Catatonia

Specialty: Psychiatry.

• Catatonic syndrome
• catatonic stupor
• waxy flexibility with catalepsy

Why it occurs

• Bipolar disorder (manic or severe depressive phase)
• Schizophrenia (catatonic subtype)
• Autoimmune encephalitis (e.g., anti-NMDA receptor antibody encephalitis)
• Neuroleptic malignant syndrome
• Major depressive disorder with psychosis
• Severe metabolic alterations (hypercalcemia, hyponatremia, uremia)

Initial workup

Bush-Francis Catatonia Scale (BFCRS); analysis with serum CPK, ions, kidney and liver function; lumbar puncture and CSF antibody panel to rule out autoimmune encephalitis; EEG to rule out nonconvulsive status epilepticus.

Standard management

• Lorazepam — administered IV at doses of 1 to 2 mg; a response of dramatic improvement within 30 minutes confirms the diagnosis and is the basis of initial treatment
• Electroconvulsive Therapy — ECT) (treatment of choice and maximum effectiveness if lorazepam fails or if there is vital compromise/malignant catatonia
• Memantine — NMDA antagonist, sometimes used in a complementary way
• *Critical note: Completely avoid typical antipsychotics such as haloperidol, as they can precipitate or drastically worsen catatonia or induce neuroleptic malignant syndrome.*