Gaps and Controversies in Catatonia as a Movement Disorder

Area of Science:

• Neuroscience
• Psychiatry
• Movement Disorders

Background:

• Catatonia, historically linked to schizophrenia, presents diverse phenotypes across various conditions.
• Despite 150 years of study, catatonia's etiology, phenomenology, diagnosis, and treatment remain debated.
• Current diagnostic criteria (ICD-11, DSM-5) rely on identifying multiple signs, with few specific motor features.

Purpose of the Study:

• To highlight existing gaps and controversies in understanding catatonia as a movement disorder.
• To emphasize the lack of a clear definition and inconsistencies in describing catatonic signs.
• To propose a novel bi-axial classification framework for catatonia.

Main Methods:

• Review of existing literature on catatonia.
• Analysis of current diagnostic criteria in ICD-11 and DSM-5.
• Proposal of a bi-axial classification framework.

Main Results:

• Significant gaps and controversies persist regarding catatonia's definition, diagnosis, and treatment.
• Current diagnostic criteria lack specificity, with only catalepsy and waxy flexibility being highly specific motor signs.
• A bi-axial classification framework is proposed to better evaluate etiologies and guide treatment.

Conclusions:

• Catatonia's classification as a movement disorder necessitates a clearer definition and diagnostic approach.
• A proposed bi-axial framework, similar to those for dystonia and tremor, could enhance etiological evaluation and therapeutic decision-making.
• Improved classification may lead to better patient outcomes in catatonia.