What Is Catatonia?
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Medically reviewed by Melissa Bronstein, LICSW
Catatonia is a psychiatric (brain-related) condition that affects your ability to process the world around you. The condition can cause you to lose awareness, change your behavior and, affect your ability to move and communicate with others.
The exact cause of catatonia is currently unknown. However, researchers believe the condition is associated with certain psychological and neurological health conditions, such as mood disorders (like bipolar disorder), personality disorders (like borderline personality disorder), and schizophrenia, among others. Catatonia is considered a rare condition and occurs in approximately 7% to 17% of people with severe psychological conditions.
If you or a loved one develop catatonia, it's common to experience a variety of symptoms. These may include excessive or abnormal movements, inability to speak (known as mutism), and a lack of response or awareness of surroundings (known as stupor). However, treatment options are available to help you better manage the condition.
Types of Catatonia
There are two types of catatonia: akinetic and excited. Akinetic catatonia is more common and milder than excited catatonia. Here's what you should know about both types.
Akinetic Catatonia
Akinetic catatonia is commonly associated with conditions that affect your mobility (movement). With this type of catatonia, you may experience:
Immobility, or inability to move
Staring out blankly
Mutism, or not being able to speech
General withdrawal from your surroundings
Decreased appetite or lack of desire to eat
Excited Catatonia
Excited catatonia is a less common, but more severe type of catatonia. The hallmark symptoms of this type of catatonia are extreme restlessness and anxiety. It may be common to also experience:
Difficulty regulating heart rate, blood pressure, and sweating
Confusion
Sudden mood swings
Aggression
Malignant Catatonia
In rare cases, catatonia affects the autonomic nervous system—a network of nerves that manages important bodily functions such as respiration (breathing), digestion, and heart rate, among others. If this happens, the condition can be fatal, especially when left untreated. Malignant catatonia can also cause life-threatening complications such as:
Tachypnea: Extremely heavy breathing
Tachycardia: Rapid heart rate
Hyperthermia: Significant increase in body temperature
Diaphoresis: Excessive sweating
If you or a loved one are experiencing symptoms of malignant catatonia, it's essential to reach out for medical attention as soon as possible by either visiting your local emergency room or calling 911. Without treatment, the condition can be fatal.
Symptoms
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) is a reference book that outlines the symptoms of catatonia. Healthcare providers use the DSM-5 to identify catatonia and give you a proper diagnosis. To receive a diagnosis for catatonia, you must have at least three of the 12 hallmark symptoms. These symptoms include:
Catalepsy: Trance-like state or loss of consciousness
Waxy flexibility: Not being able to control your own movements
Agitation: Extreme irritation
Mutism: Inability to speak or being completely silent
Negativism: Difficulty responding or reacting to something that's happening around you
Stupor: Trouble moving, speaking, or responding to external stimuli
Posturing: Holding a specific physical position that is usually uncomfortable or awkward
Mannerisms: Exaggerating movements that you usually make
Stereotypies: Performing uncontrollable movements such as finger-tapping, body rocking, stimming, or hand flapping
Grimacing: Frozen facial expressions as a result of having tight facial muscles
Echolalia: Repeating words over and over
Echopraxia: Imitating other people's movements
Causes
Researchers don't exactly know what causes catatonia. However, experts believe that catatonia occurs as a result of mood disorders or other psychiatric conditions. The current theory is that you may experience catatonia if you also live with one of the following conditions:
Schizophrenia
Schizoaffective disorder
The above conditions are the most common related conditions of catatonia. However, some studies show evidence of catatonia developing among people who have:
Down syndrome
Parkinson’s disease, dementia, or other neurodegenerative conditions
Autoimmune disorders, such as multiple sclerosis (MS) and lupus
Risk Factors
Some people may be at a higher risk of developing catatonia. Risk factors for the condition include:
Genetics: Studies have found that 27% of those with catatonia had a family member who also experienced symptoms of the condition.
Age: Some research has shown that older adults may have a higher risk of developing catatonia.
Neurological disease: A history of a neurological (brain-related) condition or previous episodes of catatonia increase the chances of having catatonic episodes.
Substance use: Using certain substances, such as cocaine, benzodiazepine (a class of tranquilizing drugs), and excess alcohol may boost the likelihood of experiencing catatonia symptoms.
