Understanding Catatonia: Symptoms and Treatment

Catatonia is a form of acute brain dysfunction characterized by psychomotor, neurological, and behavioral changes, and severe autonomic abnormalities that interfere with automatic body functions such as heart rate, blood pressure, digestion, and temperature regulation. Accordingly, in severe cases, individuals suffering from catatonia may require emergency treatment.

In a catatonic state, the individual can’t move, speak, or respond to stimuli. Often accompanied by a blank stare into the distance, without recognition of the surrounding environment. Perhaps, we all occasionally drift away from reality, escaping for a moment into a dream world, disconnected from current situations. However, catatonia does not always express itself through stupor, occasionally people with catatonia may exhibit excessive movement and agitated behavior.

Key Definition:

Catatonia is a neuropsychiatric syndrome characterized by a range of behavioral disturbances, including immobility, excessive motor activity, and peculiarities of voluntary movement. It can be associated with various medical and psychiatric conditions, such as schizophrenia, bipolar disorder, or other mental health issues. Treatment typically involves a combination of medication and therapy, tailored to the underlying cause of the catatonic symptoms. If you need more specific information on catatonia, please let me know.

Introduction

Law-enforcement often used the term “excited delirium” to describe a person’s psychological state. The law enforcement description of the behaviors associated with this term resembles the delirious mania -subsection of catatonia. The individual’s manic behaviors, their inability to properly respond to external stimuli (verbal commands) and the enforcement officer’s responsibilities to protect others and the individual, creates a horrible mismatch and dangerous encounters.

Catatonia is a neuropsychiatric disorder that affects a person’s behavior and motor functions. It can manifest in various ways, including stupor (inability to move, speak, or respond to stimuli), lack of verbal response, echolalia (repetition of another person’s spoken words), echopraxia (involuntary repetition of another person’s actions), agitation, mutism, and rigid body posture.

History

Researchers have studied catatonia since German psychiatrist Karl Kahlbaum named and described it in 1874, but it remains highly underdiagnosed. Part of this is because, until recent decades, practitioners mistakenly believed that catatonia only occurred in people with schizophrenia. Further challenges to diagnosis include disagreement within psychiatry on how many criteria and which criteria are required to diagnose catatonia. In addition, some catatonic signs, such as agitation and mutism, overlap with other conditions, most notably delirium.

Symptoms and Signs of Catatonia

Motor and Movement

Automatic Obedience: the patient is excessively cooperative and obedient to the examiner’s instructions.
Ambitendency: the patient alternates between resistance to and cooperation with instructions; for example, when asked to shake hands, the patient may repeatedly extends and withdraws the hand.
Posturing: the patient can stay in the same position for a long time. A classic example is the ‘crucifix’. An extreme form of posturing is catalepsy. Catalepsy is a nervous condition characterized by muscular rigidity and fixity of posture regardless of external stimuli, often associated with loss of responsiveness.
Waxy Flexibility (cerea flexibilitas): the examiner can make the patient hold very uncomfortable positions for a long time.
Negativism (Gegenhalten): the patient resists any attempts to move their body parts and, according to the original definition, the resistance is exactly equal to the strength applied.
Psychological Pillow: the patient lies down with their head a bit higher than the bed and can stay like this for a long time.
Forced grasping: the patient forcibly and repeatedly grasps the examiner’s hand, arm, or any available body part.
Obstruction: the patient suddenly stops in the course of a movement without a reason.
Echopraxia: the patient imitates the actions of the interviewer.
Aversion: the patient turns away from the examiner when addressed.
Mannerisms: these are repetitive, goal-directed movements (e.g. saluting).
Stereotypies: These are repetitive, regular movements with no underlying purpose (e.g. rocking).
Motor Preservation: The patient persists with a particular movement that has lost its initial relevance.

States and Speech

Stupor: the classic catatonic indication is stupor. It encompasses immobility and mutism, although each can also manifest independently.
Excitement: the patient displays excessive, purposeless motor activity that is not influenced by external stimuli.
Speech Abnormalities: Echolalia, logorrhea and verbigeration are the main speech abnormalities in catatonia. Echolalia refers to the repetition of the examiner’s words. Logorrhea is characterized by incessant, incoherent and usually monotonous speech. Verbigeration is a form of verbal perseveration in which the patient repeats certain syllables (logoclonia), words (palilalia), phrases or sentences.
Other Catatonic Signs: in addition to prominent catatonic signs, the patient exhibits hyperpyrexia, clouding of consciousness and autonomic instability, clinicians should consider a diagnosis of lethal or malignant catatonia.

