Catatonia

For more than a century, catatonia has been considered a marker of the Kraepelin/Bleuler concept of schizophrenia. However, over the past half-century, it has been increasingly recognized as a separate entity, independently diagnosable and treatable. This chapter explores the diagnosis, treatment, and biological underpinnings of catatonia. Initially, it lists certain motor behaviours whose presentation might indicate catatonia, according to the Catatonia Rating Scale (CRS) such as mutism, delirium, and repetitive rhythmic acts. Through the intravenous administration of certain drugs, such as benzodiazepines, barbiturates, or gamma-aminobutyric acid (GABA) agonists, the effect on the patient’s CRS score is used to confirm the diagnosis. The treatment history of catatonia prior to the discovery of the efficacy of benzodiazepines and induced grand mal seizures (electroconvulsive therapy) is broached, such as chemically induced seizures and amobarbital. Finally, its different presentations are discussed, along with its consideration as a biological fear response.