Catatonia in adults: Treatment and prognosis
- M Justin Coffey, MD
M Justin Coffey, MD
- Henry Ford Health System
- 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 psychiatric and general medical disorders . Prompt treatment of catatonia with benzodiazepines or electroconvulsive therapy (ECT), as well as treatment of the underlying cause, generally leads to remission of catatonia. However, failure to recognize and properly treat catatonia can lead to poor outcomes; malignant catatonia in particular can be fatal.
This topic reviews the treatment and prognosis of catatonia. The epidemiology, clinical features, assessment, underlying disorders, diagnosis, and differential diagnosis are discussed separately. (See "Catatonia in adults: Epidemiology, clinical features, assessment, and diagnosis".)
DEFINITION OF CATATONIA
Catatonia is a behavioral syndrome marked by an inability to move normally, and can occur in patients with underlying psychiatric (eg, autism spectrum disorder, bipolar disorders, psychotic disorders, and unipolar major depression) and general medical disorders. The syndrome is marked by heterogeneous signs that are observed or elicited (table 1 and table 2); the most common are immobility, rigidity, mutism, posturing, excessive motor activity, stupor, negativism, staring, and echolalia [1-3].
Subtypes of catatonia are based upon the specific nature of the movement disturbance and other associated features . The three principal forms in order of incidence are:
●Retarded – Mutism, inhibited movement, posturing, rigidity, negativism, and staring
- Fink M, Taylor MA. The catatonia syndrome: forgotten but not gone. Arch Gen Psychiatry 2009; 66:1173.
- Zisselman MH, Jaffe RL. ECT in the treatment of a patient with catatonia: consent and complications. Am J Psychiatry 2010; 167:127.
- Francis A. Catatonia: diagnosis, classification, and treatment. Curr Psychiatry Rep 2010; 12:180.
- The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. World Health Organization. http://www.who.int/classifications/icd/en/bluebook.pdf (Accessed on May 04, 2011).
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Mann SC, Caroff SN, Campbell EC, et al. Malignant catatonia. In: Current Clinical Neurology: Movement Disorder Emergencies: Diagnosis and Treatment, Frucht SI, Fahn S. (Eds), Humana Press, Totowa, NJ 2005. p.53.
- Clinebell K, Azzam PN, Gopalan P, Haskett R. Guidelines for preventing common medical complications of catatonia: case report and literature review. J Clin Psychiatry 2014; 75:644.
- Fink M, Taylor MA. Catatonia: subtype or syndrome in DSM? Am J Psychiatry 2006; 163:1875.
- Taylor MA, Abrams R. Catatonia. Prevalence and importance in the manic phase of manic-depressive illness. Arch Gen Psychiatry 1977; 34:1223.
- Taylor MA, Fink M. Catatonia in psychiatric classification: a home of its own. Am J Psychiatry 2003; 160:1233.
- Rosebush PI, Hildebrand AM, Furlong BG, Mazurek MF. Catatonic syndrome in a general psychiatric inpatient population: frequency, clinical presentation, and response to lorazepam. J Clin Psychiatry 1990; 51:357.
- Rosebush PI, Mazurek MF. Catatonia and its treatment. Schizophr Bull 2010; 36:239.
- Daniels J. Catatonia: clinical aspects and neurobiological correlates. J Neuropsychiatry Clin Neurosci 2009; 21:371.
- Hawkins JM, Archer KJ, Strakowski SM, Keck PE. Somatic treatment of catatonia. Int J Psychiatry Med 1995; 25:345.
- Martényi F, Metcalfe S, Schausberger B, Dossenbach MR. An efficacy analysis of olanzapine treatment data in schizophrenia patients with catatonic signs and symptoms. J Clin Psychiatry 2001; 62 Suppl 2:25.
- Angelopoulos EK, Corcondilas M, Kollias CT, et al. A case of catatonia successfully treated with ziprasidone, in a patient with DSM-IV delusional disorder. J Clin Psychopharmacol 2010; 30:745.
- Levy WO, Nunez CY. Use of ziprasidone to treat bipolar-associated catatonia. Bipolar Disord 2004; 6:166.
- Grenier E, Ryan M, Ko E, et al. Risperidone and lorazepam concomitant use in clonazepam refractory catatonia: a case report. J Nerv Ment Dis 2011; 199:987.
- Lee JW. Neuroleptic-induced catatonia: clinical presentation, response to benzodiazepines, and relationship to neuroleptic malignant syndrome. J Clin Psychopharmacol 2010; 30:3.
- Carroll BT, Lee JW. Catatonia is a risk factor for neuroleptic malignant syndrome. J Clin Psychiatry 2004; 65:1722.
