II. Definitions
- Catatonia
- Neuropsychiatric disorder with abnormal movement and behavior (e.g. immobility, stupor, mutism)
- Most commonly due to underlying psychiatric cause
- Catalepsy
- Decreased responsiveness in a trance-like state
- Muscle rigidity and patient maintains positions in which they are placed despite being against gravity
- Waxy Flexibility
- Resistance to movement when passively repositioning extremities (similar to bending a wax candle)
III. Epidemiology
-
Incidence
- Inpatient Psychiatry: 5-20% (esp. Schizophrenia)
- Overall Psychiatric Ilness: <2%
IV. Types
- Excited Catatonia
- Retarded Catatonia
- Malignant Catatonia (lethal Catatonia)
- See Complications below
V. Signs
- Motor
- Immobility
- Muscular rigidity
- Posturing or grimacing
- Echopraxia (mimics movement in others)
- Stereotypical or repetitive movement (e.g. picking at clothes, staring, repeated odd gestures)
- Catalepsy
- Waxy Flexibility
- Verbal
- Non-verbal (mutism)
- Echolalia (repetitive nonsensical speech)
- Mental State
- Stupor
- Failure to follow commands (negativism)
- Other features
- May be labile with sudden outbursts of Agitation, Hallucinations, panic
VI. Causes
- Most common causes
- Other causes
VII. Differential Diagnosis
- Neuroleptic Malignant Syndrome
- Serotonin Syndrome
- Encephalitis (including NMDA Encephalitis)
- Non-convulsive Status Epilepticus
- Advanced Parkinsonism
- Neurologic Injury (e.g. CVA, CNS Mass)
VIII. Management
-
Benzodiazepines are the mainstay of management
- Lorazepam 1-2 mg IV
- Consider Electroconvulsive Therapy
- Avoid Antipsychotic Medications unless specifically directed by psychiatry
- Antipsychotics risk worsening Catatonia
IX. Complications: Malignant Catatonia
- Malignant Catatonia (lethal Catatonia) is a rare type of Catatonia with risk of death within days
- Presents in similar fashion to Malignant Hyperthermia (but without drug trigger)
- Fever and diaphoresis
- Muscle Rigidity
- Labile Blood Pressure
- Evaluate broadly
- Poison control or toxicology Consultation
- Psychiatry Consultation
X. References
- Burrow (2021) Catatonia, StatPearls, accessed 8/6/2021
- Pensa and Werner (2021) EM:Rap 21(8): 13-4
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Related Studies
Definition (MSHCZE) | Chorobný stav strnulosti, která se pro zvýšené svalové napětí označuje jako "vosková" (flexibilitas cerea). Polohu (např. končetin) lze pasivně změnit proti určitému odporu a nová poloha (i velmi nepohodlná) je pak opět dlouhodobě udržována. Katalepsie bývá součástí katatonie (např. u schizofrenie), může být však také důsledkem poškození mozku po úrazu, po zánětech aj.(cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
Definition (MSH) | A condition characterized by inactivity, decreased responsiveness to stimuli, and a tendency to maintain an immobile posture. The limbs tend to remain in whatever position they are placed (waxy flexibility). Catalepsy may be associated with PSYCHOTIC DISORDERS (e.g., SCHIZOPHRENIA, CATATONIC), nervous system drug toxicity, and other conditions. |
Definition (PSY) | Condition of muscular semirigidity and trance-like postures. Cataleptic persons make no voluntary motor movements and may display waxy flexibility. |
Definition (CSP) | diminished responsiveness characterized by trancelike states and by rigidity of muscles; patient tends to remain in any position in which he is placed. |
Concepts | Mental or Behavioral Dysfunction (T048) |
MSH | D002375 |
English | Catalepsies, CATALEPSY, Anochlesias, Anochlesia, Catalepsy [Disease/Finding], catalepsy, Catalepsy |
French | CATALEPSIE, Catalepsie |
Portuguese | CATALEPSIA, Catalepsia |
Spanish | CATALEPSIA, Catalepsia |
German | KATALEPSIE, Katalepsie |
Dutch | katalepsie, Katalepsie |
