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Understanding Catatonia: Symptoms, Types, Causes, and Treatment Options

Jerome Albert Ecker | MD

Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on March 18th, 2024.

Key Takeaways

  • Diagnosis requires at least 3 out of 12 specific criteria including catalepsy (waxy flexibility), stupor, agitation, grimacing, echolalia, or negativism—symptoms must persist for hours to days.
  • Mood disorders account for 75% of cases, particularly major depression and bipolar disorder, while medical causes include autoimmune encephalitis, kidney failure, and certain medications like antipsychotics.
  • Lorazepam 1-2mg IV/IM serves as first-line treatment with response rates of 70-80% within 30 minutes to 2 hours of administration.
  • Electroconvulsive therapy achieves 85-95% response rates in benzodiazepine-resistant cases, typically requiring 6-20 sessions over 2-4 weeks.
  • Malignant cases involve autonomic instability with fever above 101°F, blood pressure fluctuations, and altered consciousness—this medical emergency has 10-20% mortality if untreated within 5 days.

Catatonia is a group of symptoms that primarily involve a lack of movement and communication. People with catatonia may also experience agitation, confusion, and restlessness. While previously thought of as a type of schizophrenia, doctors now understand that catatonia can be associated with other mental illnesses and certain medical conditions that disrupt the body's metabolism.

Symptoms and Diagnosis

Doctors can diagnose someone as catatonic if they exhibit any three of the following signs:

  • Not responding to other people or their environment

  • Not speaking

  • Holding their body in an unusual position

  • Resisting people who try to adjust their body

  • Agitation

  • Repetitive, seemingly meaningless movement

  • Mimicking someone else's speech

  • Mimicking someone else's movements

Types of Catatonia

There are three main types of catatonia:

  1. Akinetic catatonia: The most common type, characterized by a blank stare, lack of response, and unusual body positions.

  2. Excited catatonia: Involves pointless and impulsive movement, agitation, and mimicking others' movements.

  3. Malignant catatonia: Occurs when symptoms lead to dangerous changes in blood pressure, body temperature, breathing, or heart rate.

Understanding Catatonia: Symptoms, Types, Causes, and Treatment Options

Causes of Catatonia

The exact cause of catatonia is not well understood, but it is most often associated with mood disorders or psychotic disorders, such as depression, bipolar disorder, schizophrenia, post-traumatic stress disorder (PTSD), and autism spectrum disorder (ASD). Approximately one-third of people with catatonia also have bipolar disorder.

In addition to mental illnesses, several physical conditions can lead to catatonia, including:

  • Conditions that affect body chemistry, such as kidney problems, diabetes, and thyroid disorders

  • Parkinson's disease, which attacks the body's nervous system

  • Encephalitis, an infection that affects the brain

  • Autoimmune conditions

  • Drug induced (neuroleptics, withdrawal from benzodiazepines or alcohol)

Treatment Options for Catatonia

The primary treatment for catatonia is a type of sedative called a benzodiazepine, which is often used to ease anxiety. Another treatment option is electroconvulsive therapy (ECT), which sends electrical impulses to the person's brain through electrodes placed on their head. ECT may be recommended if sedatives are ineffective, the catatonia is severe, the person has had catatonia before, or quick action is needed to save someone's life.

Catatonia can be treated effectively, but if left untreated, it can lead to life-threatening problems. If you or someone you know is experiencing symptoms of catatonia, it is essential to seek medical attention promptly to ensure the best possible outcome.

The Bottom Line

This potentially life-threatening condition responds excellently to prompt treatment, with most patients recovering fully when benzodiazepines or ECT are started within days of symptom onset. The key is recognizing the distinctive motor and behavioral signs early, as delayed treatment significantly increases complications. If you're concerned about unusual movement patterns or communication changes, Doctronic can help you evaluate symptoms quickly.

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