Neurology Book



Aka: Catatonia, Catatonic, Catalepsy, Waxy Flexibility, Cerea Flexibilitas
  1. See Also
    1. Movement Disorder
  2. Definitions
    1. Catatonia
      1. Neuropsychiatric disorder with abnormal movement and behavior (e.g. immobility, stupor, mutism)
      2. Most commonly due to underlying psychiatric cause
    2. Catalepsy
      1. Decreased responsiveness in a trance-like state
      2. Muscle rigidity and patient maintains positions in which they are placed despite being against gravity
    3. Waxy Flexibility
      1. Resistance to movement when passively repositioning extremities (similar to bending a wax candle)
  3. Epidemiology
    1. Incidence
      1. Inpatient Psychiatry: 5-20% (esp. Schizophrenia)
      2. Overall Psychiatric Ilness: <2%
  4. Types
    1. Excited Catatonia
    2. Retarded Catatonia
    3. Malignant Catatonia (lethal Catatonia)
      1. See Complications below
  5. Signs
    1. Motor
      1. Immobility
      2. Muscular rigidity
      3. Posturing or grimacing
      4. Echopraxia (mimics movement in others)
      5. Stereotypical or repetitive movement (e.g. picking at clothes, staring, repeated odd gestures)
      6. Catalepsy
      7. Waxy Flexibility
    2. Verbal
      1. Non-verbal (mutism)
      2. Echolalia (repetitive nonsensical speech)
    3. Mental State
      1. Stupor
      2. Failure to follow commands (negativism)
    4. Other features
      1. May be labile with sudden outbursts of Agitation, Hallucinations, panic
  6. Causes
    1. Most common causes
      1. Schizophrenia
      2. Bipolar Disorder
    2. Other causes
      1. Major Depression
      2. Post-Traumatic Stress Disorder or Anxiety Disorder
      3. Autism
  7. Differential Diagnosis
    1. Neuroleptic Malignant Syndrome
    2. Serotonin Syndrome
    3. Encephalitis (including NMDA Encephalitis)
    4. Non-convulsive Status Epilepticus
    5. Advanced Parkinsonism
    6. Neurologic Injury (e.g. CVA, CNS Mass)
  8. Management
    1. Benzodiazepines are the mainstay of management
      1. Lorazepam 1-2 mg IV
    2. Consider Electroconvulsive Therapy
    3. Avoid Antipsychotic Medications unless specifically directed by psychiatry
      1. Antipsychotics risk worsening Catatonia
  9. Complications: Malignant Catatonia
    1. Malignant Catatonia (lethal Catatonia) is a rare type of Catatonia with risk of death within days
    2. Presents in similar fashion to Malignant Hyperthermia (but without drug trigger)
      1. Fever and diaphoresis
      2. Muscle Rigidity
      3. Labile Blood Pressure
    3. Evaluate broadly
      1. Poison control or toxicology Consultation
      2. Psychiatry Consultation
  10. References
    1. Burrow (2021) Catatonia, StatPearls, accessed 8/6/2021
    2. Pensa and Werner (2021) EM:Rap 21(8): 13-4

Catalepsy (C0007370)

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 )
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
Polish Katalepsja
Hungarian Catalepsia
Norwegian Katalepsi, Catalepsia
Italian Catalessia
Derived from the NIH UMLS (Unified Medical Language System)

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 )
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
Polish Katatonia
Hungarian Catatoniás állapot, Catatonia, Catatoniás
Norwegian Katatoni
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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