Catatonia Clinical Presentation
- Author: James Robert Brasic, MD, MPH; Chief Editor: Selim R Benbadis, MD more...
Catatonia is a syndrome—typically episodic, with periods of remission—characterized by the presence of a variety of behavioral and motoric traits. Accurate, prompt diagnosis of catatonia is crucial for preventing morbidity and death in a variety of settings (including emergency medical, psychiatric, neurologic, medical, obstetric, and surgical ones) and for instituting effective interventions.
Individuals with catatonia often cannot provide a coherent history; however, collateral sources can often relate relevant historical information. Family members can confirm the presence of typical primary features of catatonia, including immobility, stupor, posturing, rigidity, staring, grimacing, and withdrawal.
A history of behavioral responses to others usually includes the presence of the following:
A history of stereotypies, mannerisms, and verbigeration is often elicited from people who are close to the patient. Priapism was reported in a 20-year-old man with paranoid schizophrenia and catatonia.
The alternative presentation of catatonia is an excited state, possibly with impulsivity, combativeness, and autonomic instability. A history of an excited state should be sought from the family of a person with catatonia, but it is often denied by the family. When excited episodes are present, they are typically short-lived and may precipitate collapse with exhaustion. An excited state of catatonia is usually associated with bipolar disorder.
The history-taking process should include the following:
During the initial interview of the patient and the family, ask about possible precipitating events, including infection, trauma, and exposure to toxins and other substances
Inquire about any previous similar episodes of catatonia; determine whether the precipitating events of the earlier episode are present in the current episode, and record any interventions that relieved catatonia previously
Question the patient and family regarding exposure to neuroleptics and other substances associated with catatonia; catatonia and neuroleptic malignant syndrome (NMS)  may follow the administration of neuroleptic medications
Identify any comorbid disorders, including schizophrenia, mood disorders, psychological stressors, medical conditions, and obstetric conditions
Catatonia has occurred in patients after treatment with levetiracetam and levofloxacin. Catatonia developed in a 55-year-old woman with schizophrenia who was treated with rimonabant, a cannabinoid receptor (CB1) antagonist.
In an emergency setting, treatable common causes of catatonia must be rapidly considered and ruled out. The emergency physician must quickly consider the presence of NMS, encephalitis, nonconvulsive status epilepticus, and acute psychosis. Catatonia has occurred in intensive care units (ICUs). Given that the patients all had serious disorders leading to ICU placement, it is possible that the underlying disorders contributed to the development of catatonia in the units.
A history of exposure to traditional and atypical neuroleptic agents must be sought. Although NMS often follows the initiation of neuroleptic therapy or an increase in the neuroleptic dosage, exposure to neuroleptics may be minimal in some susceptible individuals. For example, Nielsen and Nielsen report the occurrence of NMS after a single dose of neuroleptic medication.
In addition, the patient’s history must be evaluated for the following conditions:
Encephalitis - Determine whether the patient has had sudden onset of headache, fever, and deterioration in mental functioning
Nonconvulsive status epilepticus - Determine whether the patient has a history of seizures and whether the patient has been prescribed antiepileptic drugs; determine whether electroencephalography (EEG) has been performed, and if it has, review the findings
Acute psychosis - Determine whether the patient has exhibited evidence of delusions and hallucinations and whether he or she has exhibited suicidal or homicidal threats or actions; record any history of prior psychiatric hospitalization and treatment
Assessment of a person with possible catatonia should include unstructured, indirect observation, as well as a direct interview. Patients with catatonia exhibit the same general behaviors whether or not the examiner is present. If a patient demonstrates behaviors consistent with catatonia only in the presence of the examiner, then catatonia is unlikely.
Because patients with catatonia may be unable to cooperate with the requests of the examiner, specific neurologic signs characteristic of catatonia must be quickly elicited, especially in emergency settings. In particular, rigidity, gegenhalten, and a grasp reflex are readily apparent signs of catatonia in such settings. During the physical examination, it is also important to test for the presence of a grasp reflex, a secondary feature of catatonia.
Excited and immobile states
The predominant activity level is either markedly slow or extremely high, and the patient’s behavior may shift suddenly and unpredictably from one state to the other.
In the excited state, people with catatonia may injure themselves and assault others. They may also experience autonomic instability manifested by hyperthermia, tachycardia, and hypertension. Individuals in the excited state are at risk for collapse from exhaustion.
