Catatonia is a psychomotor syndrome characterized by neuromotor, behavioral

and emotion. More than 40 catatonic symptoms are described as main mutism,
stupor, negativism, rigidity, catalepsy, stereotyped, automatic obedience, echo
phenomena and mannerisms (Fink & Taylor 2009; Van Hearts 2005). Although
the syndrome is already in the 19th century has been described, the discussion
regarding the definition remains and existence classification (Taylor & Fink 2003;
Ungvari et al 2010). The prevalence of psychiatric catatonia wards is estimated
around 10-15%; in the practice is probably under-diagnosed syndrome (Fink &
Taylor 2009; Van Harten 2005). In the literature, it is suggested that the
symptom profile of catatonia differs in psychiatric disorders, particularly
depression, mania and schizophrenia (Kruger et al 2003a; Usman et al 2011).
Identification and differentiation of catatonia are in these psychiatric syndromes
designated for more targeted diagnostics, understanding underlying
pathophysiology and treatment. In this literature comparing epidemiological
aspects, clinical presentation and treatment options of catatonia in patients with
schizophrenia and mood disorders.
METHOD
A literature search was performed in PubMed with terms like "catatonia" or
"catatonic" in combination with each of the disease states discussed. Relevance
of results were evaluated on the basis of title and abstract. The reference lists of
selected articles were taken for further relevant literature.
Epidemiological aspects
During the last century was mainly catatonia diagnosed as a subtype of
schizophrenia. Kraepelin (1919) described 19.5% of 500 patients with dementia
praecox as catatonic while Bleuler (1911) indicated that nearly half of the
hospitalized patients with schizophrenia exhibited catatonic features. From the
50s to present some studies report a significantly lower share of the catatonic
subtype in patients with schizophrenia with numbers between 4 and 7.6% (&
Deister Marneros 1994; Kleinhuis et al 2012; Ungvari et al 2005). With thereby
proportional figures low (10-20%) of schizophrenia catatonic populations within
some argue authors which catatonia occurs mainly in mood disorders and
wrongly decades was linked to schizophrenia (Rosebush and Mazurek 2010;
Taylor & Fink 2003).
Other studies show higher proportions of schizophrenia within catatonic
populations, although still less frequent than in mood disorders. For example, in
a review Caroff et al (2004) of 11 studies on

underlying diagnoses of catatonia with an average of 28% (Range 4-67) of

patients diagnosed with schizophrenia set; 44% (28-71) was a mood disorder.
These figures coincide with the review of Pommepuy and Januel in 2002.
Research in recent decades actually shows high prevalence of catatonia in mood
disorders, but mainly in bipolar disorder. Mania would be associated in 17-47% of
cases with catatonia compared to 0-20% in depression (Braunig et al 1998;
Kruger et al 2003a). When reported mixed episodes
Kruger et al (2003b) even catatonia in 61% of the 39 patients.
Stark Stein et al (1996) finally examined a group of patients with predominantly
unipolar depressive
disorder (n = 79), wherein met 20% of the patients the criteria of catatonia.
Clinical presentation
Kraepelin (1919) already suggested that catatonia by underlying disease specific
clinical presentation had. He described as negativism and mannerism for
characterizing and dementia praecox-related waxy flexibility, echo phenomena,
stupor and cataplexy from bipolar disorders. Schneider (1914) compared patients
with manic and catatonic (schizophrenic) agitation and found that blockades,
waxy flexibility, stereotypical statements, mutism and negativism occurred more
frequently in the group with schizophrenia (Ungvari et al 2010).
In recent research catatonic signs per diagnostic group specified. Small and / or
heterogeneouspatient populations, diversity of instruments and definition of
catatonia have no clear interpretation. Although no clear demarcation is found
between the clinical presentation of catatonia with schizophrenia and mood
disorders, suggest do some research differentiating trends.
Kruger et al (2003a) identified in a direct comparative study in 164 patients with
catatonia characterizing catatonic symptom clusters of schizophrenia, mania and
depression. Catatonia in schizophrenia, according to their research is
characterized by abnormal movements,
mannerisms, catalepsy, automatic obedience and negativism. Cohen et al (2005)
found in a small-scale comparative study in 30 adolescents with catatonia also a
higher incidence of auto
obedience and stereotypes in schizophrenic catatonia compared to nonschizophrenic catatonia.
Ungvari et al (2005) screened a group of patients with chronic schizophrenia (n =
225) to draw catatonic and identified mannerisms, grimacing, stereotypies,

