Clinical Recognition and Management of Catatonia: A Practical Guideline and Treatment Algorithm

Importance: Catatonia is a neuropsychiatric syndrome characterized by abnormalities in motor behavior, speech, volition, and affect. Although historically associated with schizophrenia, contemporary diagnostic frameworks recognize catatonia as a transdiagnostic condition occurring across psychiatric, medical, and neurological disorders. Despite its potential for serious complications (including dehydration, autonomic instability, and malignant catatonia), the syndrome remains underrecognized in many clinical settings.

Observations: A focused PubMed/MEDLINE search was conducted using combinations of keywords related to catatonia, diagnosis, and treatment. Publications from the past decade were prioritized, with foundational studies included when necessary for diagnostic instruments. Thirty PubMed-indexed studies were selected as the core evidence set and synthesized narratively due to heterogeneity in study design and outcome reporting. Across the literature, diagnosis consistently requires the presence of 3 or more characteristic psychomotor signs, with the Bush-Francis Catatonia Rating Scale representing the most widely used structured assessment tool. Epidemiologic studies estimate an annual incidence of approximately 5.15 cases per 100,000 persons, while prevalence may exceed 10% in psychiatric inpatient populations. Benzodiazepines, particularly lorazepam, remain first-line therapy with response rates ranging from 66 to 100%. Electroconvulsive therapy demonstrates response rates approaching 80-100% in severe or refractory cases.

Conclusions: Catatonia is a highly treatable yet frequently missed syndrome. Improved recognition, systematic screening, and timely treatment remain essential to reducing morbidity and improving patient outcomes.

Prim Care Companion CNS Disord 2026;28(5):26nr04231.

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