disorder. People with this form are awake but don’t react to what’s happening around them, as if they just aren’t aware of their surroundings. They’re usually silent and have little or no facial expressions. They also might hold themselves in an unusual posture or position and may even resist attempts to move them. They often don’t eat or drink and may have incontinence.
Mixed. This form combines features of hyperkinetic and hypokinetic catatonia. A person with catatonia can quickly switch between hyperkinetic and hypokinetic behaviors without warning.
Malignant catatonia
In some cases, catatonia can have deadly complications. When this happens, it’s known as malignant catatonia. This condition causes dysautonomia, which is when your autonomic nervous system doesn’t work as it should. Your autonomic nervous system is what controls the automatic body processes you don’t need to think about, such as heartbeat, blood pressure, etc.
Cyanosis (this is low blood oxygen that causes areas of your skin, especially around your lips and fingernails, to turn blue).
Because malignant catatonia disrupts how your brain runs your body’s automatic processes, it has the potential to cause death. That means it’s a problem that needs immediate medical care.
The treatment for catatonia usually depends on the condition(s) with which it happens. If it happens with a medical or a neurological condition, treating that condition — if possible— will often reverse the effects of catatonia. Other treatment approaches have the best chances of success when it happens along with mental health conditions.
What medications or treatments are used?
There are two main ways to treat catatonia: medications and electroconvulsive therapy. There are other possible treatments like transcranial magnetic stimulation, but more research is necessary to understand if these are effective enough for widespread use.
Medications
Benzodiazepines are the primary medication for treating catatonia because they’re safe and very effective. Between 60% and 90% of people with catatonia will improve if treated with benzodiazepines. Lorazepam is the medication of choice, but others like clonazepam, diazepam and zolpidem are also effective. Healthcare providers can give these medications as an infusion through intravenous (IV) lines, an injection or in pill form depending on the particular medication.
Other medications (such as mood stabilizers or antipsychotic drugs) may also help but usually aren’t first-line treatments. These are most helpful for treating other symptoms after the initial catatonia symptoms improve, especially because antipsychotic medications can cause catatonia to become malignant catatonia or neuroleptic malignant syndrome.
Electroconvulsive therapy
Electroconvulsive therapy (ECT) is a treatment that involves running a very mild electrical current through an area of your brain to cause a short seizure. People who undergo ECT do so under general anesthesia, which means they’re in a deep sleep so they don’t feel pain from this treatment.
ECT is also very effective, helping nearly all people with catatonia who receive it. It’s the main treatment for people who have malignant catatonia and is often a life-saving treatment in those cases. It’s also helpful for people whose catatonia isn’t responding to medications.
Complications/side effects of the treatment
The possible complications and side effects of treatments for catatonia can vary depending on which treatment — or combination of treatments — a person receives. A healthcare provider is the best person to explain the side effects or complications that are possible or likely.
How do I take care of myself or manage symptoms?
Catatonia is a difficult condition to diagnose even for trained, experienced healthcare providers. It also can happen because of life-threatening conditions that need immediate medical care. Because of both those factors, you shouldn’t try to self-diagnose or treat it.
Your healthcare provider will diagnose catatonia using a combination of methods. This usually starts with a neurological examination. During that exam, your provider will test your reflexes, reactions and how they respond (or don’t respond) to the world around you.
Your provider will then use a standardized assessment tool, usually the Bush Francis Catatonia Rating Scale, to rate the presence or absence of catatonia and the degree of severity. Once catatonia is identified, healthcare providers must then identify the cause of catatonia, as catatonia is always associated with another psychiatric or medical condition. As catatonia can occur alongside serious or even deadly conditions, ruling out more severe underlying conditions is a priority.
What tests will be done to diagnose this condition?
Diagnosing catatonia and identifying the underlying condition usually involves lab, diagnostic and imaging tests.