The Variants of the Catatonia

Authors: K. Látalová 1,2;  J. Praško  1 4;  M. Maršálek 5
Authors‘ workplace: Klinika psychiatrie FN Olomouc 1;  LF UP v Olomouci 2;  Centrum neuropsychiatrických studií, Praha 3;  Psychiatrické centrum Praha 4;  Psychiatrické léčebna Praha 8-Bohnice 5
Published in: Cesk Slov Neurol N 2009; 72/105(6): 518-524
Category: Review Article


Catatonia was originally described by Kahlbaum as a psychomotor syndrome involving motor, affective, and behavioral symptoms. At the beginning of the twentieth century it was generally accepted that catatonia is a motoric manifestation of schizophrenia. Today we see catatonia as an etiologically heterogeneous syndrome that may occur with many psychiatric disorders: organic, affective, psychological, and with schizophrenic psychosis. Catatonic symptoms may occur with disorders at borderline between psychiatry and neurology such as neuroleptic malignant syndrome, toxic serotonine syndrome, benign stupor, catatonic excitement and others. About 10% of patients with severe acute psychiatric illness exhibit motor signs of catatonia. Research implies that catatonia is a consequence of the hypoactivity of the dopaminergic system and its imbalance with the GABA system. Preexisting hypodopaminergic state has been proposed as a risk factor for catatonia. Such state may be a consequence of organic disorder, acute or chronic stress, antipsychotic treatment, or abrupt discontinuation of antipsychotics. Administration of benzodiazepines or electroconvulsive therapy are the primary treatment strategies.

Key words:
catatonia – neuroleptic malignant syndrome – serotonine syndrome – schizophrenia – mania


1. Kahlbaum KL. Catatonia (Die Katatonie oder das Span nungrirresien). Baltimore: Johns Hopkins University Press 1973.

2. Caroff SN, Mann SC, McCarthy M, Naser J, Rynn M, Morrison M. Acute infectious encephalitis complicated by neuroleptic malignant syndrome. J Clin Psychopharmacol 1998; 18(4): 349– 351.

3. Carroll BT, Anfinson TJ, Kennedy JC, Yendrek R, Boutros M, Bilon A. Catatonic disorder due to general medical conditions. J Neuropsychoat Clin Neurosci 1994; 6(2): 122– 133.

4. White DA. Catatonia and the neuroleptic malignant syndrome –  a single entity? Br J Psychiatry 1992; 161: 558– 560.

5. Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia: I. Rating scale and standardized examination. Acta Psychiatr Scand 1996; 93(2): 129– 136.

6. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005; 352(11): 1112– 1120.

7. Fink M. Neuroleptic malignant syndrome and catatonia: one entity or two? Biol Psychiatry 1996; 39(1): 1– 4.

8. Keck PE jr, Pope HG jr, Cohen BM, McElroy SL, Nierenberg AA. Risk factors for neuroleptic malignant syndrome. A case control study. Arch Gen Psychiatry 2000; 46(10): 914– 918.

9. Rosebush PI, Hildebrand AM, Furlong BG, Mazurek MF. Catatonic syndrome in a general psychiatric inpatient population: frequency, clinical presentation, and response to lorazepam. J Clin Psychiatry 1990; 51(9): 357– 362.

10. Beckmann H, Franzek E, Stöber G. Genetic heterogeneity in catatonic schizophrenia: a family study. Am J Med Gen 1996; 67(3): 289– 300.

11. Lohr JB, Wisniewski AA. Movement disorders: A Neuropsychiatric Approach. New York: Guilford 1987.

12. Stauder KH. Die tödliche Katatonia. Arch Psychiat Nervenkr Z Gesamte Neurol Psychiatr 1934; 102: 614– 634.

13. Bell LV. On a form of disease resembling some advanced stages of mania and fever. Am J Insanity 1849; 6: 97– 127.

14. Fricchione G, Mann SC, Caroff SN. Catatonia, lethal catatonia and neuroleptic malignant syndrome. Psychiatr Ann 2000; 30: 347– 355.

15. Meduna LJ. Oneirophrenia: the Confusional State. Urbana: University of Illinois Press 1956.

16. Penn H, Racy J, Lapham L, Mandel M, Sandt J. Catatonic behavior, viral encephalopathy and death. The problem of fatal catatonia. Arch Gen Psychiatry 1972; 27(6): 758– 761.

17. Philbrick KL, Rummans TA. Malignant catatonia. J Neuropsychiatry Clin Neurosci 1994; 6(1): 1– 13.

18. Koch M, Chandragiri S, Rizvi S, Petrides G, Francis A. catatonic signs in neuroleptic malignant syndrome. Compr Psychiatry 2000; 41(1): 73– 75.

