Catatonia and Neuroleptic Malignant Syndrome Management

Catatonia is a complex neuropsychiatric syndrome marked by disturbances in motor behaviour, ranging from stupor and immobility to agitation and posturing. Its aetiology spans psychiatric disorders, medical conditions and medication withdrawal. The initial management of catatonia centres on rapid recognition through clinical rating scales and prompt initiation of high-dose benzodiazepines, particularly lorazepam. For refractory cases, electroconvulsive therapy (ECT) remains the gold standard, often yielding dramatic improvement within days. Neuroleptic Malignant Syndrome (NMS) is an acute idiosyncratic reaction to dopamine-blocking agents characterised by rigidity, fever and autonomic instability. Effective management demands immediate cessation of causative agents, intensive supportive measures and, in selected cases, pharmacological interventions such as dantrolene or bromocriptine. Early diagnosis is critical to reducing morbidity and mortality. Emerging advances in neuroimaging, electrophysiology and machine learning are refining diagnostic precision, while ongoing research explores novel biomarkers and optimises therapeutic algorithms to enhance prognosis and guide personalised care worldwide.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Catatonia and Neuroleptic Malignant Syndrome Management publication trend

The graph below shows the total number of articles in catatonia and neuroleptic malignant syndrome management across all publications each year (not limited to Nature Index journals).

Technical terms

Catatonia: A neuropsychiatric syndrome marked by motor, behavioural and speech disturbances, often responsive to benzodiazepines.

Neuroleptic Malignant Syndrome (NMS): A life-threatening reaction to dopamine-blocking drugs characterised by rigidity, hyperthermia and autonomic dysfunction.

Benzodiazepine: A class of sedative-hypnotic agents that enhance gamma-aminobutyric acid (GABA) neurotransmission, first-line in catatonia treatment.

Electroconvulsive Therapy (ECT): A procedure inducing controlled seizures under anaesthesia, used for refractory catatonia with high efficacy.

Fractional Anisotropy (FA): A diffusion tensor imaging metric reflecting the directional coherence of white matter fibres, used to assess microstructural integrity.

Electroencephalogram (EEG): A non-invasive recording of cortical electrical activity, useful in evaluating the aetiology of catatonic states.

Dantrolene: A muscle-relaxant that inhibits calcium release from the sarcoplasmic reticulum, employed in NMS management.

References

1. Deciphering white matter microstructural alterations in catatonia according to ICD-11: replication and machine learning analysis. Molecular Psychiatry (2024).
2. The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracy. EClinicalMedicine (2023).
3. Drug information update. Atypical antipsychotics and neuroleptic malignant syndrome: Nuances and pragmatics of the association. BJPsych Bulletin (2017).