No. 139; October 2023

Catatonia is a complicated medical problem with a mixture of body movement, emotional and behavioral symptoms. It can happen due to various mental or medical disorders, but it needs its own specific treatment separate from the main illness. 

What is catatonia?

The exact cause of catatonia is still unknown, and we don’t know why it affects some people but not others with similar conditions. Studies have shown that it impacts the connections between the parts of the brain that control movement and those responsible for more complicated processes, like memory, learning, and reasoning. Catatonia happens more often in certain illnesses, such as bipolar disorder, depression, psychosis, and autism spectrum disorder. 

What are the symptoms of catatonia?

Catatonia symptoms can range from very little to no movement to too much movement. It can be hard for someone to start, stop, or plan actions. Sometimes, patients might repeat movements or speak phrases as if they are on a loop. These actions often do not serve any purpose. Common signs include: 

  • Not being able to move
  • Not being able to talk
  • Not being very alert
  • Difficulty following instructions
  • Difficulty being moved
  • Staring for long periods without focus
  • Copying others’ speech or actions without reason

Catatonia can also impact a person’s desire to eat and drink and control basic body functions, like temperature, breathing and heart rate. If these symptoms are severe, catatonia can become a medical emergency needing rapid treatment. We sometimes refer to this as “malignant catatonia.” 

Types of Catatonia

There are two main types of catatonia, based on movements and symptoms:

  1. Stuporous: This type includes symptoms that make a person seem slow, like trouble talking, moving, staring or getting “stuck” in positions.
  2. Excitatory: This type includes symptoms where the person appears overly sped up, such as having too much movement, talking as if on a loop, pacing, or other repeating behaviors that serve no purpose.

How is catatonia diagnosed?

Patients who have symptoms of catatonia need to be evaluated by a medical doctor with experience diagnosing this condition. They will perform a physical exam to look for some of the signs described above. They may use a rating scale such as the Bush Francis Catatonia scale to measure symptoms. The doctor will ask questions about your child’s medical and psychiatric history to figure out if there is an underlying psychiatric or medical diagnosis that has brought on these catatonia symptoms. Sometimes they may do blood work to assess for things like inflammation or muscle breakdown in the body or underlying causes of the suspected catatonia. If catatonia is suspected, a “test” or “challenge” dose of medicine that is used to treat catatonia is given under the doctor’s supervision. If the child shows improvement, it usually means catatonia is present. 

How is catatonia treated?

The recommended treatment for children with catatonia is a group of medications called benzodiazepines. Lorazepam is used most often and is the most well-studied; however other medications in this group can also be used. About 60-80% of patients respond to lorazepam alone, while others may need additional medications. Electroconvulsive therapy (ECT), alone or in addition to medications, is also effective and safe for treating catatonia in adults and children.

For dangerous or “malignant” catatonia, rapid use of ECT is the most effective treatment. In addition, because this type of catatonia can be life-threatening, hospital admission is necessary to safely monitor blood pressure, body temperature, and other vital functions.

Some medications can make catatonia symptoms worse, but no medications are completely off limits. Some may increase the chances of complications. The patient’s doctor will decide if the risks of any medication are worth the potential benefit in each specific situation.

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