In the immobile state, the individual may not move. Akinesia and stupor are synonyms for this state. The patient may appear unresponsive to external stimuli. He or she may be unable to eat and therefore may die unless parenteral nutrition and fluids are administered. People with catatonia may exhibit catalepsy, the persistent maintenance of spontaneous or imposed postures.
Negativistic phenomena (eg, gegenhalten [“to hold against” in German; the apparent resistance of the movement of the extremities by the examiner], and mitgehen [“to go along with” in German; movement in the direction of a slight push from the examiner in spite of the command to remain still]) are typically observed in catatonia.
Examination should include checking for cogwheeling at the wrist and elbow. Patients should be instructed to keep their arms loose and limp (like a dead fish), and the arms should be moved with varying degrees of force. Rigidity is commonly elicited in the extremities of patients with catatonia.
The particular phenomenon of gegenhalten is characteristic. Patients with gegenhalten demonstrate increasing resistance to passive movement of the limbs. The patient appears to be deliberately opposing the movements of the examiner. Mitgehen is characterized by the patient moving in the direction of a slight push from the examiner in spite of the command to remain still. The physical examination should include tests for these.
Motor persistence (ie, maintenance of a posture when commanded not to maintain it) is a manifestation of catatonia that is associated with right hemispheric strokes. Other negativistic phenomena are withdrawal from all usual activities and refusal to eat.
In addition to negativistic phenomena, individuals with catatonia may display other behaviors, indicating inability to appropriately modulate the inhibition of impulses. For example, patients with catatonia may demonstrate automatic obedience, meaning the performance of tasks at the command of the examiner even though the tasks are inappropriate or dangerous.
Peculiarities of movement are common in catatonia. Stereotypies, in which the patient repetitively performs apparently meaningless activities, are common. These may take the form of repetitive actions or sounds. Verbigeration (verbal stereotypies) refers to the presence of repetitive, apparently meaningless utterances, such as sniffing, clicking, snorting, and nonmeaningful sounds.
Common motor stereotypies include the following:
Repetitive movements of the mouth and the jaw
Repetitive eye movements
Repetitive tapping of the foot, the finger, or the hand
Repetitive abdomen patting, shoulder shrugging, or body rocking
Other movements associated with catatonia include mannerisms, postures, gaze fixation, and choreoathetoid movements of the trunk and extremities.
Patients with catatonia may also display preservation (ie, the inappropriate repetition of acts).
Echophenomena are typical in catatonia. Echolalia (repetition of the words spoken by the examiner) and echopraxia (repetition of the motor acts performed by the examiner) are common.
In France, the inappropriately formal use of vous (the formal form of “you”) by the patient to address his or her spouse has been identified as a finding in catatonia. Normally, tu (the informal form of “you”) is used by an individual to address a spouse.
Clinicians must identify comorbid disorders, including schizophrenia, mood disorders, and neurologic and medical conditions. Neuroleptic-induced parkinsonism may also be associated with catatonia. Headache, fever, and a stiff neck in an acutely ill patient suggest encephalitis. The presence of severe muscle rigidity, autonomic dysregulation, and hyperthermia suggests NMS. Acute psychosis is suggested by the presence of hallucinations, delusions, and suicidal and homicidal threats and behaviors.
Psychogenic movement disorders
Patients with catatonia exhibit the same general behaviors whether or not the examiner is present. If a patient demonstrates behaviors consistent with catatonia only in the presence of the examiner, then catatonia is unlikely, and conditions characterized by the presence of medical symptoms and signs without physical illness must be considered.
More specifically, catatonia that occurs only when the patient is directly observed by the examiner suggests the presence of somatoform disorders, factitious disorders, or malingering. In the movement disorders literature, somatoform disorders, factitious disorders, and malingering in patients exhibiting abnormal movements are commonly classified as psychogenic movement disorders.
Patients with somatoform disorders (eg, somatization disorder, conversion disorder, and hypochondriasis) report symptoms and signs that they truly believe they have, despite the absence of confirmation on physical examination. Patients with factitious disorders and malingering deliberately report symptoms and signs that they know to be false.
Patients with Munchausen syndrome and other factitious disorders fabricate symptoms and signs because they want to be patients. In Munchausen syndrome by proxy, the parents of the patient (who is typically an infant unable to communicate) fabricate symptoms and signs in the patient.
