For Healthcare Professionals
A goal of The Catatonia Foundation is to provide easily accessible information and resources about Catatonia to healthcare professionals so that patients are diagnosed accurately and can access highly effective treatment options quickly. In spite of the vast amount and scope of literature about Catatonia diagnoses and treatment, Catatonia is still relatively unknown.
Patients who experience the sudden onset of unusual and out of character behaviors may be seen by physicians who are not familiar with Catatonia. Patients with Catatonia may first be seen by a variety of specialists including Emergency Medicine, Internal Medicine, Pediatric, Infectious Disease, Neurology, Psychiatry, Psychology, Intensive and Critical Care, physician assistants, nurses, social workers, EMTs and paramedics.
Physicians who are not familiar with current criteria for diagnosing Catatonia may not make an accurate diagnosis and therefore not recommend appropriate treatment options to a patient.
​
Physicians who are not educated on the effectiveness of high-dose Lorazepam (Ativan) may not prescribe an appropriate dose.
Physicians who are not educated on the effectiveness of ECT in Catatonia may discourage patients from receiving this highly effective treatment.
If Catatonia is suspected, the patient should be referred to a psychiatrist who has expertise in Catatonia diagnosis and treatment. For a list of physicians with expertise in Catatonia and/or ECT, click here.
Our hope is that Catatonia will become more widely recognized among all healthcare providers who may encounter patients with the symptoms of Catatonia. This page is dedicated to that mission.
Treating Catatonia
Catatonia websites created by medical professionals
Several websites and training videos/modules have been created by healthcare professionals with expertise in Catatonia. Descriptions and links to these sites are listed below.
1
Dr. Joshua R. Wortzel and Dr. Mark A. Oldham, in collaboration with Dr. Andrew Francis, have developed educational resources on how to assess for Catatonia using the Bush-Francis Catatonia Rating Scale. To access the website, click here.
2
The Catatonia Information Center was created in 2017 to raise awareness and provide information on the occurrence and treatment of Catatonia. Dr. Andrew Francis serves as the Director and Dr. Max Fink serves as the Senior Advisor. The website includes the following information: What is Catatonia, Recognizing Catatonia, Treating Catatonia, Cites to articles by renowned researchers and physicians, and Videos that describe some symptoms of Catatonia. To access the website, click here.
3
A website written and maintained by Dr. Jonathan Rogers and Professor Anthony David at University College London provides information on Catatonia, including Diagnosis, Treatment, Underlying Disorders, and Patient/Caregiver Information. To access the website, click here.
4
A website by Dr. Joseph Kugler and Dr. Joseph Cooper provides a series of modules in which learners are introduced to the syndrome of Catatonia through an example in the inpatient psychiatric hospital. The website teaches how to identify common symptoms of Catatonia, and reviews techniques necessary for identifying signs on motor and cognitive exams, normal motor regulatory systems in the brain and what is known about dysfunction in these systems in Catatonia. To access the website, click here.
5
Website/training modules by Dr. Scott Beach presents issues regarding Catatonia such as types, diagnosis, causes, pharmacological treatments, ECT, and TMS. It also presents an algorithm to guide the clinician on the implementation of these treatments. To access the website, click here.
Diagnosing Catatonia
For scholarly articles, books, and other resources on diagnosing Catatonia, click here.
What’s the prevalence of Catatonia?
Based on reviews of the literature, statistics regarding the prevalence of Catatonia are highly variable. It is difficult to determine prevalence because of the lack of awareness and education of how to diagnose Catatonia. For example, a Dutch study found that clinicians identified Catatonia in only 2% of 139 patients, whereas a research team identified Catatonia in 18%.
​
For more information on Prevalence, click here.
Different expressions of Catatonia
It’s important to recognize that Catatonia expresses in more ways than what is typically thought of as being catatonic. The different expressions are described briefly below.
Retarded (Akinetic) Catatonia
Retarded (Akinetic) Catatonia is the most well-known type of Catatonia. Its symptoms include bizarre or inappropriate body position or attitude for an extended period of time, muscle rigidity, mutism, repetitive actions, and failure to respond to painful stimuli.
Excited Catatonia
Excited Catatonia is characterized by extreme talkativeness, psychomotor agitation, frenzy, rapid onset of delirium, psychosis, decreased sleep, etc.
Agitated Catatonia
Agitated Catatonia is often associated with self-injurious and typically stereotyped behavior, commonly seen in autism and other developmental disorders.
Periodic Catatonia
In Periodic Catatonia, the catatonic phases (either retarded or excited phases) often repeat regularly. Between the catatonic periods, the symptoms totally disappear, making the diagnosis difficult.
Malignant Catatonia
Malignant Catatonia, which can be fatal if not treated with urgency, is a syndrome of acute onset and is characterized by stupor, mutism, catalepsy, waxy flexibility, negativism, fever, autonomic dysfunction, muscle rigidity and increased CPK levels. It can be brought on by certain medications such as antipsychotics or serotonin reuptake inhibitors.
Anti–NMDA Receptor Encephalitis
Catatonia may be the result of Anti-NMDA receptor encephalitis. It typically starts with nonspecific flu-like symptoms, followed by sudden onset of psychiatric manifestations. This phase is usually followed by a change in level of alertness with periods of extreme agitation, bizarre movements of the jaw, face, mouth and tongue or other movement disorders, and dysfunction of the nerves that regulate involuntary body functions of heart rate, blood pressure and sweating.
The COVID-19 virus
The COVID-19 virus may be responsible for the onset of Catatonia without a prior mental health condition.
For more information about the different expressions of Catatonia, click here.
For scholarly articles, books, and other resources about the different expressions of Catatonia, click here.
What are the treatment options for Catatonia?
When a patient is diagnosed with Catatonia, it’s important to know what highly effective treatment options are available. Proper treatment can be the difference between the patient experiencing devastating consequences (losing all quality of life, being institutionalized, or death) and a patient returning to their baseline and/or better.
Catatonia generally responds well to Lorazepam and ECT.
In cases of Anti-NMDA receptor encephalitis, effective treatments may include tumor removal or immunotherapy (steroids, IVIG, plasma exchange). Treatment may also include adjuvant ECT.
There are novel treatments that have been used with varying success, such as other benzodiazepines, zolpidem, glutamate antagonists, and others.
For more information on treatment, click here.
For scholarly articles, books, and other resources about treatments, click here.
ECT is the standard today for Catatonia.
Bilateral ECT is 80-90% effective in treating Catatonia.
ECT affects hormones.
Cure rates
Cure rates with Lorazepam:
In a 2010 study, the effective rate of Lorazepam in reducing the symptoms of Catatonia was shown to be 68.7 percent and the effective rate of Lorazepam in resolving the symptoms of Catatonia has been shown to be 32.3 percent. 

​
In a 2014 literature review, Lorazepam demonstrated a 79 percent remission rate. However, it is noted that the symptoms may return when Lorazepam was discontinued requiring a continuation of treatment with Lorazepam.
NOTE: It should be noted that adequate Lorazepam doses for Catatonia may be higher than typically used in generalized anxiety disorders. The literature suggests doses that range from 6 to 40 mg per day are effective in treating Catatonia.
Cure Rates with ECT
Cure rates of Catatonia to ECT are excellent, with most modern studies reporting full response in 80–100% of cases, including in the setting of non-response to benzodiazepines.