Diagnostic Considerations

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Acute stress disorder
Anti-NMDA receptor encephalitis
Astrocytoma
Autistic disorder^[5]
Brief reactive psychosis with catatonia
Carotid disease
Cephalosporin-associated neurotoxicity^[71]
Cocaine-induced leukoencephalopathy^[72]
Conversion disorder^{[73, 74]}
Delirium
Dystonia
Encephalopathy - HIV infection
Extrapontine myelinolysis
Fabry disease
Hallervorden-Spatz disease
Huntington disease
Inherited metabolic disorders
Inherited neurometabolic disorders
Latah betul^{[43, 44, 45]}
Locked-in syndrome
Low-grade astrocytoma
Major depression, single episode with catatonic features
Malignant hyperthermia
Manganese neurotoxicity^[75]
Medication adverse effect - Levetiracetam, zotepine
Mega cisterna magna^[76]
Meningioma
Mood disorders
Neuroleptic malignant syndrome (NMS)
Neurosarcoidosis
Neurosyphilis
Pantothenate kinase-associated neurodegeneration (PKAN), also known as neurodegeneration with brain iron accumulation 1 (NBIA1), also called Hallervorden-Spatz syndrome
Parkinson disease
Parkinson-plus syndromes
Posttraumatic stress disorder
Posterior reversible encephalopathy syndrome^[77]
Prion disease^[37]
Progressive multifocal leukoencephalopathy
Progressive supranuclear palsy
Renal failure^[71]
Schizophrenia
Serotonin syndrome^[78]- the serotonin syndrome checklist^[79]is a simple tool to assess a patient for evidence of serotonin syndrome
Stiff-person syndrome
Stupor
Subdural hematoma
Substance intoxication - Cyclosporine, phencyclidine
Syphilis
Systemic lupus erythematosus^[80]
Tay-Sachs disease
Thermal injury
Torticollis
Transplantation of kidney and liver^[81]
Tuberculosis
Vegetative states
Von Economo encephalitis
Zaghrouta^{[73, 74]}
Zolpidem withdrawal^[82]

Differential Diagnoses

Workup

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Table. Causes of Catatonia by Category

Table. Causes of Catatonia by Category

Category	Causes
Neurologic conditions	Neuroleptic malignant syndrome^[28] Administration of agents that block postsynaptic dopamine receptors* Administration of sibutramine^[29](withdrawn from US market October 8, 2010) Withdrawal of lorazepam and other sedatives Akinetic-rigid syndrome Anti-NMDA receptor encephalitis^[4] Arachnoid cyst in right parietal region Astrocytoma Atrophy of left amygdala^[30] Autistic disorder^{[17, 10, 11, 31, 32, 33, 34, 35, 36, 12, 13]} Basilar artery thrombosis Bilateral hemorrhagic lesions of temporal lobes Cerebellar catalepsy Cerebral hemorrhage Cerebral infarct Cerebrovascular disease Cortical venous thrombosis Central pontine myelinolysis Cortical basal ganglionic degeneration Dystonia Encephalitis (herpesvirus, Trypanosoma cruzi) Encephalopathy (Borrelia burgdorferi, HIV infection, Wernicke encephalopathy) Familial fatal insomnia^[37] Fibromuscular dysplasia with dissection of basilar artery Frontal lobotomy Head injury Huntington disease Hydrocephalus Hypopituitarism secondary to postpartum hemorrhage Idiopathic recurring stupor Inherited neurometabolic disorders Locked-in syndrome Meningitis, tuberculous Meningoencephalitis Multiple sclerosis^{[38, 39]} Neurosyphilis Nonconvulsive status epilepticus Pervasive developmental disorders^{[10, 11, 35]} Pallidoluysian atrophy Paraneoplastic encephalitis^[40] Parkinsonism Postencephalitic parkinsonism Progressive multifocal leukoencephalopathy Progressive supranuclear palsy Schizencephaly Seizures (complex with partial symptomatology) Stiff-man syndrome Stroke Stupor Subarachnoid hemorrhage Subdural hematoma Substance intoxication (alcohol, disulfiram, organic fluorides, phencyclidine) Subthalamic mesencephalic tumor Surgical removal of cerebellar tumor Tay-Sachs disease Temporal lobe epilepsy Tuberous sclerosis Tumors (corpus callosum, glioma of third ventricle, supraventricular diffuse pinealoma) Vegetative state Von Economo (lethargic) encephalitis Wilson disease
Psychiatric conditions	Acute stress disorder Anorexia nervosa Autistic disorder^[17] Brief reactive psychosis with catatonia Conversion disorder Hysteria Major depression, single episode with catatonic features Mood disorders Neuroleptic malignant syndrome^[28] Posttraumatic stress disorder Schizophrenia Substance intoxication (3,4-methylenedioxymethamphetamine [“ecstasy”], alcohol, amphetamine, phencyclidine, substance withdrawal, hypnotic-sedative, lorazepam)
Psychological factors	Immigration Experiencing rejection of an expression of love Feelings of alienation in an unfamiliar country
Medical conditions	AIDS Acute intermittent porphyria Addison disease Bacterial septicemia Bronchorrhea Carcinoid tumors Diabetic ketoacidosis Encephalopathy (hepatic, HIV infection, Wernicke encephalopathy) Fever of unknown cause Heat stroke Hepatic failure Hereditary coproporphyria Homocystinuria Hypercalcemia Hyperparathyroidism Hyperthyroidism Hyponatremia Hypothermia Intestinal atony Malaria Neuroleptic malignant syndrome^[28] Poisoning (carbon monoxide, tetraethyl lead) Renal failure Substance intoxication (alcohol, cyclosporine, disulfiram, organic fluorides, phencyclidine) Syndrome of inappropriate antidiuretic hormone (SIADH) Syphilis Systemic lupus erythematosus Thermal injury Thrombotic thrombocytopenic purpura Tuberculosis Typhoid fever Uremia 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.

