The following information and resources have been provided courtesy of The Lurie Center for Autism, a program of Massachusetts General Hospital and Mass General for Children.

The Lurie Center for Autism is committed to advancing treatments for and knowledge about Autism Spectrum Disorder (ASD) and other developmental disorders, and translating these discoveries into exceptional clinical care. A program of Massachusetts General Hospital and Mass General for Children, The Lurie Center is a multidisciplinary treatment, research, training, and advocacy organization dedicated to supporting individuals and their families across the lifespan.

This resource is intended to provide information so that you can be better informed. It is not a substitute for medical advice and should not be used to treat any medical conditions.

What is catatonia?

What is catatonia?

Catatonia is a motor syndrome consisting of changes in movement, speech, and behaviors. The movement symptoms typically involve difficulty starting or stopping a movement. It can be due to a range of neuropsychiatric (e.g., Autism spectrum disorder, schizophrenia, bipolar disorder, depression, etc.) or medical illnesses (e.g., infection).

There are three subtypes:

• Excited: increased movement, speech, impulsivity, and abnormal repetitive behaviors;
• Withdrawn: decreased movement, freezing, loss of speech, and decreased engagement/interaction;
• Mixed: features of both excited and withdrawn catatonia.

Catatonia is increasingly recognized in patients with ASD, often beginning at the end of adolescence or early adulthood.

Who should be evaluated for catatonia?

Any person who has at least 1 of the following symptoms:

• Freezing in the middle of an action
• Difficulty crossing thresholds (e.g., doorways)
• Slowed movements or needing prompts to start or complete actions
• Loss of verbal language
• Loss of self-help skills (e.g., toileting, feeding)
• New repetitive movements or difficulty stopping actions
• New repetitive vocalizations or speech
• Decreased interest in the environment
• Odd, stiff postures or gait.

How is catatonia diagnosed?

There is no laboratory test that can make the diagnosis; however, it may be necessary to complete a workup to determine if there is a medical illness causing catatonia.

It is diagnosed based on clinical history, observation, and physical examination. A physical exam for catatonia includes checking for the motor signs including muscle stiffness and echopraxia (imitating another person’s movements).

What is the treatment for catatonia?

• Discontinue medications that may be making the catatonia worse (e.g., risperidone, aripiprazole).
• First line: high dose lorazepam (Ativan).
• Second line: electroconvulsive therapy or possibly clozapine.