Catatonia in the medically ill and dying: a review for palliative care clinicians.

Abstract

Catatonia is a severe and potentially life-threatening but often reversible neuropsychiatric syndrome. While commonly associated with psychiatric disorders, it is increasingly recognized in medically ill populations, including patients with serious illness. Catatonia frequently overlaps with delirium, dementia, and end-of-life changes, and can mimic irreversible decline, contributing to missed diagnoses and goal-discordant care. Palliative care (PC) clinicians are uniquely positioned to identify and treat catatonia in this context, yet awareness and familiarity with its assessment and management remain limited outside of psychiatric settings. This review aims to synthesize current evidence and provide practical guidance to help PC clinicians recognize, assess, and manage catatonia in patients with serious illness. We highlight the epidemiology, pathophysiology, clinical features, assessment and management of catatonia in seriously ill patients, with a focus on practical application for PC clinicians. We also provide guidance on screening, diagnosis, and treatment-emphasizing the use of bedside tools such as the Bush-Francis Catatonia Rating Scale and the lorazepam challenge-and review first-line and adjunctive therapies, including benzodiazepines and electroconvulsive therapy. Clinical overlap with delirium and other forms of altered mental status is discussed, as is the importance of incorporating catatonia into routine diagnostic frameworks and prognostic conversations. Recognizing and treating catatonia can relieve suffering, restore communication, and shift clinical trajectories in ways that support patients' goals of care. Awareness of catatonia among PC teams can lead to earlier diagnosis, effective treatment, and better alignment of care with patient values.