19. Gjessing RR. Disturbances of somatic functions in catatonia with a periodic course and their compensation. J Ment Sci 1983; 84: 608– 621.

20. Linsday JS. Periodic catatonia. J Ment Sci 1948; 94(396): 590– 602.

21. Minde K. Periodic catatonia: review with special reference to Rolv Gjessing. Psychiatr Assoc J 1966; 11: 421– 425.

22. Leonard K. The Classification of Endogenous psychoses. 5th ed. New York: Irvington Publications 1950.

23. Stöber G, Franzek E, Lesch KP, Beckmann H. Periodic catatonia: a schizophrenic subtype with major gene effect and anticipation. Eur Arch Psychiatry Clin Neurosci 1995; 245(3): 135– 141.

24. Stöber G, Saar KM, Rüschendorf F, Meyer J, Nürnberg J, Jatzke S et al. Splitting schizophrenia : periodic catatonia susceptibility locus on chromosome 15q15. Am J Hum Genet 2000; 67(5): 1201– 1207.

25. Fink M. Delirious mania. Bipolar Disorders 1999; 1(1): 54– 60.

26. McCall WV, Shelp FE, McDonald WM. Controlled investigation of the amobarbital interview in catatonic mutism. Am J Psychiatry 1992; 149(2): 202– 206.

27. Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia: II. Treatment with lorazepam and electroconvulsive therapy. Acta Psychiatr Scand 1996; 93(2): 137– 143.

28. Saba G, Rocamora JF, Kalalou K, Benadhira R, Plaze M, Aubriot- Delmas B et al. Catatonia and transcranial magnetic stimulation. Am J Psychiatry 2002; 159(10): 1794.

29. Carroll BT, Kennedy JC, Goforth HW. Catatonic signs in medical and psychiatric catatonias. CNS Spectr 2000; 5(7): 66– 69.

30. Fink M. Toxic serotonin syndrome or neuroleptic malignant syndrome? Pharmacopsychiatry 1996; 29(4): 159– 161.

31. Caroff SN. The neuroleptic malignant syndrome. J Clin Psychiatry 1980; 41(3): 79– 83.

32. Abay E, Kose R. Amisulpride –  induced neuroleptic malignant syndrome. J Neuropsychiatry Clin Neurosci 2007; 19(4): 488– 489.

33. Chakraborty N, Johnston T. Aripiprazole and neuroleptic malignant syndrome. Int Clin Psychopharmacol 2004; 19(6): 351– 353.

34. Duggal HS, Kithas J. Possible neuroleptic malignant syndrome with aripiprazole and fluoxetine. Am J Psych 2005; 162(2): 397– 398.

35. Duggal HS. Possible neuroleptic malignant syndrome associated with paliperidone. J Neuropsychiatry Clin Neurosci 2007; 19(4): 477– 478.

36. Srephichit S, Sanchez R, Bourgeois JA. Neuroleptic malignant syndrome and aripiprazole in an antipsychotic –  naive patient. J Clin Psychopharmacol 2006; 26(1): 94– 95.

37. White DA. Catatonia and the neuroleptic malignant syndrome –  a single entity? Br J Psychiatry 1992; 161: 558– 560.

38. Berardi D, Amore K, Keck PE jr, Troia M, Dell’Atti M. Clinical and pharmacologic risk factors for neuroleptic malignant syndrome: a case- control study. Biol Psychiatry 1998; 44(8): 748– 754.

39. Strawn JR, Keck PE jr, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry 2007; 164(6): 870– 876.

40. Lazarus A, Mann SC, Caroff SN. The Neuroleptic Malignant Syndrome and Related Conditions. Washington DC: American Psychiatric Press 1987.

41. Seifertová D. Neuroleptický maligní syndrom. In: Seifertová D, Praško J, Höeschl C (eds). Postupy v léčbě psychických poruch. Praha: Academia Medica Pragensis 2008: 522– 527.

42. Keck PE jr, Arnold LM. The serotonin syndrome. Psychiatr Ann 2000; 30: 333– 343.

43. Radomski JW, Dursun SM, Reveley MA, Kutcher SP. An exploratory approach to the serotonin syndrome: an update of clinical phenomenology and revised diagnostic criteria. Med Hypotheses 2000; 55(3): 218– 224.

44. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005; 352(11): 1112– 1120.

45. Mohr P. Serotoninový syndrom. In: Seifertová D, Praško J, Horáček J et al (eds). Postupy v léčbě psychických poruch. Praha: Academia Medica Pragensis 2008: 528– 530.

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