Catatonia in adults: Epidemiology, clinical features, assessment, and diagnosis
- M Justin Coffey, MD
M Justin Coffey, MD
- Associate Professor of Psychiatry & Behavioral Sciences
- Baylor College of Medicine
- Section Editors
- Peter P Roy-Byrne, MD
Peter P Roy-Byrne, MD
- Editor-in-Chief — Psychiatry
- Section Editor — Depressive Disorders
- Professor of Psychiatry and Behavioral Sciences
- University of Washington School of Medicine
- Stephen Marder, MD
Stephen Marder, MD
- Section Editor — Psychotic Disorders
- Professor of Psychiatry
- Semel Institute of Neuroscience at UCLA
Catatonia is a behavioral syndrome marked by an inability to move normally, which can occur in the context of many underlying psychiatric and general medical disorders . Within psychiatric nosology, catatonia is not conceptualized as a separate diagnostic entity [2,3]. Rather, the term catatonia is used to specify a subtype of the underlying disorder, similar to the term “psychotic features.” (However, some experts view catatonia as a syndrome that warrants a stand-alone diagnosis .)
Recognizing catatonia is important because it may be caused or exacerbated by treatment of the underlying disorder. As an example, antipsychotic drugs used for bipolar or psychotic disorders may worsen catatonia .
This topic reviews the epidemiology, pathogenesis, clinical features, assessment, and diagnosis of catatonia, as well as the disorders that can progress to catatonia. The treatment and prognosis of catatonia are discussed separately. (See "Catatonia: Treatment and prognosis".)
The estimated incidence of catatonia has been studied primarily in acutely ill psychiatric inpatients . The incidence is approximately 10 percent, but estimates range from 5 to 20 percent, based upon prospective studies conducted for one to twelve months at individual psychiatric units [6-14]. The range is probably due in part to differences in study methods, including how catatonia was defined. The syndrome may go unrecognized, leading to the false conclusion that it is rare. In a Dutch study of 139 acutely psychotic inpatients, the treatment team diagnosed catatonia nine times less often than the research team (2 versus 18 percent of patients) .
It is not clear if there are any sociodemographic risk factors for catatonia. Catatonia seems to occur more commonly in patients with unipolar major depression or bipolar disorder, compared with other disorders . In addition, catatonia may perhaps occur more often in patients with prior episodes. (See 'Underlying disorders' below and 'Recurrence' below.)
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