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Catatonia

Nature Reviews Disease Primers volume 10, Article number: 49 (2024) Cite this article

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Abstract

Catatonia is a neuropsychiatric disorder characterized by motor, affective and cognitive–behavioural signs, which lasts from hours to days. Intensive research over the past two decades has led to catatonia being recognized as an independent diagnosis in the International Classification of Diseases, 11th Revision (ICD-11) since 2022. Catatonia is found in 5–18% of inpatients on psychiatric units and 3.3% of inpatients on medical units. However, in an unknown number of patients, catatonia remains unrecognized and these patients are at risk of life-threatening complications. Hence, recognizing the symptoms of catatonia early is crucial to initiate appropriate treatment to achieve a favourable outcome. Benzodiazepines such as lorazepam and diazepam, electroconvulsive therapy, and N-methyl-d-aspartate antagonists such as amantadine and memantine, are the cornerstones of catatonia therapy. In addition, dopamine-modulating second-generation antipsychotics (for example, clozapine and aripiprazole) are effective in some patient populations. Early and appropriate treatment combined with new screening assessments has the potential to reduce the high morbidity and mortality associated with catatonia in psychiatric and non-psychiatric settings.

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Fig. 1: Overview of the neurotransmitter systems (biochemical level) and brain networks (system level) involved in the pathogenesis of catatonia.
Fig. 2: LCT algorithm in urgent and low suspicion of catatonia.
Fig. 3: An algorithm for the management of catatonia.

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Acknowledgements

The authors thank all study participants who took part in the numerous studies conducted by the authors.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    Dusan Hirjak, Stefan Fritze & Andreas Meyer-Lindenberg

  2. German Centre for Mental Health (DZPG), Partner site Mannheim, Mannheim, Germany

    Dusan Hirjak & Andreas Meyer-Lindenberg

  3. Division of Psychiatry, University College London, London, UK

    Jonathan P. Rogers

  4. Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany

    Robert Christian Wolf & Katharina Maria Kubera

  5. Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Jo Ellen Wilson

  6. Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

    Jo Ellen Wilson

  7. Geriatric Research, Education and Clinical Center (GRECC), Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA

    Jo Ellen Wilson

  8. Department of Neuroscience (DNS), University of Padova, Padova, Italy

    Fabio Sambataro

  9. Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Gregory Fricchione

  10. Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Western Australia, Australia

    Gabor S. Ungvari

  11. Section of Psychiatry, School of Medicine, University Notre Dame Australia, Fremantle, Western Australia, Australia

    Gabor S. Ungvari

  12. Mind, Brain Imaging and Neuroethics Research Unit, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada

    Georg Northoff

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  1. Dusan Hirjak
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  2. Jonathan P. Rogers
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  11. Georg Northoff
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Contributions

Introduction (D.H., G.F., G.N., G.S.U. and A.M.-L.); Epidemiology (D.H., G.N. and J.P.R.); Pathophysiology (D.H., G.N., F.S., R.C.W. and G.S.U.); Diagnosis, screening and prevention (D.H., G.N., J.E.W., S.F., F.S. and G.S.U.); Management (D.H., G.N., J.P.R., G.S.U., G.F. and F.S.); Quality of life (D.H., G.N., K.M.K. and S.F.); Outlook (D.H., G.N., A.M.-L. and G.S.U.); overview of the Primer (all authors).

Corresponding author

Correspondence to Dusan Hirjak.

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The authors declare no competing interests.

Peer review

Peer review information

Nature Reviews Disease Primers thanks A. Amad, J. J. Cooper, S. K. Grover, S. N. Caroff and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Related links

BAP guidelines: https://www.bap.org.uk/pdfs/BAP_Guidelines-Catatonia.pdf

Bush–Francis Catatonia Rating Scale Assessment Resources: https://www.urmc.rochester.edu/psychiatry/divisions/collaborative-care-and-wellness/bush-francis-catatonia-rating-scale.aspx

Northoff Catatonia Rating Scale Assessment Resources: http://www.georgnorthoff.com/scales

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Hirjak, D., Rogers, J.P., Wolf, R.C. et al. Catatonia. Nat Rev Dis Primers 10, 49 (2024). https://doi.org/10.1038/s41572-024-00534-w

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