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Table of Contents

Types

Symptoms

Causes

Diagnosis

Treatment

Catatonia is not itself a disorder. Rather, it’s a set of symptoms that occur due to an underlying condition.An estimated 10% of people hospitalized for acute psychiatric conditions (experiencing a sudden psychiatric crisis) have symptoms of catatonia.

This article will discuss the types and symptoms of catatonia, as well as explore some of its causes. It will then cover how catatonia can be diagnosed and effectively treated.

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Types of Catatonic Behavior

Over the years, psychiatrists have grouped catatonic behaviors informally under three main types.

While catatonia is defined in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), the types are not. The designations are useful, however, for both clinicians and patients to understand the various ways catatonic behavior can present.

Informal types of catatonia include:

Retarded or Akinetic Catatonia Behavior

Behaviors of people retarded or akinetic catatonia can include:

Excited Catatonia Behavior

Behaviors characteristic of this type can include:

Malignant or Lethal Catatonia Behavior

Malignant or lethal catatonia is often associated with the excited type. It can lead to autonomic dysregulation (including drastic changes in blood pressure, heart rate, temperature, and respiratory rate) and altered levels of consciousness.

This type of catatonia can be lethal and requires immediate medical attention.Its behaviors and symptoms include:

Symptoms of catatonia are broad and differ based on the type.

According to the DSM-5, at least three of the 12 symptoms below should be present to meet the criteria for a catatonia diagnosis:

Sometimes catatonia involves a refusal to eat.This can lead to malnourishment and dehydration—not symptoms of catatonia, but consequences of some catatonic behaviors.

People with catatonia may seem to be unaware of their surroundings. Sometimes people who recover from catatonia report that they recall the period and were completely aware during their catatonic state.

Catatonia is associated with more than 100 medical conditions, including conditions that are:

In 2013, the new DSM-5 listed catatonia as an independent syndrome, as well as a specifier for many primary diagnoses.

People with mental health conditions like bipolar disorder, schizophrenia, and depression are more likely to experience catatonia. About 20% of people with catatonia experience it due to a physical, rather than psychiatric, cause—such as infections, strokes, and certain drugs.

It is difficult to identify a single biological cause of catatonia because this syndrome occurs in the context of so many different disorders. Scientists suggest that irregularities in thegamma-aminobutyric acid (GABA)and glutamate neurotransmitter systems may contribute to catatonia.

Brain imaging research studies have found decreased resting-state activity and decreased task activation in the motor areas of the frontal and parietal cortex in association with catatonia.

Other reports have found increased activity in premotor areas, specifically in the akinetic type of catatonia.

Ultimately, more research is needed to make conclusions about brain activity changes and other causes of catatonia.

Catatonia and COVID-19One 2020 study examined a case of catatonia in a man withCOVID-19.The study posited that due to its neuroinvasive characteristics and no other medical explanation, the SARS-CoV-2 caused catatonia in this patient. This is the first study to associate catatonia with the coronavirus.

Catatonia and COVID-19

One 2020 study examined a case of catatonia in a man withCOVID-19.The study posited that due to its neuroinvasive characteristics and no other medical explanation, the SARS-CoV-2 caused catatonia in this patient. This is the first study to associate catatonia with the coronavirus.

To be diagnosed with catatonia, a person must have three of the 12 symptoms listed in the DSM-5.

If you have signs of catatonia, your healthcare provider will complete a thorough neuropsychiatric evaluation. This may include catatonia screening tools such as the Bush-Francis Catatonia Rating Scale and the Northoff Catatonia Rating Scale.

No laboratory test can diagnose catatonia. However, your practitioner may order a complete blood count (CBC), metabolic panel, serum iron,cerebrospinal fluid analysis, and drug screens, among other tests, to rule out underlying conditions or potential causes.

A catatonia diagnosis will be classified as one of the following:

Potential for MisdiagnosisThere is significant potential for catatonia to be misunderstood or misdiagnosed as another disorder. Many psychiatric conditions present with clinical signs that overlap with catatonia. Your healthcare provider may consider other potential conditions when diagnosing catatonia.Conditions with features similar to catatonia include:Autoimmune diseasesAbulia or akinetic mutismAutismElective mutismEncephalopathyExtrapyramidal side effectsLocked-in syndromeMalignant hyperthermiaNon-catatonic stuporNonconvulsive status epilepticusParkinson’s diseaseSchizophreniaSevere depressionSevere obsessive-compulsive disorderStatus epilepticusStiff-person syndromeStrokeVegetative state

Potential for Misdiagnosis

There is significant potential for catatonia to be misunderstood or misdiagnosed as another disorder. Many psychiatric conditions present with clinical signs that overlap with catatonia. Your healthcare provider may consider other potential conditions when diagnosing catatonia.Conditions with features similar to catatonia include:Autoimmune diseasesAbulia or akinetic mutismAutismElective mutismEncephalopathyExtrapyramidal side effectsLocked-in syndromeMalignant hyperthermiaNon-catatonic stuporNonconvulsive status epilepticusParkinson’s diseaseSchizophreniaSevere depressionSevere obsessive-compulsive disorderStatus epilepticusStiff-person syndromeStrokeVegetative state

There is significant potential for catatonia to be misunderstood or misdiagnosed as another disorder. Many psychiatric conditions present with clinical signs that overlap with catatonia. Your healthcare provider may consider other potential conditions when diagnosing catatonia.

