Catatonia-Related Clinical Challenges in Neurological and Neurodevelopmental Conditions

Catatonia is a neuropsychiatric syndrome that can occur in association with psychiatric conditions, general medical disorders, or use of psychoactive substances. Roughly 20% of catatonia cases are due to general medical conditions, two-thirds of which are neurological conditions. The authors aimed to review the diagnostic and treatment challenges posed by catatonia due to neurological conditions, including neurodevelopmental disorders.

The authors considered the diagnostic and treatment challenges of catatonia in three areas: neurodevelopmental disorders, with a focus on autism spectrum disorder; acquired neurological disorders of epilepsy, anti-N-methyl-d-aspartate receptor encephalitis, and neuropsychiatric disorders due to traumatic brain injury; and the neurocognitive conditions delirium and dementia. One consideration was how clinicians might differentiate features of catatonia from common neurological findings in these conditions.

Many of catatonia's features overlap with those in neurological conditions and vice versa. This overlap often leads to underdiagnosis of catatonia, misdiagnosis, or diagnostic uncertainty, which may introduce clinical conundrums and make accurate identification of catatonia clinically important, with potential diagnostic and therapeutic implications.

Accurate diagnosis of catatonia is necessary to ensure timely workup and clinical management. The challenges reviewed here emphasize the importance of a collaborative and multidisciplinary approach to managing catatonia in neurological and psychiatric settings. Additional research is needed to understand the complex relationship between catatonia and neurological conditions.