- Berardi D, Dell'Atti M, Amore M, et al. Clinical risk factors for neuroleptic malignant syndrome. Hum Psychopharmacol 2002; 17:99.
- White DA, Robins AH. Catatonia: harbinger of the neuroleptic malignant syndrome. Br J Psychiatry 1991; 158:419.
- Strawn JR, Keck PE Jr, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry 2007; 164:870.
- White DA, Robins AH. An analysis of 17 catatonic patients diagnosed with neuroleptic malignant syndrome. CNS Spectr 2000; 5:58.
- Freudenreich O, Nejad SH, Francis A, Fricchione GL. Psychosis, mania, and catatonia. In: Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition, Levenson JL. (Ed), American Psychiatric Publishing, Washington, DC 2011. p.219.
- Trollor JN, Chen X, Sachdev PS. Neuroleptic malignant syndrome associated with atypical antipsychotic drugs. CNS Drugs 2009; 23:477.
- Paparrigopoulos T, Tzavellas E, Ferentinos P, et al. Catatonia as a risk factor for the development of neuroleptic malignant syndrome: report of a case following treatment with clozapine. World J Biol Psychiatry 2009; 10:70.
- Falkai P, Wobrock T, Lieberman J, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, Part 1: acute treatment of schizophrenia. World J Biol Psychiatry 2005; 6:132.
- American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia, Second Edition, 2004 http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx (Accessed on May 10, 2011).
- Bipolar disorder: The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. National Institute for Health and Clinical Excellence clinical guideline 38, 2006 http://guidance.nice.org.uk/CG38 (Accessed on May 11, 2011).
- American Psychiatric Association Practice Guideline for the Treatment of Patients With Bipolar Disorder, Second Edition, 2002. http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx (Accessed on May 11, 2011).
- American Psychiatric Association Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition, 2010. http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx (Accessed on May 11, 2011).
- Bush G, Fink M, Petrides G, et al. Catatonia. II. Treatment with lorazepam and electroconvulsive therapy. Acta Psychiatr Scand 1996; 93:137.
- van Waarde JA, Tuerlings JH, Verwey B, van der Mast RC. Electroconvulsive therapy for catatonia: treatment characteristics and outcomes in 27 patients. J ECT 2010; 26:248.
- Fink M, Taylor MA. Catatonia: A Clinician's Guide to Diagnosis and Treatment, Cambridge University Press, Cambridge, UK 2003.
- Koek RJ, Mervis JR. Treatment-refractory catatonia, ECT, and parenteral lorazepam. Am J Psychiatry 1999; 156:160.
- Schmider J, Standhart H, Deuschle M, et al. A double-blind comparison of lorazepam and oxazepam in psychomotor retardation and mutism. Biol Psychiatry 1999; 46:437.
- Fink M, Taylor MA. The many varieties of catatonia. Eur Arch Psychiatry Clin Neurosci 2001; 251 Suppl 1:I8.
- Hung YY, Huang TL. Lorazepam and diazepam for relieving catatonic features in multiple sclerosis. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1537.
- Tsai MC, Huang TL. Lorazepam and diazepam for relieving catatonic features precipitated by initial hemodialysis in a uremic patient: a case report. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:423.
- Hung YY, Huang TL. Lorazepam and diazepam rapidly relieve catatonic features in major depression. Clin Neuropharmacol 2006; 29:144.
- Huang TL. Lorazepam and diazepam rapidly relieve catatonic signs in patients with schizophrenia. Psychiatry Clin Neurosci 2005; 59:52.
- McEvoy JP, Lohr JB. Diazepam for catatonia. Am J Psychiatry 1984; 141:284.
- Delisle JD. Catatonia unexpectedly reversed by midazolam. Am J Psychiatry 1991; 148:809.
- Benazzi F. Parenteral clonazepam for catatonia. Can J Psychiatry 1991; 36:312.
- Kumar R. Acute severe catatonia in a young woman with chronic schizophrenia responding to parenteral clonazepam. Aust N Z J Psychiatry 2001; 35:391.
- Cottencin O, Warembourg F, de Chouly de Lenclave MB, et al. Catatonia and consultation-liaison psychiatry study of 12 cases. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1170.
- Northoff G. What catatonia can tell us about "top-down modulation": a neuropsychiatric hypothesis. Behav Brain Sci 2002; 25:555.
- McCall WV, Shelp FE, McDonald WM. Controlled investigation of the amobarbital interview for catatonic mutism. Am J Psychiatry 1992; 149:202.
- Ungvari GS, Caroff SN, Gerevich J. The catatonia conundrum: evidence of psychomotor phenomena as a symptom dimension in psychotic disorders. Schizophr Bull 2010; 36:231.
