What Is Catatonia?
Catatonia is a psychomotor syndrome -- a cluster of signs affecting movement, speech, and behaviour that occur together. Rather than being a single illness, it is a recognisable pattern that can appear in the course of several psychiatric and medical conditions. People with catatonia may become profoundly still and unresponsive, or intensely agitated and overactive, and some move between these states.
Catatonia was once associated mainly with schizophrenia, but it is now understood to occur most commonly with mood disorders, and also with a range of medical and neurological illnesses. It can affect people of any age. Importantly, catatonia is a treatable condition: with prompt recognition and appropriate treatment, most people improve, often within days. Left untreated, however, severe catatonia can become life-threatening, which is why early assessment matters.
Types of Catatonia: Excited vs Hypokinetic
Clinicians often describe catatonia as falling into two broad presentations. Both are serious and can occur in the same person at different times.
Excited (Hyperkinetic / Agitated) Catatonia
Excited catatonia is dominated by excessive, purposeless activity. A person may be severely restless, agitated, or combative, with rapid or repetitive movements and pressured, disorganised, or incoherent speech. There may be impulsive behaviour, echolalia (repeating others' words), or echopraxia (mirroring others' movements). Because sustained agitation can cause exhaustion, injury, dehydration, and dangerous changes in temperature, heart rate, and blood pressure, excited catatonia is treated as a medical emergency.
Hypokinetic (Withdrawn / Stuporous) Catatonia
Hypokinetic catatonia is the withdrawn, slowed-down form and is the more commonly recognised picture. It is marked by greatly reduced movement and responsiveness: stupor and immobility, mutism, negativism, staring, fixed posturing, and waxy flexibility. People may stop eating and drinking and may not respond to those around them. This form also needs urgent care, because reduced movement and poor intake raise the risk of dehydration, pressure injuries, blood clots, and other complications.
Catatonic Movements and Signs
Catatonic movements are the abnormal motor and behavioural signs used to recognise the syndrome. A person does not need to show all of them; a small number of clear signs can be enough for clinicians to suspect catatonia.
Stupor
A state of greatly reduced movement and reaction to the surroundings, in which the person appears awake but barely responds.
Mutism
Little or no verbal response, despite the physical ability to speak. The person may remain silent even when addressed directly.
Negativism
Resisting or doing the opposite of instructions, or not responding to them -- for example resisting attempts to move a limb.
Posturing & Waxy Flexibility
Holding unusual positions for long periods. In waxy flexibility, limbs stay where another person gently places them, as if made of wax.
Echopraxia & Echolalia
Automatically mirroring another person's movements (echopraxia) or repeating their words (echolalia).
Stereotypy & Mannerisms
Repetitive, non-goal-directed movements, odd caricatured gestures, grimacing, or rigidity of posture and muscles.
Agitation
Excessive, purposeless motor activity not influenced by the surroundings, seen in the excited form of catatonia.
Other Signs
Staring, automatic obedience, ambitendency (starting and stopping an action), and verbigeration (repeating phrases) may also appear.
What Causes Catatonia?
Catatonia is best understood as a final common pathway that can be triggered by different underlying conditions. Finding and treating the cause is part of managing it.
Psychiatric Causes
- Mood disorders -- severe depression, bipolar disorder, and mania are among the most common associations with catatonia.
- Schizophrenia and other psychotic disorders -- catatonia can occur during psychotic episodes.
- Other conditions -- it is sometimes seen with autism spectrum conditions and in states of severe stress.
Medical and Neurological Causes
- Infections and inflammation -- including encephalitis and autoimmune (immune-mediated) brain conditions.
- Neurological conditions -- seizures, stroke, brain injury, and certain movement and degenerative disorders.
- Metabolic and systemic illness -- disturbances of salts, blood sugar, thyroid, liver, or kidney function.
- Drug-related causes -- effects of some medicines or substances, and withdrawal states.
How Catatonia Is Assessed
Diagnosis begins with a careful clinical examination by a doctor, looking for the characteristic signs described above. Clinicians frequently use the Bush-Francis Catatonia Rating Scale, a standardised tool that screens for and measures the severity of catatonic signs, helping to confirm the diagnosis and track response to treatment.
Because catatonia can be caused by medical and neurological illness, assessment usually also includes a physical examination and investigations -- such as blood tests, and sometimes brain imaging or an EEG -- to identify any underlying condition. In some cases, a supervised dose of a benzodiazepine (a "benzodiazepine challenge") is used both to help confirm the diagnosis and to begin treatment, as a clear improvement supports the diagnosis of catatonia.
