Malignant catatonia--a continuing reality

A comprehensive review of the world literature confirms that malignant catatonia continues to occur and is reported and discussed in psychiatric community. It is associated with affective disorders as well as schizophrenia. The pathophysiology is still unclear but most reports suggest a hypodopaminergic state. Its reported mortality has declined from 75-100% in the preneuroleptic era to 31% during the review period (1986-1992). Bomocriptine, dantrolene, and benzodiazepines have been used with success but ECT has been found to be life-saving. The present review supports earlier reports that neuroleptics are frequently lethal in some patients with malignant catatonia.