Conditions with features similar to catatonia include:

It is very important to seek treatment for catatonia. Not only is this condition incredibly life-limiting, but it can lead to life-threatening complications. Fortunately, catatonia is highly treatable, and it has a good prognosis when treated.Try to see a healthcare provider early on to reduce the risk of complications.

Clinical evidence supports two main treatment pathways for catatonia: benzodiazepine medications andelectroconvulsive therapy (ECT).

Medication

Catatonia is typically first treated with benzodiazepines. Lorazepam is the most commonly used medication—a 2 milligram (mg) dose has been shown to help with most catatonia symptoms, though higher doses can be used.

Between 66% and 100% of people see a remission of catatonia after benzodiazepine treatment. They usually feel better within three to seven days. Patients with longer-term catatonia symptoms may not respond as well to medication treatment.

Sometimes, other medications are used for catatonia symptoms as well. These include memantine and amantadine. In rare cases, atypical antipsychotic medications like Abilify (aripiprazole) can be combined with benzodiazepines. However, these medications can worsen catatonia symptoms so your healthcare provider is unlikely to use this option.

Electroconvulsive Therapy

ECT is effective for treating catatonia, but it is typically used as a second-line treatment after a trial of medication.

ECT treatment requires general anesthesia. The treatment involves electric brain stimulation, typically performed bilaterally (on both sides of the brain), three times a week on average. In studies, the success rate of ECT for the remission of catatonia ranges from 59%–100%. People typically start feeling better after at least six sessions.

In rarer cases, ECT may be used as a first-line treatment for people with malignant catatonia and life-threatening symptoms. Initially, the treatment is typically administered daily.

ECT can cause cognitive side effects. Your healthcare provider will discuss the pros and cons of ECT and your unique situation before recommending the treatment.

Summary

Catatonia is a set of movement, behavioral, and physiological symptoms that occur together due to a number of underlying psychiatric and physical conditions. Depending on the type of catatonia, a person may appear slow or unmoving or overly fast and moving too much. In rare cases, catatonia may be associated with dangerous changes in consciousness and blood pressure, heart rate, temperature, and respiratory rate.

Fortunately, treatment for catatonia is available. Medications called benzodiazepines (including lorazepam) are typically used first. Electroconvulsive therapy (ECT) can also help. Seeing a healthcare provider early can reduce the risk of complications.

12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Edinoff AN, Kaufman SE, Hollier JW, et al.Catatonia: clinical overview of the diagnosis, treatment, and clinical challenges.Neurol Int. 2021;13(4):570-586. doi:10.3390/neurolint13040057Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G.A clinical review of the treatment of catatonia.Front Psychiatry. 2014;5. doi:10.3389/fpsyt.2014.00181Rasmussen SA, Mazurek MF, Rosebush PI.Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology.World J Psychiatry. 2016;6(4):391-398. doi:10.5498/wjp.v6.i4.391Bhati MT, Datto CJ, O’Reardon JP.Clinical manifestations, diagnosis, and empirical treatments for catatonia.Psychiatry (Edgmont). 2007;4(3):46-52.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013.StatPearls.Catatonia.Caan MP, Lim CT, Howard M.A case of catatonia in a man with COVID-19.Psychosomatics. 2020;61(5):556-560. doi:10.1016/j.psym.2020.05.021Walther S, Strik W.Catatonia.CNS Spectrums. 2016;21(4):341-348. doi:10.1017/S1092852916000274Walther S, Stegmayer K, Wilson JE, Heckers S.Structure and neural mechanisms of catatonia.The Lancet Psychiatry. 2019;6(7):610-619.Hirjak D, Brandt GA, Fritze S, Kubera KM, Northoff G, Wolf RC.Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types.Schizophr Res. 2024;263:93-98. doi:10.1016/j.schres.2022.12.019Breit S, Meyer A, Schmitt W, Bracht T, Walther S.The effect of electroconvulsive therapy on specific catatonia symptoms and predictors of late response.Pharmacopsychiatry. 2024;57(1):13-20. doi:10.1055/a-2195-1499Pelzer AC, van der Heijden FM, den Boer E.Systematic review of catatonia treatment.Neuropsychiatr Dis Treat. 2018;14:317-326. doi:10.2147/NDT.S147897