- Ungvari GS, Chiu HF, Chow LY, et al. Lorazepam for chronic catatonia: a randomized, double-blind, placebo-controlled cross-over study. Psychopharmacology (Berl) 1999; 142:393.
- Nisijima K, Ishiguro T. Electroconvulsive therapy for the treatment of neuroleptic malignant syndrome with psychotic symptoms: a report of five cases. J ECT 1999; 15:158.
- Trollor JN, Sachdev PS. Electroconvulsive treatment of neuroleptic malignant syndrome: a review and report of cases. Aust N Z J Psychiatry 1999; 33:650.
- Ungvari GS, Leung CM, Wong MK, Lau J. Benzodiazepines in the treatment of catatonic syndrome. Acta Psychiatr Scand 1994; 89:285.
- Tharyan P, Adams CE. Electroconvulsive therapy for schizophrenia. Cochrane Database Syst Rev 2005; :CD000076.
- Manjunatha N, Saddichha S, Khess CR. Idiopathic recurrent catatonia needs maintenance lorazepam: case report and review. Aust N Z J Psychiatry 2007; 41:625.
- American Psychiatric Association Task Force on Electroconvulsive Therapy. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. American Psychiatric Association, Washington, DC 2001.
- Fam J, Lee TS, Lee HY, Ng BY. Electroconvulsive therapy for catatonia in neuropsychiatric systemic lupus erythematosus. J ECT 2010; 26:143.
- Gupta N, Pennell I, Hargovan H. Relief of catatonia associated with concurrent relief of sigmoid volvulus after electroconvulsive therapy. J ECT 2010; 26:134.
- Romanowicz M, Sola CL. Electroconvulsive therapy-responsive catatonia in a medically complicated patient. J ECT 2010; 26:234.
- Petrides G, Divadeenam KM, Bush G, Francis A. Synergism of lorazepam and electroconvulsive therapy in the treatment of catatonia. Biol Psychiatry 1997; 42:375.
- Espínola-Nadurille M, Ramírez-Bermúdez J, Fricchione GL. Pregnancy and malignant catatonia. Gen Hosp Psychiatry 2007; 29:69.
- Martyn JA, Richtsfeld M. Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology 2006; 104:158.
- Pontikes TK, Dinwiddie SH. Electroconvulsive therapy in a patient with multiple sclerosis and recurrent catatonia. J ECT 2010; 26:270.
- Kritzinger PR, Jordaan GP. Catatonia: an open prospective series with carbamazepine. Int J Neuropsychopharmacol 2001; 4:251.
- McDaniel WW, Spiegel DR, Sahota AK. Topiramate effect in catatonia: a case series. J Neuropsychiatry Clin Neurosci 2006; 18:234.
- Krüger S, Bräunig P. Intravenous valproic acid in the treatment of severe catatonia. J Neuropsychiatry Clin Neurosci 2001; 13:303.
- Yoshida I, Monji A, Hashioka S, et al. Prophylactic effect of valproate in the treatment for siblings with catatonia: a case report. J Clin Psychopharmacol 2005; 25:504.
- Zaw ZF, Bates GD. Replication of zolpidem test for catatonia in an adolescent. Lancet 1997; 349:1914.
- Thomas P, Rascle C, Mastain B, et al. Test for catatonia with zolpidem. Lancet 1997; 349:702.
- Carpenter SS, Hatchett AD, Fuller MA. Catatonic schizophrenia and the use of memantine. Ann Pharmacother 2006; 40:344.
- Thomas C, Carroll BT, Maley RT, et al. Memantine and catatonic schizophrenia. Am J Psychiatry 2005; 162:626.
- Munoz C, Yulan N, Achaval V, et al. Memantine in major depression with catatonic features. J Neuropsychiatry Clin Neurosci 2008; 20:119.
- Carroll BT, Goforth HW, Thomas C, et al. Review of adjunctive glutamate antagonist therapy in the treatment of catatonic syndromes. J Neuropsychiatry Clin Neurosci 2007; 19:406.
- Tang CP, Leung CM, Ungvari GS, Leung WK. The syndrome of lethal catatonia. Singapore Med J 1995; 36:400.
- Clark T, Rickards H. Catatonia. 2: Diagnosis, management and prognosis. Hosp Med 1999; 60:812.
- Francis A, Divadeenam KM, Bush G, Petrides G. Consistency of symptoms in recurrent catatonia. Compr Psychiatry 1997; 38:56.
- DEFINITION OF CATATONIA
- Setting and management
- Underlying disorder
- - Avoid dopamine blocking drugs
- Treatment algorithm
- - Malignant catatonia
- - Retarded or excited catatonia
- Benzodiazepine safety and administration
- Electroconvulsive therapy safety and administration
- Other treatments
- LONG-TERM PROGNOSIS
- SUMMARY AND RECOMMENDATIONS