Swedish | Katalepsi |
Japanese | カタレプシー, 強硬症, カタレプシー |
Czech | katalepsie, Katalepsie |
Finnish | Katalepsia |
Russian | KATALEPSIIA, КАТАЛЕПСИЯ |
Polish | Katalepsja |
Hungarian | Catalepsia |
Norwegian | Katalepsi, Catalepsia |
Italian | Catalessia |
Ontology: Catatonia (C0007398)
Definition (MSHCZE) | Pohybové abnormality vyvolané duševním stavem, obv. duševní chorobou. Projevují se buď nadměrnou aktivitou: stereotypní pohyby či mimika, grimasování nebo naopak sníženou aktivitou až ztuhnutím, stuporem v bizarních polohách, často po dlouhou dobu. K. se objevuje u schizofrenie, hysterie, epilepsie, ale i po náhlém zdrcujícím zážitku. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
Definition (MSH) | A neuropsychiatric disorder characterized by one or more of the following essential features: immobility, mutism, negativism (active or passive refusal to follow commands), mannerisms, stereotypies, posturing, grimacing, excitement, echolalia, echopraxia, muscular rigidity, and stupor; sometimes punctuated by sudden violent outbursts, panic, or hallucinations. This condition may be associated with psychiatric illnesses (e.g., SCHIZOPHRENIA; MOOD DISORDERS) or organic disorders (NEUROLEPTIC MALIGNANT SYNDROME; ENCEPHALITIS, etc.). (From DSM-IV, 4th ed, 1994; APA, Thesaurus of Psychological Index Terms, 1994) |
Definition (PSY) | Reaction characterized by muscular rigidity or stupor sometimes punctuated by sudden violent outbursts, panic, or hallucinations. |
Concepts | Mental or Behavioral Dysfunction (T048) |
MSH | D002389 |
SnomedCT | 192321002, 247917007, 76839006 |
LNC | LP121767-0, MTHU039945 |
English | Catatonias, CATATONIA, catatonia, catatonia (physical finding), demonstrated behavior catatonia, catatonia was seen, Catatonic, Catatonic state, Catatonia [Disease/Finding], catatonic, catatonic state, Catatonia, [X]Catatonic stupor, Catatonia (finding), Catatonia, NOS |
French | CATATONIE, Catatonique, Etat catatonique, Catatonie |
Portuguese | CATATONIA, Catatónico, Estado catatónico, Catatonia |
Spanish | CATATONIA, Catatónico, Estado catatónico, catatonía (hallazgo), catatonía, Catatonia |
German | KATATONIE, katatonischer Zustand, katatonisch, Katatonie |
Dutch | katatonisch, katatonische toestand, katatonie, Katatonie |
Italian | Catatonico, Stato catatonico, Catatonia |
Japanese | カタトニー状態, カタトニージョウタイ, カタトニー, 緊張病-悪性, 致死性緊張病, 致死緊張病, 緊張病-致死性, 緊張病症, カタトニー, 急性致死緊張病, 急性致死性緊張病, 緊張症, 緊張病-急性致死性, 緊張病, 悪性緊張病 |
Swedish | Katatoni |
Czech | katatonie, Katatonie, Katatonní stav, Katatonní |
Finnish | Katatonia |
Russian | KATATONIIA, КАТАТОНИЯ |
Polish | Katatonia |
Hungarian | Catatoniás állapot, Catatonia, Catatoniás |
Norwegian | Katatoni |
Ontology: Waxy flexibility (C0233612)
Concepts | Sign or Symptom (T184) |
MSH | D002375 |
SnomedCT | 13052006 |
English | Cerea flexibilitas, cerea flexibilitas, waxy flexibility, Flexibilitas, Cerea, Flexibilities, Waxy, Waxy Flexibilities, Flexibility, Waxy, Waxy Flexibility, Flexibilitas cerea, Waxy flexibility (finding), Waxy flexibility, Cerea Flexibilitas |
Italian | Flessibilità cerea, Cerea flexibilitas |
Dutch | flexibilitas cerea, wasachtige buigzaamheid, Flexibilitas cerea, Flexibiliteit, wasachtige |
Japanese | ろう屈症, ロウクツショウ |
Spanish | Cerea Flexibilitas, flexibilidad cerúlea (hallazgo), flexibilidad cerúlea, flexibilitas cerea, Flexibilidad cérea, Flexibilidad Cérea |
French | Flexibilité cireuse, Catalepsie, Flexibilité cireuse catatonique, Flexibilité cireuse de Wernicke |
German | Flexibilitas cerea, Beweglichkeit, wächserne |
Czech | Vosková ohebnost, Flexibilitas cerea, flexibilitas cerea, vosková flexibilita |
Hungarian | Viaszhajlékonyság, Flexibilitas cerea |
Norwegian | Voksaktig bevegelighet |
Portuguese | Flexibilidade cérea, Flexibilidade Cérea |