Unlike patients with factitious disorders, patients with malingering deliberately report false symptoms and signs for specific gain—for example, to obtain disability benefits and to be excused from work.
The following complications are associated with catatonia:
Trauma - During an excited state, patients with catatonia may cause serious, even fatal, injuries to themselves and others; they may cause marked destruction of property
Refusal to eat - Patients with catatonia may refuse to eat; death may result unless parenteral nutrition and fluids are administered on an involuntary basis
Autonomic instability - Patients with catatonia may experience autonomic instability manifested by hyperthermia, hypertension, and tachycardia; medical intervention is required
NMS - If this condition occurs, medical consultation is appropriate
Pulmonary embolism – The risk of fatal pulmonary embolism is increased in catatonia; to prevent thromboembolic disease, fibrin D-dimer levels should be checked; if evidence of early coagulation activation is found, hematologic consultation is appropriate 
Other - Patients with catatonia are at risk of complications from the underlying neurologic, psychiatric, medical, and obstetric causes of catatonia
Ungvari GS, Goggins W, Leung SK, Lee E, Gerevich J. Schizophrenia with prominent catatonic features ('catatonic schizophrenia') III. Latent class analysis of the catatonic syndrome. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Feb 1. 33(1):81-5. [Medline].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
Lafargue T, Brasic J. Neurodevelopmental hypothesis of schizophrenia: a central sensory disturbance. Med Hypotheses. 2000 Oct. 55(4):314-8. [Medline].
Zervas IM, Theleritis C, Soldatos CR. Using ECT in schizophrenia: A review from a clinical perspective. World J Biol Psychiatry. 2011 Apr 12. [Medline].
Kannabiran M, McCarthy J. The mental health needs of people with autism spectrum disorders. Psychiatry. 2009 Oct. 8(10):398-401.
Brasic JR, Zagzag D, Kowalik S, et al. Clinical manifestations of progressive catatonia. German Journal of Psychiatry [serial online]. 2000. [Full Text].
Brasic JR, Zagzag D, Kowalik S, et al. Progressive catatonia. Psychol Rep. 1999 Feb. 84(1):239-46. [Medline].
Gaind GS, Rosebush PI, Mazurek MF. Lorazepam treatment of acute and chronic catatonia in two mentally retarded brothers. J Clin Psychiatry. 1994 Jan. 55(1):20-3. [Medline].
Hare DJ, Malone C. Catatonia and autistic spectrum disorders. Autism. 2004 Jun. 8(2):183-95. [Medline].
Baguley IJ. The excitatory:inhibitory ratio model (EIR model): An integrative explanation of acute autonomic overactivity syndromes. Med Hypotheses. 2008. 70(1):26-35. [Medline].
Coconcea C. Zolpidem in treatment resistant catatonia: 2 case reports and literature review [abstract]. Schizophrenia Res. 2008. 98:134.
Uzbay IT. L-NAME precipitates catatonia during ethanol withdrawal in rats. Behav Brain Res. 2001 Feb 15. 119(1):71-6. [Medline].
Kahlbaum KL. Catatonia. Baltimore, Md: Johns Hopkins University Press; 1874/1973.
Vesperini S, Papettia F, Pringuey D. Existe-t-il un lien entre catatonie et syndrome malin des neuroleptiques ? [Are catatonia and neuroleptic malignant syndrome related conditions?]. L’Encéphale. 2009.
Lee J, Teoh T, Lee TS. Catatonia and psychosis associated with sibutramine: a case report and pathophysiologic correlation. J Psychosom Res. 2008 Jan. 64(1):107-9. [Medline].
Neto B. Catatonia with left temporal lesion on MRI: crossing borders. European Psychiatry. 2009. 24 supplement 1:S727.
Wachtel L. Catatonia in autism: Etiology, incidence and treatment [abstract]. European Psychiatry. 2008. 23:S402-S402.
Wachtel LE, Contrucci-Kuhn SA, Griffin M, Thompson A, Dhossche DM, Reti IM. ECT for self-injury in an autistic boy. Eur Child Adolesc Psychiatry. 2009 Jul. 18(7):458-63. [Medline].
