Catatonia: Treatment and prognosis
- 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 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
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- 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