Catatonia

Catatonia is a syndrome, not a discrete illness, and was first recognized by Kahlbaum in the 19th century. Catatonia is underdiagnosed and often goes unrecognized despite its clinical significance and treatment implications. The syndrome’s motor symptoms include muteness, rigidity, and stupor. Catatonia has been associated with various psychiatric, medical, and neurologic disorders and is no longer only considered a subtype of schizophrenia. There is no known etiology, but its rapid improvement with benzodiazepines suggests that γ-aminobutyric acid (GABA), an inhibitory neurotransmitter, is involved. Patients displaying catatonic symptoms should have a comprehensive evaluation to rule out medical and neurologic causes and to assess hydration and nutritional status. Patients can have significant nursing care needs, and some might need tube feedings. Benzodiazepines are the first-line treatment, with electroconvulsive therapy reserved for those who fail to respond or have an inadequate response to benzodiazepines. Psychiatrists and other clinicians should understand the diagnosis and treatment of catatonia. This review contains 4 tables and 52 references Key words: bipolar disorder, catatonia, delirium, GABA, glutamate, major depressive disorder, schizophrenia