Definition

Catatonia is a condition marked by changes in muscle
tone or activity associated with a large number of
serious mental and physical illnesses. There are two distinct
sets of symptoms that are characteristic of this condition.
In catatonic stupor the individual experiences a
deficit of motor (movement) activity that can render
him/her motionless. Catatonic excitement, or excessive
movement, is associated with violent behavior directed
toward oneself or others.

Features of catatonia may also be seen in Neuroleptic
Malignant Syndrome (NMS) which is an uncommon (but
potentially lethal) reaction to some medications used to
treat major mental illnesses. NMS is considered a medical
emergency since 25% of untreated cases result in death.
Catatonia can also be present in individuals suffering
from a number of other physical and emotional conditions
such as drug intoxication, depression, and schizophrenia.
It is most commonly associated with mood disorders.

Description

In catatonic stupor, motor activity may be reduced to
zero. Individuals avoid bathing and grooming, make little
or no eye contact with others, may be mute and rigid, and
initiate no social behaviors. In catatonic excitement the
individual is extremely hyperactive although the activity
seems to have no purpose. Violence toward him/herself
or others may also be seen.

NMS is observed as a dangerous side effect associated
with certain neuroleptic (antipsychotic) drugs such as
haloperidol (Haldol). It comes on suddenly and is characterized
by stiffening of the muscles, fever, confusion
and heavy sweating.

Catatonia can also be categorized as intrinsic or
extrinsic. If the condition has an identifiable cause, it is
designated as extrinsic. If no cause can be determined
following physical examination, laboratory testing, and
history taking, the illness is considered to be intrinsic.

Causes and symptoms

The causes of catatonia are largely unknown
although research indicates that brain structure and function
are altered in this condition. While this and other
information point to a physical cause, none has yet been
proven. A variety of medical conditions also may lead to
catatonia including head trauma, cerebrovascular disease,
encephalitis, and certain metabolic disorders. NMS is an
adverse side effect of certain antipsychotic drugs.

A variety of symptoms are associated with catatonia.
Among the more common are echopraxia (imitation of
the gestures of others) and echolalia (parrot-like repetition
of words spoken by others). Other signs and symptoms
include violence directed toward him/herself, the
assumption of inappropriate posture, selective mutism,
negativism, facial grimaces, and animal-like noises.

Catatonic stupor is marked by immobility and a behavior
known as cerea flexibilitas (waxy flexibility) in which
the individual can be made to assume bizarre (and sometimes
painful) postures that they will maintain for extended
periods of time. The individual may become dehydrated and
malnourished because food and liquids are refused. In
extreme situations such individuals must be fed through a
tube. Catatonic excitement is characterized by hyperactivity
and violence; the individual may harm him/herself or others.
On rare occasions, isolation or restraint may be needed
to ensure the individual