The New England Journal of MedicineCatatonia

Unraveling the Enigma of a Multifaceted Psychiatric Syndrome

Catatonia, a complex psychiatric syndrome, has long been misunderstood and often misdiagnosed. This comprehensive review explores the intricacies of catatonia, its varied presentations across different clinical settings, and the recent changes in its classification. The article reinforces the need for heightened awareness and understanding of catatonia among physicians to ensure accurate diagnosis and appropriate treatment.

Key Points

• Catatonia was recognized as an independent diagnostic entity by the International Classification of Diseases, 11th revision (ICD-11) in 2022.
• Catatonia presents in various forms, ranging from subtle behavioral abnormalities to malignant, potentially lethal forms.
• Catatonia is common in psychiatric emergency rooms and inpatient units, with prevalence estimates ranging from 9 to 30%.
• Catatonia can present in three clinical settings: the emergency department, medical units, and psychiatric settings.
• In the emergency department, catatonia often presents as failure to respond to questioning (mutism) and very little spontaneous movement (stupor).
• In medical units, catatonia requires extensive diagnostic efforts as it can be associated with numerous underlying disorders.
• In psychiatric settings, catatonia may present in less severe forms such as elective mutism or ambitendency.
• The primary treatment of catatonia includes lorazepam administration and electroconvulsive therapy (ECT), both leading to a response in 60 to 100% of patients.

According to a study published in the Journal of Clinical Psychiatry, catatonia is present in up to 38% of acute psychiatric inpatients, a statistic significantly higher than previously thought.

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