Catatonia Treatment
Catatonia is generally highly treatable, and treatment is often effective quickly. Care has two aims: relieving the catatonia itself and treating the underlying cause, alongside supportive medical care such as hydration, nutrition, and prevention of complications.
Benzodiazepines (benzodiazepine challenge)
Benzodiazepines are a widely used first-line treatment. A monitored test dose -- a benzodiazepine challenge -- can both support the diagnosis and relieve symptoms, with the dose adjusted according to response.
Electroconvulsive therapy (ECT)
ECT is an effective treatment for catatonia, particularly in severe, rapidly worsening, or treatment-resistant cases, and in life-threatening forms. It is delivered by specialists under anaesthesia.
Treating the underlying cause
Identifying and treating the psychiatric or medical condition driving the catatonia -- for example a mood disorder, infection, or metabolic problem -- is central to recovery and to preventing relapse.
Supportive care
Maintaining fluids and nutrition, protecting the skin, preventing blood clots, and close monitoring of vital signs help keep the person safe while treatment takes effect.
General information, not medical advice
This article is for general education only and is not a substitute for professional diagnosis or treatment. Decisions about medicines and procedures such as ECT should be made with a qualified doctor. If you think someone may have catatonia -- especially with severe agitation, not eating or drinking, or fever and an unstable pulse or breathing -- seek urgent medical care immediately.
Catatonia often overlaps with other mental health conditions. You can read more about related care on the schizophrenia treatment and depression treatment pages.
When to Seek Help
Catatonia is a medical emergency. Seek urgent medical care if a person shows:
- Sudden immobility, not speaking, or not responding to people around them
- Holding unusual postures, stiffness, or not eating or drinking
- Severe agitation, restlessness, or combative behaviour that is purposeless
- Fever with an unstable pulse, blood pressure, or breathing, or heavy sweating
- Any rapid change in movement, alertness, or behaviour in someone with a known mental health or medical condition
If in doubt, contact a doctor or emergency services without delay. Early treatment improves outcomes and can prevent serious complications.
Frequently Asked Questions
Excited catatonia (also called hyperkinetic or agitated catatonia) is a form of catatonia dominated by excessive, purposeless motor activity. A person may be severely restless, agitated, or combative, with rapid or repetitive movements, pressured or incoherent speech, and at times echolalia or echopraxia. Because agitation can lead to exhaustion, injury, dehydration, or dangerous autonomic instability, excited catatonia is a medical emergency that needs urgent assessment and treatment.
Hypokinetic catatonia is the withdrawn or stuporous form, marked by greatly reduced movement and responsiveness. Features can include stupor and immobility, mutism (little or no speech), negativism (resisting or not responding to instructions), fixed posturing, waxy flexibility, and staring. The person may stop eating and drinking, so hypokinetic catatonia also requires prompt medical attention to prevent complications such as dehydration, pressure injury, and blood clots.
Catatonia is a syndrome that can arise from several underlying conditions rather than a single cause. Psychiatric causes include mood disorders (such as severe depression, bipolar disorder, and mania) and schizophrenia or other psychotic disorders. Medical and neurological causes include infections (including encephalitis), autoimmune and metabolic disturbances, seizures, brain injury, and the effects of certain drugs or withdrawal states. Identifying and treating the underlying cause is a key part of care.
Agitated (excited) catatonia involves marked restlessness and excessive, purposeless movement that is not goal-directed. Symptoms can include severe agitation, hyperactivity, repetitive or stereotyped movements, pressured or disorganised speech, impulsive or combative behaviour, and echolalia or echopraxia (repeating others' words or actions). It may alternate with periods of withdrawal, and can be accompanied by fever and unstable pulse, blood pressure, or breathing, which signal the need for emergency care.
Catatonic movements are the abnormal motor signs seen in catatonia. They include stupor (little movement or reaction), mutism, negativism, posturing (holding unusual positions), waxy flexibility (limbs staying where another person places them), rigidity, stereotypy (repetitive movements), mannerisms, grimacing, echopraxia (mirroring movements), and echolalia (repeating speech). Excited catatonia instead shows agitation and excessive activity. Clinicians often use the Bush-Francis Catatonia Rating Scale to identify and measure these signs.
Yes. Catatonia is generally highly treatable, and many people improve quickly once it is recognised. Benzodiazepines, often started with a monitored test dose (a benzodiazepine challenge), are a common first-line treatment, and electroconvulsive therapy (ECT) is an effective option for severe or treatment-resistant cases. Treating the underlying medical or psychiatric cause and providing supportive care are also important. Because untreated catatonia can become life-threatening, urgent assessment by a doctor is essential.