impulsiveness, mutism, catalepsy and automatic obedience as the most common

signs.
Catatonia with mania according to the aforementioned investigation of Kruger et
al (2003a) characterized by motor while inhibition agitation, stupor and
withdrawal more common in catatonic depression. Braunig et al (1998) showed
in a study of 19 patients with catatonia and mania motor restlessness,
impulsiveness, verbigeratie, stereotypies and mutism as most common
signs. Mutism and stare appear both in schizophrenia As with mood disorders
frequently act (Braunig et al, 1998; Cohen et al 2005; Ungvari et al 2005;
Usman et al 2011).
Clinical course
Several prospective studies describing the association
of catatonia with a more severe disease course in both
schizophrenia and mood disorders.
According to the study by Cohen et al (2005) in adolescents
schizophrenic catatonia is characterized by a
insidious onset in contrast to the acute onset of
non-schizophrenic catatonia. Catatonic schizophrenia is further
associated with more prolonged and more frequent shots,
more negative symptoms, behavioral problems and
reduced generally function with respect to
non-catatonic schizophrenia (Cohen et al 2005; Deister &
Marneros 1994; Ungvari et al 2005). Additionally observe
Kleinhuis et al (2012), a higher incidence of suicide.
Relative to non-catatonic schizophrenia permanent
Recording occur less frequently (Deister &
Marneros 1994).
In mania, the presence of catatonia also
related to longer hospital stay, less commonly
function and a higher psychiatric comorbidity
(Braunig et al 1998). Even when depression appears catatonia
To go along with poorer overall functioning, worse
episodes and more cognitive problems (Stark et al Stein
1996).
Treatment
Benzodiazepines are the first line treatment of catatonic

images with remission rates of 70-100% (Hawkins

et al 1995; Huang et al 2013; Rosebush and Mazurek 2010). The
However, treatment response varies depending on the underlying
disorder. Rosebush and Mazurek (2010) saw
prospective study in 80% of patients with
mood problems fast and complete brightening
the catatonic image after treatment with benzodiazepines.
In their earlier studies in patients with schizophrenia
was only at 20-30% a brightening of the
catatonic state image observed (Rosebush &
Mazurek 2004). In a randomized double blind placebo controlled
study in patients with chronic
Schizophrenia could Ungvari et al (1999) even benefit
detection of lorazepam relative to placebo. Too
Beckmann et al (1992) saw no improvement in catatonia after prolonged
benzodiazepine treatment.
In refractory or malignant catatonia is electroconvulsive therapy
(Ect) designated with remission rates of 59 to 93%
(Rohland et al, 1993; of Value et al 2010). Although this subject
Little research exists,
there are indications that
ect with catatonic schizophrenia is less effective than
underlying mood problems. Rohland et al
(1993) evaluated retrospectively 28 ECT treatments
for catatonic episodes. Patients with a mood disorder
had on average a larger, but non-significant,
symptom reduction than those with schizophrenia.
Raveendranathan et al (2012) found recently that a shorter
duration of catatonic episode before ect related
was to a more rapid response. The figures show
higher proportion of patients with a rapid response to ECT in
underlying mood disorder than psychotic
disorders.
Given the risk of increasing the catatonic signs and
it may be triggering malignant catatonia
typical antipsychotics advised to catatonia. Although

also a risk of malignant catatonia with atypical antipsychotics

has been described, some suggest that by treatment
of psychotic symptoms also catatonic signs
clear (Van Den Eede et al 2005; Van Harten 2005).
CONCLUSION
The traditional view of catatonia as a subtype of schizophrenia
recent decades criticized. This criticism
was accompanied by an under-diagnosis of the catatonic
subtypes in schizophrenia and overvalued
catatonia in mood disorders. The latest literature
shows a high prevalence of catatonia in both
schizophrenia and mood disorders with light
higher occur in the latter.
Despite some overlap, the symptom profile appears
of catatonia in these syndromes mutually
differences. Catatonia with schizophrenia seem more marked
automatic obedience, stereotypies,
waxy flexibility, negativism, grimacing, mannerisms
and other abnormal movements. In mania
catatonia is rather characterized by agitation,
while inhibition, stupor and withdrawal occur more
with catatonic depression. Mutism and stare act
both schizophrenia and mood disorders frequently
on.
Both schizophrenia and mood disorders is
catatonia a marker for more severe disease. Catatonia
in schizophrenia is further characterized by a
limited response to benzodiazepine treatment and ect
compared catatonia in mood disorders.
This clinical diversity and differences in treatment response
between different psychiatric diagnoses suggesting heterogeneity in the
pathophysiology of catatonia
within these syndromes. From imaging research
Moreover, it appears that altered activity in certain
areas of the brain and can cause their interconnections
to a unique combination of psychomotor

symptoms (Northoff et al 2004).

So far catatonic images were not mutually differentiated
in research on pathophysiology.
Insufficient accurate characterization of catatonia in
various psychiatric syndromes contributes presumably
to this. Better understanding of psychomotor symptom clusters
in psychiatric syndromes require comparative
research on clinical presentation and
pathophysiology. The decoupling of catatonia and schizophrenia
and the equal position of catatonia in psychotic
and mood disorders within the current DSM-5 classification
To this end, provide a clearer diagnostic framework
(Tandon et al 2013).
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