Steven L. Dubovsky, MD Professor and Chair Department of Psychiatry State University of New York at Buffalo Buffalo, New York Adjoint Professor of Psychiatry and Medicine University of Colorado Aurora, Colorado
Amelia N. Dubovsky, MD Assistant Professor Department of Psychiatry University of Washington Seattle, Washington
Disclosures Dr. Steven L. Dubovsky receives grant or research support from Allergan, Janssen, Neurim, Neurocrine, and Tower Foundation. Dr. Amelia N. Dubovsky reports no financial relationships with any company whose products are mentioned in this article, or with manufacturers of competing products.
The response to benzodiazepines or ECT can vary from episode to episode11 and is similar in adults and younger patients.22 Many patients recover completely after a single episode, while relapse after remission occurs repeatedly in periodic catatonia, which involves chronic alternating stupor and excitement waxing and waning over years.11 Relapses may occur frequently, or every few years.11 Some cases of catatonia initially have an episodic course and become chronic and deteriorating, possibly paralleling the original descriptions of the natural history of untreated catatonia, while malignant catatonia can be complicated by medical morbidity or death.4 The long-term prognosis generally depends on the underlying cause of catatonia.5
Bottom Line
Much more common than many clinicians realize, catatonia can be overlooked because symptoms can mimic or overlap with features of an underlying medical or neurologic disorder. Suspect catatonia when one of these illnesses has an unexpected course or an inadequate treatment response. Be alert to characteristic changes in behavior and speech. A benzodiazepine challenge can be used to diagnose and begin treatment of catatonia. Consider electroconvulsive therapy sooner rather than later, especially for severely ill patients.
Related Resources
Gibson RC, Walcott G. Benzodiazepines for catatonia in people with schizophrenia and other serious mental illnesses. Cochrane Database Syst Rev. 2008;(4):CD006570.
