Catatonia has a complex presentation that is composed of multiple signs and symptoms, of which only three need to be present for diagnosis. It may be thought of as occurring with schizophrenia or with mania; however, patients in other settings with various general medical health conditions may develop an episode of catatonia. It is essential to identify catatonia early on for treatment to protect the patient from developing any further complications. A number of medical conditions can mask catatonia, delaying its treatment.
The diagnostic criteria for catatonia in the current DSM-5 require three or more of the following symptoms: stupor, waxy flexibility, catalepsy, mutism, posturing, negativism, stereotypes, mannerisms, grimacing, agitation, echopraxia, and echolalia. These diagnostic criteria apply to both adults and children, but in children, catatonia often presents as a result of somatic conditions or substance use.
| Diagnostic Criteria for Catatonia | ||
| 1 | Stupor | No psychomotor activity; not actively relating to environment |
| 2 | Catalepsy | Passive induction of a posture held against gravity |
| 3 | Waxy flexibility | Slight, even resistance to positioning by examiner |
| 4 | Mutism | No, or very little, verbal response not related to an aphasia |
| 5 | Negativism | Opposition or no response to instructions or external stimuli |
| 6 | Posturing | Spontaneous and active maintenance of a posture against gravity |
| 7 | Mannerism | Odd, circumstantial caricature of normal actions |
| 8 | Stereotypy | Repetitive, abnormally frequent, non–goal-directed movements |
| 9 | Agitation | Agitation not influenced by external stimuli |
| 10 | Grimacing | Painful or aggressive facial expression |
| 11 | Echolalia | Mimicking another’s speech |
| 12 | Echopraxia | Mimicking another’s movements |
References:
- Edinoff AN, Kaufman SE, Hollier JW, Virgen CG, Karam CA, Malone GW, Cornett EM, Kaye AM, Kaye AD. Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges. Neurol Int. 2021 Nov 8;13(4):570-586. [Medline]
- Heckers S, Walther S. Catatonia. N Engl J Med. 2023 Nov 9;389(19):1797-1802. [Medline]
Created Mar 13, 2024.