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Author

James Robert Brasic, MD, MPH, MS, MA Assistant Professor, Russell H Morgan Department of Radiology and Radiological Science and Neurology, Division of Nuclear Medicine and Molecular Imaging, Assistant Professor, Department of Neurology, Johns Hopkins University School of Medicine

James Robert Brasic, MD, MPH, MS, MA is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Neurology, International Parkinson and Movement Disorder Society, Society for Neuroscience, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Johns Hopkins University School of Medicine Serve(d) as a speaker or a member of a speakers bureau for: Society of Nuclear Medicine and Molecular Imaging, Maryland Regional Council of Child and Adolescent Psychiatry Received research grant from: National Institutes of Health, Johns Hopkins University School of Medicine, Intellectual & Developmental Disabilities Research Center (U54 HD079123) at the Kennedy Krieger Institute Received income in an amount equal to or greater than $250 from: Gerson Lehrman Group; Guidepost Received royalty from Medscape for other.

Coauthor(s)

Farzaneh Farhadi, MD Postdoctoral Research Fellow, Johns Hopkins Hospital

Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Bioserenity, Ceribell, Eisai, Jazz, LivaNova, Neurelis, Neuropace, SK life science, Sunovion, Takeda, UCB Serve(d) as a speaker or a member of a speakers bureau for: Aquestive, Bioserenity, Eisai, Jazz, LivaNova, Neurelis, SK life science, Stratus, Sunovion, UCB Received research grant from: Cerevel Therapeutics, Ovid Therapeutics, Neuropace, Greenwich Jazz, SK Life Science, Xenon Pharmaceuticals, UCB, Marinus, Neuroelectrics Corporation, Longboard, Janssen, Equilibre Biopharmaceuticals.

Acknowledgements

Nestor Galvez-Jimenez, MD, MSc, MHA Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Acknowledgments

The research for this article was supported by the Essel Foundation; the National Alliance for Research on Schizophrenia and Depression (NARSAD); the Tourette Syndrome Association, Inc; the National Institutes of Health; and the Department of Psychiatry of Bellevue Hospital Center and the New York University School of Medicine, New York, New York. The cooperation of the Health and Hospitals Corporation of the City of New York is gratefully acknowledged.

Catatonia Differential Diagnoses

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Differential Diagnoses

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