Subtypes of Catatonia

Subtypes of catatonia include:

Non-Malignant (Kahlbaum Syndrome).
Catatonic excitement (Delirious Mania): Individuals are hyperactive and show purposeless agitation.
Malignant catatonia (MC): Malignant catatonia is the most dangerous form of catatonia. Medical professionals commonly refer to it as catatonia presenting with autonomic dysfunction (Connell et al., 2023).

Causes of Catatonia

Medical research has yet to identify an exact cause for catatonia. However, we know it is associated with irregularities in neurotransmitter levels often linked to mental illnesses like mood disorders, schizophrenia, and medical conditions such as infections or severe vitamin B12 deficiency. It can also be a side effect of certain medications physician’s use to treat mental illnesses. Withdrawal from medications like clozapine may also cause catatonia.

Some illegal drugs, most notably phencyclidine (PCP), also can cause catatonic states.

An extreme experience, such as a traumatic event, a severe infection, or a drug overdose, can potentially trigger catatonia in some people, especially if they have a predisposing condition or a genetic vulnerability. However, this is not always the case, and the exact mechanism of how an extreme experience can ignite catatonia is not fully understood.

Diagnosis and Treatment of Catatonia

Diagnosis involves ruling out other conditions and comparing symptoms with standard manuals like the DSM criteria. Treatment options include medications such as benzodiazepines, which are the first line of treatment, and electroconvulsive therapy (ECT), especially when pharmacotherapy doesn’t work (Sedain, 2015; Connell et al., 2023).

When a patient doesn’t respond to benzodiazepines or electroconvulsive therapy other treatment options may include:

Mood stabilizers: especially carbamazepine
Antipsychotics
NMDA antagonists: amantadine and memantine
Dopamine agonists (e.g. bromocriptine) and skeletal muscle relaxants (e.g. dantrolene), especially when, physician suspects neuroleptic malignant syndrome (Sedain, 2015).

If you are seeking help for someone exhibiting signs and symptoms of catatonia there are specialists who treat catatonia include neurologists, who specialize in diseases of the nervous system, and mental health professionals. Because malignant catatonia may cause serious injury or death, seeking medical help immediately is essential.

Associated Concepts

Psychosis: This refers to a severe mental condition where thought and emotions lose contact with external reality.
Brief Psychotic Disorder: This disorder is a time-limited mental illness with sudden onset of severe psychotic symptoms. Markedly, this disorder typically lasts less than a month and is often triggered by stress.
Alexithymia: This is a complex disorder characterized by difficulty identifying and expressing emotions, often co-occurring with other mental health issues like autism and depression. Individuals with alexithymia struggle to perceive and describe their feelings, leading to challenges in relationships and coping with stress.
Dissociative Disorders: These disorders, formerly known as hysteria, are characterized by a disconnection between thoughts, memories, surroundings, actions, and identity. They provide an escape from stress and discomfort but can interfere with everyday life and relationships.
Paraphrenia: This is a psychiatric condition characterized by chronic delusions, typically seen in late life. It is often considered a subtype of schizophrenia due to the presence of delusions, but with less pronounced symptoms such as hallucinations or disorganized speech.
Dementia Praecox: This disorder is now known as schizophrenia, was historically characterized by symptoms like hallucinations, delusions, and emotional withdrawal.

A Few Words by Psychology Fanatic

A person lost in a catatonic state presents a significant threat to themselves and those around them. They often fail to respond to normal stimuli in the environment. Often subjects in a catatonic state lose normal future oriented behavioral control and may harm themselves or others. Accordingly, an individual in a catatonic state presents a unique and dangerous challenge for law enforcement, catatonia nullifies the effectiveness of most common law enforcements tactics such as verbal directions and pain compliance. Yet, because they often present a significant danger to themselves and the community, law enforcement officers must take some action to ensure the safety of those involved.

If you or someone you know is exhibiting symptoms of catatonia, it’s important to seek medical attention immediately. For more consult with a mental health professional.

Last Update: February 28, 2026

References:

Connell, J., Oldham, M., Pandharipande, P., Dittus, R., Wilson, A., Mart, M., Heckers, S., Ely, E., & Wilson, J. (2023). Malignant Catatonia: A Review for the Intensivist. Journal of Intensive Care Medicine, 38(2), 137-150. DOI: 10.1177/08850666221114303
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Kahlbaum, Karl Ludwig (1874). Die Katatonie, oder, Das Spannungsreihe: eine klinische Form psychischer Krankheit.
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Sedain, C. P. (2015). Catatonia. Journal of Psychiatrists’ Association of Nepal. DOI: 10.3126/jpan.v3i3.11838
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