Catatonia

Catatonia, a neuropsychiatric syndrome characterized by abnormal movements, behaviors, and withdrawal, is a condition that is most often seen in mood disorders but can also be seen in psychotic, medical, neurologic, and other disorders. Most studies on the incidence of catatonia find it to be between 5% - 20% in the acute inpatient psychiatric setting. Most episodes of catatonia can be classified as excited, retarded, or malignant. Symptoms can wax, wane, or change during these episodes, and patients affected can have periods of withdrawal and periods of excitation. Studies have suggested a connected pathway between the cortex, basal ganglia, and thalamus underpins these different subtypes and results in catatonic symptoms. Recognition and treatment of catatonia can play an important part in both psychiatric and medical treatment as it can inhibit treatment, confusing diagnoses, and be potentially fatal if untreated. There are a few different catatonia rating scales that have been developed to both screen for and monitor the progression of symptoms during an episode (e.g., Bush-Francis Catatonia Rating Scale and the Northoff Catatonia Scale), but the DSM-V gives 12 categories for symptoms that can lead to a diagnosis of catatonia. These symptoms include stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypy, agitation not influenced by external stimuli, grimacing, echolalia, and echopraxia. At least three of these symptoms must be present for the diagnosis of catatonia. Some other criteria used in the Bush-Francis rating scale include automatic obedience, autonomic abnormalities, and the presence of a grasp reflex. These together present a wide variety of symptoms that can be present, and while there is a crossover between them and aspects of other illnesses, findings such as waxy flexibility, posturing, and automatic obedience can be more specific for catatonia.