Diagnosis
To receive a diagnosis for catatonia, your primary care provider may work with a psychiatrist (a medical doctor who specializes in brain disorders) to better understand your symptoms. During the diagnostic process, your healthcare providers will typically learn about your personal and family medical history, perform a physical exam, and conduct a psychological evaluation to better understand your thoughts and behaviors.
In some cases, they may order additional tests to learn about the underlying cause of your symptoms or rule out other conditions. They can do so by using one or more of the following tests:
Electroencephalogram (EEG): An EEG observes and tracks the electrical activity in your brain. The test can diagnose seizures and other psychiatric conditions that may be causing catatonia symptoms.
Imaging scans: Tests such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) can detect structural changes, bleeding, bruising, inflammation, or tumors in the brain. This helps your healthcare providers understand potential causes or underlying conditions that can influence the onset of catatonia symptoms.
Laboratory screening: Your healthcare providers may order a complete blood count (CBC), thyroid function, glucose, and urine tests to learn more about your overall health and rule out other conditions that may be causing catatonia-related symptoms.
Treatment
If you or a loved one receive a diagnosis for catatonia, the exact treatment plan will depend on the underlying cause of the condition. Generally, treatments for catatonia include medication and electroconvulsive therapy (ECT).
Medications
The first line of treatment for catatonia is benzodiazepines, a drug class of tranquilizer medications. Healthcare providers often prescribe this medication for a variety of other psychological or neurological conditions such as anxiety, seizures, and insomnia.
The most common benzodiazepine medication for catatonia is Atavan (lorazepam). The exact dose that you receive for this medication will depend on the underlying cause of your symptoms and the severity of your condition. Generally, your provider may prescribe you between 6 and 20 milligrams (mg) of the drug for best results.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is another effective option for treating a variety of psychiatric conditions, including catatonia. The treatment involves sending an electric current to your brain using low-wattage electrical waves. The purpose of this is to induce (or, intentionally cause) a mild seizure to produce blood flow and electrical activity in the brain. Studies have found this therapy to be effective for catatonia symptoms in more than 80% of cases.
How to Prevent Catatonia
Since researchers don't know the exact cause of catatonia, there's no surefire way to prevent catatonia symptoms. However, your healthcare provider may recommend the following strategies to reduce the severity of catatonia symptoms or the frequency of episodes:
Avoiding or reducing the dosage of antipsychotic medications—as catatonia may sometimes occur as a side effect of these drugs
Taking your catatonia medications (e.g., benzodiazepines) as prescribed
Keeping in touch with your healthcare provider about your condition and the symptom you're experiencing so they can make adjustments to your treatment plan as needed
Related Conditions
Sometimes, having recurrent episodes of catatonia raises the risk of developing other related conditions. These conditions may include:
Neuroleptic malignant syndrome: A serious and life-threatening neurological condition that produces symptoms similar to catatonia and can occur as a result of taking too many antipsychotic medications
Dehydration: Catatonia can make it difficult for you to move or be aware of your environment, which may cause you to forget to drink enough water and lead to dehydration
Malnutrition: Similar to dehydration, catatonia symptoms can disrupt your appetite and eating behaviors, which can raise your risk of not getting enough nutrients that your body needs
Pneumonia: Catatonia symptoms and the conditions they cause (e.g., dehydration and malnutrition) can make you more prone to developing serious infections, such as pneumonia
Deep vein thrombosis: Not being able to move properly as a result of your catatonia boosts your chances of developing deep vein thrombosis (DVT)—a condition that occurs when blood clots develop in your legs
Living With Catatonia
Depending on the underlying cause of the condition, catatonia can be dangerous, severely affect your quality of life, and sometimes be fatal. While symptoms can be very disruptive to your life, it's important to know that getting prompt medical treatment can improve symptoms.
If you or a loved one is experiencing symptoms of catatonia, a primary care provider is best fit to offer a diagnosis and treatment plan. The healthcare provider may work with a team of medical professionals including a psychiatrist, psychologist, neurologist, and mental health nurse to provide a holistic treatment approach.
Extra accommodations may sometimes be necessary for those living with catatonia. People with frequent and severe catatonia episodes may not be able to live alone and may require attention from a caretaker. A caretaker may include one's loved ones, a healthcare provider, or a full-time nurse. It may also help to talk to a healthcare provider about support groups or advocacy organizations that can offer resources to help you or a loved one with the condition.
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