Schizophrenia spectrum and other psychotic disorders
Catatonia
Catatonia is a serious psychomotor syndrome that may involve profound immobility and minimal response or intense, purposeless agitation. It requires urgent medical recognition.
Catatonia is not synonymous with schizophrenia
It can occur with mood or psychotic disorders, autism and other neurodevelopmental conditions, as well as neurological, autoimmune, infectious, metabolic and medicine-related causes. The same person may alternate between stupor, mutism and agitation.
Malignant catatonia includes fever, autonomic instability and severe systemic illness. Dehydration, blood clots, aspiration, pressure injury and other complications can become life-threatening, so the condition is assessed and treated in hospital rather than through routine outpatient care alone.
Recognition and differential diagnosis
- At least three recognised psychomotor signs are present, such as stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, stereotypy, agitation, grimacing, echolalia or echopraxia.
- Clinicians investigate psychiatric, neurological, autoimmune, infectious and metabolic causes and review substances, medicines and abrupt withdrawal.
- Delirium, seizures, severe depression, neuroleptic malignant syndrome and other neurological states may overlap or appear similar and require urgent differentiation.
- In an autistic person or someone with longstanding movement patterns, diagnosis requires a clear and substantial change from their usual functioning.
Hospital treatment
Medical care protects hydration, nutrition, breathing, mobility and skin and prevents thrombosis and other complications. Lorazepam or another appropriate benzodiazepine is commonly used as first-line treatment under direct medical supervision.
Electroconvulsive therapy can be highly effective and may be needed quickly for malignant, severe or treatment-resistant catatonia. The underlying cause is treated at the same time. Antipsychotics may worsen active catatonia or relate to neuroleptic malignant syndrome, so medicine changes are made only by the treating medical team.
When immediate help is needed
New immobility, mutism, unusual posturing, unexplained agitation, imitation of speech or movement, or sudden inability to eat and care for oneself needs immediate hospital assessment. Fever, severe rigidity, confusion or unstable pulse and blood pressure after an antipsychotic is especially urgent. Do not force movement or food and do not change medication at home.