Wachtel LE, Griffin M, Reti IM. Electroconvulsive Therapy in a Man With Autism Experiencing Severe Depression, Catatonia, and Self-Injury. J ECT. 2009 May 27. [Medline].
Dhossche DM, Reti IM, Wachtel LE. Catatonia and autism: a historical review, with implications for electroconvulsive therapy. J ECT. 2009 Mar. 25(1):19-22. [Medline].
Wachtel LE. Catatonia in autism and other neurodevelopmental disorders. European Psychiatry. 2009. 24, Supplement 1:S737.
Kakooza-Mwesige A, Wachtel LE, Dhossche DM. Catatonia in autism: implications across the life span. Eur Child Adolesc Psychiatry. 2008 Sep. 17(6):327-35. [Medline].
Gonzalez Oliveros R, Saracibar N, Gutierrez M, DNA Bank UPV/EHU, Munon T, Gonzalez-Pinto A. Catatonia due to a prion familial disease. Schizophrenia Research. 2009 Mar. 108, Issues 1-3:309-10.
Scozzafava J, Aladdin Y, Jickling G, Asdaghi N, Hussain M, Giuliani F. Stuporous catatonia and white matter lesions. J Clin Neurosci. 2009 Oct. 16(10):1328, 1386. [Medline].
Blanc F, Berna F, Fleury M, Lita L, Ruppert E, Ferriby D, et al. [Inaugural psychotic events in multiple sclerosis?]. Rev Neurol (Paris). 2009 Sep 5. [Medline].
Le Foll J, Pelletier A. Symptômes psychiatriques d’une encéphalite paranéoplasique à anticorps antirécepteurs NMDA : à propos d’un cas [Psychiatric symptoms of a paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis: A case report]. L'Encéphale. 2009.
Nielsen N, Nielsen NB. [Malignant neuroleptic syndrome in a 15-year old girl after a single injection of a high-dose neuroleptic]. Ugeskr Laeger. 1991 Aug 5. 153(32):2239-40. [Medline].
Winzeler RL. Latah in Southeast Asia: the history and ethnography of a culture-bound syndrome. Cambridge, Great Britain: Cambridge University Press; 1995.
Simons RC. Latah: a culture-specific elaboration of the startle reflex [film]. Bloomington, Indiana: Indiana University Audiovisual Center; 1983.
Tanner CM, Chamberland J. Latah in Jakarta, Indonesia. Mov Disord. 2001 May. 16(3):526-9. [Medline].
Fink M, Bush G, Francis A. Catatonia: a treatable disorder, occasionally recognized. Directions in Psychiatry. 1993. 13(3):1-8.
Escobar R, Rios A, Montoya ID, et al. Clinical and cerebral blood flow changes in catatonic patients treated with ECT. J Psychosom Res. 2000 Dec. 49(6):423-9. [Medline].
Chalasani P, Healy D, Morriss R. Presentation and frequency of catatonia in new admissions to two acute psychiatricadmission units in India and Wales. Psychol Med. 2005 Nov. 35(11):1667-75. [Medline].
Peralta V, Cuesta MJ, Serrano JF, Mata I. The Kahlbaum syndrome: a study of its clinical validity, nosological status, and relationship with schizophrenia and mood disorder. Compr Psychiatry. 1997 Jan-Feb. 38(1):61-7. [Medline].
Vorspan F, Cornic F, Mathis D, Cohen D, Lepine JP. Catatonia in a French forensic psychiatric facility: Frequency, prognosis and treatment [abstract]. European Psychiatry. 2008. 23:S332-S333.
Benegal V, Hingorani S, Khanna S. Idiopathic catatonia: validity of the concept. Psychopathology. 1993. 26(1):41-6. [Medline].
Johnson J. Catatonia: the tension insanity. Br J Psychiatry. 1993 Jun. 162:733-8. [Medline].
Rogers D. Catatonia: a contemporary approach. J Neuropsychiatry Clin Neurosci. 1991 Summer. 3(3):334-40. [Medline].
Guggenheim FG, Babigian HM. Catatonic schizophrenia: epidemiology and clinical course. A 7-year register study of 798 cases. J Nerv Ment Dis. 1974 Apr. 158(4):291-305. [Medline].
Abrams R, Taylor MA. Catatonia. A prospective clinical study. Arch Gen Psychiatry. 1976 May. 33(5):579-81. [Medline].
