Catatonia is a disturbance of motor behavior that can have either a psychological or neurological cause. Its most well-known form involves a rigid, immobile position that is held by a person for a considerable length of time— often days, weeks, or longer. It can also refer to agitated, purposeless motor activity that is not stimulated by something in the environment. A less extreme form of catatonia involves very slowed motor activity. Often, the physical posture of a catatonic individual is unusual and/or inappropriate, and the individual may hold a posture if placed in it by someone else. According to the handbook used by mental health professionals to diagnose mental disorders, the Diagnostic and Statistical Manual of the American Psychiatric Association , 4th Edition, Text Revision, also known as the DSM-IV-TR , some 5–9% of all psychiatric inpatients show some catatonic symptoms. Of these, 25–50% are associated with mood disorders, 10–15% are associated with schizophrenia , and the remainder are associated with other mental disorders.
Types of catatonia
CATATONIC SCHIZOPHRENIA. As with all types of schizophrenia, the catatonic type, fortunately rare today, involves a marked disturbance in all spheres of life. As a schizophrenic disorder, the individual shows disturbances in thinking, feeling, and behavior. Most schizophrenics are unable to form meaningful intimate relationships or train for and sustain meaningful employment.
The catatonic type of schizophrenia is characterized by severe psychomotor disturbance. Individuals with this disorder show extreme immobility. They may stay in the same position for hours, days, weeks, or longer. The position they assume may be unusual and appear uncomfortable to the observer. If another person moves part of the catatonic individual's body, such as a limb, he or she may maintain the position into which they are placed, a condition known as "waxy flexibility." Sometimes catatonia presents itself as excessive motor activity, but the activity seems purposeless, and does not appear to fit with what is happening in the environment. In its most severe forms, whether stupor or agitation, the individual may need close supervision to keep from injuring him- or herself, or others.
DEPRESSION WITH CATATONIC FEATURES. Individuals who are severely depressed may show disturbances of motor behavior that is similar to that of catatonic schizophrenics, as previously described. They may be essentially immobile, or exhibit excessive but random-seeming motor activity. Extreme negativism, elective mutism (choosing not to speak), peculiar movements, mimicking words or phrases (known as "echolalia") or mimicking movements (known as "echopraxia") may also be part of the picture. Again, in its most extreme forms, catatonic stupor (not moving for hours, days, weeks, or longer), and catatonic activity (random-seeming activity) may necessitate supervision so that the individual does not hurt him- or herself, or others. Catatonic behaviors may also be seen in persons with other mood disorders, such as manic or mixed-mood states; these are also known as Bipolar I and Bipolar II disorders.
CATATONIC DISORDER DUE TO GENERAL MEDICAL CONDITION. Individuals with catatonia due to a medical condition may show symptoms similar to persons with catatonic schizophrenia and catatonic depression. However, the cause is believed to be physiological. Certain neurologic diseases, such as encephalitis, may cause catatonic symptoms that can be either temporary, or lasting.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.
Kaplan, Harold I., MD, and Benjamin J. Sadock, MD. Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 8th edition. Baltimore, MD: Lippincott Williams and Wilkins, 1998.
Barbara Sternberg, Ph.D.