12 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Edinoff AN, Kaufman SE, Hollier JW, et al.Catatonia: clinical overview of the diagnosis, treatment, and clinical challenges.Neurol Int. 2021;13(4):570-586. doi:10.3390/neurolint13040057Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G.A clinical review of the treatment of catatonia.Front Psychiatry. 2014;5. doi:10.3389/fpsyt.2014.00181Rasmussen SA, Mazurek MF, Rosebush PI.Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology.World J Psychiatry. 2016;6(4):391-398. doi:10.5498/wjp.v6.i4.391Bhati MT, Datto CJ, O’Reardon JP.Clinical manifestations, diagnosis, and empirical treatments for catatonia.Psychiatry (Edgmont). 2007;4(3):46-52.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013.StatPearls.Catatonia.Caan MP, Lim CT, Howard M.A case of catatonia in a man with COVID-19.Psychosomatics. 2020;61(5):556-560. doi:10.1016/j.psym.2020.05.021Walther S, Strik W.Catatonia.CNS Spectrums. 2016;21(4):341-348. doi:10.1017/S1092852916000274Walther S, Stegmayer K, Wilson JE, Heckers S.Structure and neural mechanisms of catatonia.The Lancet Psychiatry. 2019;6(7):610-619.Hirjak D, Brandt GA, Fritze S, Kubera KM, Northoff G, Wolf RC.Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types.Schizophr Res. 2024;263:93-98. doi:10.1016/j.schres.2022.12.019Breit S, Meyer A, Schmitt W, Bracht T, Walther S.The effect of electroconvulsive therapy on specific catatonia symptoms and predictors of late response.Pharmacopsychiatry. 2024;57(1):13-20. doi:10.1055/a-2195-1499Pelzer AC, van der Heijden FM, den Boer E.Systematic review of catatonia treatment.Neuropsychiatr Dis Treat. 2018;14:317-326. doi:10.2147/NDT.S147897

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Edinoff AN, Kaufman SE, Hollier JW, et al.Catatonia: clinical overview of the diagnosis, treatment, and clinical challenges.Neurol Int. 2021;13(4):570-586. doi:10.3390/neurolint13040057Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G.A clinical review of the treatment of catatonia.Front Psychiatry. 2014;5. doi:10.3389/fpsyt.2014.00181Rasmussen SA, Mazurek MF, Rosebush PI.Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology.World J Psychiatry. 2016;6(4):391-398. doi:10.5498/wjp.v6.i4.391Bhati MT, Datto CJ, O’Reardon JP.Clinical manifestations, diagnosis, and empirical treatments for catatonia.Psychiatry (Edgmont). 2007;4(3):46-52.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013.StatPearls.Catatonia.Caan MP, Lim CT, Howard M.A case of catatonia in a man with COVID-19.Psychosomatics. 2020;61(5):556-560. doi:10.1016/j.psym.2020.05.021Walther S, Strik W.Catatonia.CNS Spectrums. 2016;21(4):341-348. doi:10.1017/S1092852916000274Walther S, Stegmayer K, Wilson JE, Heckers S.Structure and neural mechanisms of catatonia.The Lancet Psychiatry. 2019;6(7):610-619.Hirjak D, Brandt GA, Fritze S, Kubera KM, Northoff G, Wolf RC.Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types.Schizophr Res. 2024;263:93-98. doi:10.1016/j.schres.2022.12.019Breit S, Meyer A, Schmitt W, Bracht T, Walther S.The effect of electroconvulsive therapy on specific catatonia symptoms and predictors of late response.Pharmacopsychiatry. 2024;57(1):13-20. doi:10.1055/a-2195-1499Pelzer AC, van der Heijden FM, den Boer E.Systematic review of catatonia treatment.Neuropsychiatr Dis Treat. 2018;14:317-326. doi:10.2147/NDT.S147897

Edinoff AN, Kaufman SE, Hollier JW, et al.Catatonia: clinical overview of the diagnosis, treatment, and clinical challenges.Neurol Int. 2021;13(4):570-586. doi:10.3390/neurolint13040057

Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G.A clinical review of the treatment of catatonia.Front Psychiatry. 2014;5. doi:10.3389/fpsyt.2014.00181

Rasmussen SA, Mazurek MF, Rosebush PI.Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology.World J Psychiatry. 2016;6(4):391-398. doi:10.5498/wjp.v6.i4.391

Bhati MT, Datto CJ, O’Reardon JP.Clinical manifestations, diagnosis, and empirical treatments for catatonia.Psychiatry (Edgmont). 2007;4(3):46-52.

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013.

StatPearls.Catatonia.

Caan MP, Lim CT, Howard M.A case of catatonia in a man with COVID-19.Psychosomatics. 2020;61(5):556-560. doi:10.1016/j.psym.2020.05.021

Walther S, Strik W.Catatonia.CNS Spectrums. 2016;21(4):341-348. doi:10.1017/S1092852916000274

Walther S, Stegmayer K, Wilson JE, Heckers S.Structure and neural mechanisms of catatonia.The Lancet Psychiatry. 2019;6(7):610-619.

Hirjak D, Brandt GA, Fritze S, Kubera KM, Northoff G, Wolf RC.Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types.Schizophr Res. 2024;263:93-98. doi:10.1016/j.schres.2022.12.019

Breit S, Meyer A, Schmitt W, Bracht T, Walther S.The effect of electroconvulsive therapy on specific catatonia symptoms and predictors of late response.Pharmacopsychiatry. 2024;57(1):13-20. doi:10.1055/a-2195-1499

Pelzer AC, van der Heijden FM, den Boer E.Systematic review of catatonia treatment.Neuropsychiatr Dis Treat. 2018;14:317-326. doi:10.2147/NDT.S147897

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