Ungvari GS, Leung SK, Ng FS, et al. Schizophrenia with prominent catatonic features ('catatonic schizophrenia'): I. Demographic and clinical correlates in the chronic phase. Prog Neuropsychopharmacol Biol Psychiatry. 2005 Jan. 29(1):27-38. [Medline].
Carroll BT. Kahlbaum's catatonia revisited. Psychiatry Clin Neurosci. 2001 Oct. 55(5):431-6. [Medline].
Bonnot O, Tanguy ML, Consoli A, Cornic F, Graindorge C, Laurent C, et al. Does catatonia influence the phenomenology of childhood onset schizophrenia beyond motor symptoms?. Psychiatry Res. 2008 Apr 15. 158(3):356-62. [Medline].
Cornic F, Consoli A, Tanguy ML, Bonnot O, Périsse D, Tordjman S, et al. Association of adolescent catatonia with increased mortality and morbidity: evidence from a prospective follow-up study. Schizophr Res. 2009 Sep. 113(2-3):233-40. [Medline].
Haouzir S, Lemoine X, Desbordes M, Follet M, Meunier C, Baarir Z, et al. The role of coagulation marker fibrin D-dimer in early diagnosis of catatonia. Psychiatry Res. 2009 Jun 30. 168(1):78-85. [Medline].
Krishna KR, Maniar RC, Harbishettar VS. A comparative study of "idiopathic catatonia’’ with catatonia in schizophrenia. Asian J Psych. 2011. 4:129-33.
Fischel T, Krivoy A, Brenner I, Weizman A. Priapism as an unusual manifestation of catatonia: a case report. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Apr 30. 33(3):570. [Medline].
Chouinard MJ, Nguyen DK, Clement JF, Bruneau MA. Catatonia induced by levetiracetam. Epilepsy Behav. 2006 Feb. 8(1):303-7. [Medline].
Youssef NA, Benazzi F, Desan PH. Levofloxacin-induced catatonia. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Jun 15. 33(4):741-2. [Medline].
Reddy NN, Rao NP, Venkatasubramanian G, Arasappa R, Behere RV, Divakaran A, et al. Rimonabant-induced catatonia in schizophrenia: A case report. Obesity Research & Clinical Practice. 2009 Nov. 3 (4):237-239.
Rizos DV, Peritogiannis V, Gkogkos C. Catatonia in the intensive care unit. Gen Hosp Psychiatry. 2011 Jan-Feb. 33(1):e1-2. [Medline].
Brasic JR, Barnett JY, Will MV, Nadrich RH, Sheitman BB, Ahmad R, et al. Dyskinesias differentiate autistic disorder from catatonia. CNS Spectr. 2000 Dec. 5(12):19-22. [Medline].
Denysenko L, Nicolson SE. Cefoxitin and ciprofloxacin neurotoxicity and catatonia in a patient on hemodialysis. Psychosomatics. 2011 Jul-Aug. 52(4):379-83. [Medline].
Anbarasan D, Campion P, Howard J. Drug-induced leukoencephalopathy presenting as catatonia. Gen Hosp Psychiatry. 2011 Jan-Feb. 33(1):85.e1-3. [Medline].
Brasic JR, Andrews SR, Housain B, Alexander M, Mohamed M. Characterization of zaghrouta, an expression of happiness in the Middle East, a component of the differential diagnosis of psychogenic disorders. 2nd International Conference on Psychogenic Movement Disorders and Other Conversion Disorders. 2008 Apr. 78-79.
Brasic JR, Alexander M, Mohamed M. Differentiation of zaghrouta, an expression of happiness by women in the Middle East, from medical disease. Southern Medical Journal. 2003 Oct. 96(Suppl10):S35.
Jain S, Ferrando SJ. Manganese neurotoxicity presenting with depression, psychosis and catatonia. Psychosomatics. 2011 Jan-Feb. 52(1):74-7. [Medline].
Kumar S, Sur S, Singh A. Mega cisterna magna associated with recurrent catatonia: a case report. Biol Psychiatry. 2011 Aug 15. 70(4):e19. [Medline].
Spiegel DR, Varnell C Jr. A case of catatonia due to posterior reversible encephalopathy syndrome treated successfully with antihypertensives and adjunctive olanzapine. Gen Hosp Psychiatry. 2011 May-Jun. 33(3):302.e3-5. [Medline].
