Catatonia
Catatonia is a group of symptoms that usually involve a lack of movement and communication, and also can include agitation, confusion, and restlessness. Catatonia can occur in the context of several disorders, including neurodevelopmental, psychotic, bipolar, depressive disorders, and other medical conditions (e.g., cerebral folate deficiency, rare autoimmune and paraneoplastic disorders. The manual does not treat catatonia as an independent class but recognizes a) catatonia associated with another mental disorder (i.e., a neurodevelopmental, psychotic disorder, a bipolar disorder, a depressive disorder, or other mental disorder), b) catatonic disorder due to another medical condition, and c) unspecified catatonia.
Catatonia is defined by the presence of three or more of 12 psychomotor features in the diagnostic criteria for catatonia associated with another mental disorder and catatonic disorder due to another medical condition. The essential feature of catatonia is a marked psychomotor disturbance that may involve decreased motor activity, decreased engagement during interview or physical examination, or excessive and peculiar motor activity. The clinical presentation of catatonia can be puzzling, as the psychomotor disturbance may range from marked unresponsiveness to marked agitation. Motoric immobility may be severe (stupor) or moderate (catalepsy and waxy flexibility). Similarly, decreased engagement may be severe (mutism) or moderate (negativism). Excessive and peculiar motor behaviors can be complex (e.g., stereotypy) or simple (agitation) and may include echolalia and echopraxia. In extreme cases, the same individual may wax and wane between de¬ creased and excessive motor activity. The seemingly opposing clinical features and variable manifestations of the diagnosis contribute to a lack of awareness and decreased recognition of catatonia. During severe stages of catatonia, the individual may need careful supervision to avoid self-harm or harming others. There are potential risks from malnutrition, exhaustion, hyperpyrexia and self-inflicted injury.
Diagnostic Criteria
A. The clinical picture is dominated by three (or more) of the following symptoms:
- Stupor (i.e., no psychomotor activity; not actively relating to environment).
- Catalepsy (i.e., passive induction of a posture held against gravity).
- Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
- Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).
- Negativism (i.e., opposition or no response to instructions or external stimuli).
- Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
- Mannerism (i.e., odd, circumstantial caricature of normal actions).
- Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).
- Agitation, not influenced by external stimuli.
- Grimacing.
- Echolalia (i.e., mimicking another’s speech).
- Echopraxia (i.e., mimicking another’s movements)