Effective Management of Catatonia in Clinical Practice

Definition and Historical Context of Catatonia

Catatonia was first described in the 19th century, with Karl Ludwig Kahlbaum being credited for its systematic categorization in 1874. He defined catatonia as an independent clinical entity characterized by alternating states of motor agitation and stupor, which could be associated with various psychiatric and medical conditions (Rogers et al., 2025). Historically, catatonia was primarily viewed as a subtype of schizophrenia, but the understanding of its broader clinical implications has evolved significantly over the years.

The recognition of catatonia as a syndrome rather than a symptom of another disease marks a pivotal shift in psychiatric diagnosis. The ICD-10 included organic catatonic disorder, acknowledging that catatonia could present in conditions beyond schizophrenia, such as mood disorders and organic brain syndromes. The ICD-11 further refines this understanding by defining catatonia as an independent disorder with specific diagnostic criteria, allowing for a more personalized approach to treatment (Rogers et al., 2025).

Diagnostic Criteria for Catatonia in ICD-11 and DSM-5-TR

The diagnostic criteria for catatonia have been extensively revised to enhance clinical recognition. According to the ICD-11, a diagnosis of catatonia requires the presence of at least three clinical features from the following categories:

1. Decreased Psychomotor Activity: This includes features such as stupor, mutism, and waxy flexibility.
2. Increased Psychomotor Activity: This can manifest as echolalia, echopraxia, or excessive movement.
3. Abnormal Psychomotor Activity: Features such as posturing, negativism, or stereotypies fall under this category (Rogers et al., 2025).

The DSM-5-TR similarly recognizes catatonia but emphasizes its association with various mental disorders, highlighting its occurrence in schizophrenia, mood disorders, and neurodevelopmental disorders. The criteria from both classification systems allow for a comprehensive evaluation of catatonia, fostering an understanding that it can be a standalone diagnosis or a manifestation of various underlying conditions.

Clinical Presentation and Symptoms of Catatonia

Catatonia presents with a diverse array of symptoms, which can be broadly categorized into motor, behavioral, and autonomic features.

Motor Symptoms

Patients may exhibit significant motor disturbances, including:

• Stupor: Marked by a lack of response to the environment and decreased motor activity.
• Catalepsy: Characterized by the maintenance of an abnormal posture for an extended period.
• Echolalia and Echopraxia: Automatic repetition of words or movements, respectively.

Behavioral Symptoms

Behavioral abnormalities may include:

• Negativism: Resistance to instructions or attempts to move the patient.
• Stereotypy: Repetitive, non-functional movements that may appear purposeless.

Autonomic Features

Autonomic dysfunction can manifest as:

• Fluctuations in blood pressure and heart rate.
• Hyperhidrosis and hyperthermia.

Understanding the multifaceted nature of catatonia is essential for accurate diagnosis and effective management. The symptoms can mimic other psychiatric conditions, making early recognition critical.

Treatment Approaches and Interventions for Catatonia

Management of catatonia requires a multifaceted approach, often integrating pharmacological and non-pharmacological strategies. The choice of treatment may depend on the underlying cause of catatonia, if identified.

Pharmacological Treatments

1. Benzodiazepines: Medications such as lorazepam are often the first line of treatment due to their rapid sedative effects and potential to alleviate motor symptoms.
2. Antipsychotics: In cases where catatonia is associated with schizophrenia or severe mood disorders, atypical antipsychotics may be utilized, though caution is advised due to the risk of exacerbating symptoms.
3. Electroconvulsive Therapy (ECT): ECT is an effective treatment for severe catatonia, particularly when pharmacological interventions fail to produce adequate responses.

Non-Pharmacological Treatments

• Psychotherapy: Engaging patients in supportive therapy can assist in addressing psychological factors contributing to catatonia.
• Physical Therapy: Tailored physical rehabilitation may help in restoring motor function and preventing complications arising from immobility.

Importance of Early Recognition and Management of Catatonia

Early identification of catatonia is crucial for improving patient outcomes. Delayed recognition can lead to prolonged hospitalizations, increased morbidity, and the potential for irreversible complications. A proactive approach involving thorough assessments, consideration of catatonia in differential diagnoses, and prompt initiation of treatment can significantly enhance recovery trajectories (Rogers et al., 2025).

Data Table: Summary of Treatment Approaches for Catatonia

FAQs

What is catatonia?

Catatonia is a neuropsychiatric syndrome characterized by motor disturbances, behavioral abnormalities, and autonomic dysfunction. It can occur in various psychiatric and medical conditions.

How is catatonia diagnosed?

Diagnosis is based on clinical features as outlined in the ICD-11 and DSM-5-TR, requiring the presence of at least three specific symptoms.

What are the treatment options for catatonia?

Treatment typically includes pharmacological interventions such as benzodiazepines and antipsychotics, as well as non-pharmacological approaches like psychotherapy and physical therapy.

Why is early recognition of catatonia important?

Prompt identification and treatment can prevent complications, reduce hospital stays, and improve overall patient outcomes.

References

1. Rogers, J. P., Wilson, J. E., & Oldham, M. A. (2025). Catatonia in ICD-11. BMC Psychiatry. Retrieved from https://doi.org/10.1186/s12888-025-06857-6

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