CATATONIA: FROM DIAGNOSIS TO MANAGEMENT

Catatonia is a complex psychomotor syndrome characterized by a range of motor, behavioral, and speech abnormalities. It can occur in the context of psychiatric disorders such as mood disorders, schizophrenia, autism spectrum disorders, and intellectual disabilities, as well as in various medical and neurological conditions including encephalitis, encephalopathies, metabolic disorders, and drug withdrawal. Early recognition and management are crucial to prevent serious psychiatric, organic, and vital complications. Diagnosis is primarily clinical, based on DSM-5-TR criteria, requiring at least three key features such as stupor, catalepsy, mutism, negativism, posturing, stereotypies, or echolalia/echopraxia. Differential diagnoses include obsessive compulsive disorder, autism spectrum disorder, selective mutism, conversion disorder, tics, and drug induced movement disorders. Management involves a comprehensive evaluation of psychiatric and non-psychiatric etiologies, severity assessment using tools like the Bush Francis Catatonia Rating Scale, and appropriate investigations to rule out organic causes. First-line treatment is benzodiazepines, particularly lorazepam, with rapid and effective response in many cases.