Brelinski L, Cottencin O, Guardia D, Anguill JD, Queyrel V, Hatron PY. Catatonia and systemic lupus erythematosus: a clinical study of three cases. Gen Hosp Psychiatry. 2009 Jan-Feb. 31(1):90-2. [Medline].
Kalivas KK, Bourgeois JA. Catatonia after liver and kidney transplantation. Gen Hosp Psychiatry. 2009 Mar-Apr. 31(2):196-8. [Medline].
Hsieh MH, Chen TC, Chiu NY, Chang CC. Zolpidem-related withdrawal catatonia: a case report. Psychosomatics. 2011 Sep-Oct. 52(5):475-7. [Medline].
Lahutte B, Cornic F, Bonnot O, Consoli A, An-Gourfinkel I, Amoura Z. Multidisciplinary approach of organic catatonia in children and adolescents may improve treatment decision making. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Mar 7. [Medline].
Sienaert P, Rooseleer J, De Fruyt J. Measuring catatonia: a systematic review of rating scales. J Affect Disord. 2011 Dec. 135(1-3):1-9. [Medline].
Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand. 1996 Feb. 93(2):129-36. [Medline].
Larsen HH, Ritchie JC, McNutt MD, Musselman DL. Pulmonary embolism in a patient with catatonia: an old disease, changing times. Psychosomatics. 2011 Jul-Aug. 52(4):387-91. [Medline].
England ML, Ongür D, Konopaske GT, Karmacharya R. Catatonia in psychotic patients: clinical features and treatment response. J Neuropsychiatry Clin Neurosci. 2011 Spring. 23(2):223-6. [Medline].
Peralta V, Campos MS, de Jalon EG, Cuesta MJ. DSM-IV catatonia signs and criteria in first-episode, drug-naive, psychotic patients: psychometric validity and response to antipsychotic medication. Schizophr Res. 2010 May. 118(1-3):168-75. [Medline].
Van Den Eede F, Van Hecke J, Van Dalfsen A, Van den Bossche B, Cosyns P, Sabbe BG. The use of atypical antipsychotics in the treatment of catatonia. Eur Psychiatry. 2005 Aug. 20(5-6):422-9. [Medline].
Askenazy F, Dor E, Benoit M, Dupuis G, Serret S, Myquel M, et al. Catatonie chez une adolescente de 14 ans : traitement par clorazépam et carbamazépine et évolution à dix ans [Catatonia in a 14 year-old girl: Treatment with clonazepam and carbamazepine, a 10-year follow-up]. L’Encéphale. 2009.
Chang CH, Hsiao YL, Hsu CY, Chen ST. Treatment of catatonia with olanzapine: a case report. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Nov 13. 33(8):1559-60. [Medline].
Huang YC, Lin CC, Hung YY, Huang TL. Rapid relief of catatonia in mood disorder by lorazepam and diazepam. Biomed J. 2013 Jan-Feb. 36(1):35-9. [Medline].
Lin CC, Huang TL. Lorazepam-diazepam protocol for catatonia in schizophrenia: A 21-case analysis. Compr Psychiatry. 2013 Jul 12. [Medline].
Gupta A, Dhir A, Kumar A, Kulkarni SK. Protective effect of cyclooxygenase (COX)-inhibitors against drug-induced catatonia and MPTP-induced striatal lesions in rats. Pharmacol Biochem Behav. 2009 Dec. 94(2):219-26. [Medline].
Krivoy A, Weizman A, Kimchi-Nesher S, Zemishlany Z, Fischel T. Recurrnet [sic] catatonia: Fluctuating between psychotic and catatonic dimensions [abstract]. European Psychiatry. 2008. 23:S328-S329.
Huang TL, Hung YY. Lorazepam reduces the serum brain-derived neurotrophic factor level in schizophrenia patients with catatonia. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Feb 1. 33(1):158-9. [Medline].
Grover S, Aggarwal M. Long-term maintenance lorazepam for catatonia: a case report. Gen Hosp Psychiatry. 2011 Jan-Feb. 33(1):82.e1-3. [Medline].
Chanpattana W, Kramer BA, Kunigiri G, Gangadhar BN, Kitphati R, Andrade C. A Survey of the Practice of Electroconvulsive Therapy in Asia. J ECT. 2009 May 13. [Medline].
