Diagnosing and Treating Catatonia: An Update

Catatonia is a severe neuropsychiatric syndrome comprising a variety of signs and symptoms ranging from simple motor signs to complex behavioural abnormalities. If recognized and treated early, catatonia usually has an excellent prognosis. Observation and psychiatric interview will not suffice to detect the catatonic syndrome, since the most striking symptoms such as posturing, are present only in a minority of the cases. Therefore, catatonic signs should be elicited during a neuropsychiatric examination. Patients with severe psychiatric conditions, such as bipolar disorder, depression or schizophrenia, should be examined routinely for catatonic signs and symptoms. A number of rating scales, such as the Bush-Francis Catatonia Rating Scale, are available offering the clinician a scheme to aid neuropsychiatric examination. The most robust argument for identifying catatonia as a separate syndrome is that it has a rather specific treatment, either benzodiazepines or electroconvulsive therapy (ECT), irrespective of the underlying etiology. Among the benzodiazepines, lorazepam is the best studied and is currently used as first line treatment for catatonia. ECT in recent clinical practice is usually considered as second line treatment for the syndrome, although in certain conditions, especially in malignant catatonia, its early administration could be lifesaving. A further issue supporting the use of ECT in catatonia is that regardless of the origin of the condition it is effective, while certain antipsychotics or antidepressants can even worsen catatonic phenomena if they go unrecognized.