Chanpattana W. A survey of the practice of electroconvulsive therapy in Asia. European Psychiatry. 2009. 24 Supplement 1:S770.
Wachtel LE, Kahng S, Dhossche DM, Cascella N, Reti IM. ECT for catatonia in an autistic girl. Am J Psychiatry. 2008 Mar. 165(3):329-33. [Medline].
Moss L, Vaidya N. Does Comorbid Alcohol and Substance Abuse Affect Electroconvulsive Therapy Outcome in the Treatment of Mood Disorders?. J ECT. 2013 Jul 15. [Medline].
Consoli A, Boulicot V, Cornic F, Fossati P, Barbeau M, Cohen D. Moderate clinical improvement with maintenance ECT in a 17-year-old boy with intractable catatonic schizophrenia. Eur Child Adolesc Psychiatry. 2009 Apr. 18(4):250-4. [Medline].
Slooter AJ, Braun KP, Balk FJ, et al. Electroconvulsive therapy for malignant catatonia in childhood. Pediatr Neurol. 2005 Mar. 32(3):190-2. [Medline].
Rhoads JC, Votolato NA, Young JL, Gilchrist RH. The successful use of right unilateral ultra-brief pulse electroconvulsive therapy in an adolescent with catatonia. Brain Stimulation. 2009.
Nomoto H, Hatta K, Usui C, Ito M, Kita Y, Arai H. Vitamin K deficiency due to prolongation of antibiotic treatment and decrease in food intake in a catatonia patient. Psychosomatics. 2011 Sep-Oct. 52(5):486-7. [Medline].
|Neurologic conditions||Neuroleptic malignant syndrome
Administration of agents that block postsynaptic dopamine receptors*
Administration of sibutramine (withdrawn from US market October 8, 2010)
Withdrawal of lorazepam and other sedatives
Arachnoid cyst in right parietal region
Atrophy of left amygdala
Autistic disorder[6, 7, 8, 18, 19, 20, 21, 22, 23]
Basilar artery thrombosis
Bilateral hemorrhagic lesions of temporal lobes
Cortical venous thrombosis
Central pontine myelinolysis
Cortical basal ganglionic degeneration
Encephalitis (herpesvirus, Trypanosoma cruzi)
Encephalopathy (Borrelia burgdorferi, HIV infection, Wernicke encephalopathy)
Familial fatal insomnia
Fibromuscular dysplasia with dissection of basilar artery
Hypopituitarism secondary to postpartum hemorrhage
Idiopathic recurring stupor
Inherited neurometabolic disorders
Multiple sclerosis[25, 26]
Nonconvulsive status epilepticus
Pervasive developmental disorders[7, 8, 22]
Progressive multifocal leukoencephalopathy
Progressive supranuclear palsy
Seizures (complex with partial symptomatology)
Substance intoxication (alcohol, disulfiram, organic fluorides, phencyclidine)
Subthalamic mesencephalic tumor
Surgical removal of cerebellar tumor
Temporal lobe epilepsy
Tumors (corpus callosum, glioma of third ventricle, supraventricular diffuse pinealoma)
Von Economo (lethargic) encephalitis
|Psychiatric conditions||Acute stress disorder
Brief reactive psychosis with catatonia
Major depression, single episode with catatonic features
Neuroleptic malignant syndrome
Posttraumatic stress disorder
Substance intoxication (3,4-methylenedioxymethamphetamine [“ecstasy”], alcohol, amphetamine, phencyclidine, substance withdrawal, hypnotic-sedative, lorazepam)
Experiencing rejection of an expression of love
Feelings of alienation in an unfamiliar country
Acute intermittent porphyria
Encephalopathy (hepatic, HIV infection, Wernicke encephalopathy)
Fever of unknown cause
Neuroleptic malignant syndrome
Poisoning (carbon monoxide, tetraethyl lead)
Substance intoxication (alcohol, cyclosporine, disulfiram, organic fluorides, phencyclidine)
Syndrome of inappropriate antidiuretic hormone (SIADH)
Systemic lupus erythematosus
Thrombotic thrombocytopenic purpura
Von Economo (lethargic) encephalitis
|Obstetric conditions||Hypopituitarism secondary to postpartum hemorrhage|
|*Administration of agents that block postsynaptic dopamine receptors is associated with the onset of catatonia in some individuals.|