Schizophrenia Symptoms and Diagnosis Catatonic Symptoms in Schizophrenia and Other Conditions How to recognize the signs of catatonia By Kendra Cherry, MSEd Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book." Learn about our editorial process Updated on August 31, 2024 Learn more." tabindex="0" data-inline-tooltip="true"> Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Verywell / Chelsea Damraksa Table of Contents View All Table of Contents Characteristics Diagnosis Causes Treatment Coping Trending Videos Close this video player Catatonia is marked by a significant decrease in someone's reactivity to their environment. This can involve stupor, mutism, negativism, or motor rigidity, and even purposeless excitement. Although you may have heard the term "catatonic schizophrenia," this diagnosis no longer officially exists in the current "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR). It was previously one of the subtypes of schizophrenia. Currently, it is used to describe someone who is diagnosed with schizophrenia and who also meets the diagnostic criteria for catatonia. Catatonia can also occur in other conditions. While these symptoms can be scary and extremely debilitating, knowing more about them (and what treatments are available) can help you better manage them or help a loved one. At a Glance Catatonic schizophrenia is no longer an officially recognized diagnosis, but catatonic behavior can still occur in schizophrenia as well as in other mental health conditions. Signs of catatonia often include an inability to move or speak. People experiencing it may appear rigid, repeat words, or perform strange movements. They may also display other signs of schizophrenia, including hallucinations, problems with thinking, difficulty expressing emotions, and social withdrawal. If a person is experiencing catatonia, seeing a doctor for a diagnosis and treatment recommendations is important. Schizophrenia is typically treated with medications, but electroconvulsive therapy is also sometimes recommended. Characteristics of Catatonic Behavior According to the DSM-5-TR, catatonia is characterized by: Agitation: Feeling upset and irritable Catalepsy: Holding the body in the same position Echolalia: Echoing what others say Echopraxia: Mimicking other people's movements Grimacing: Holding the same tense facial expression Mannerisms: Making exaggerated movements Mutism: Being unable to speak or unusually quiet Negativism: Not responding to environmental events Stereotypy: Repetitive movements that occur without a purpose Stupor: Being awake but non-responsive Waxy flexibility: Resistance to changing body positions followed by slow responses Someone with this condition might experience rigidity or stupor, or be unable to speak, respond, or even move. This can last for hours or even days if left untreated. Catatonia can also cause a person to perform strange movements. They may also experience catatonic posturing where they stay in uncomfortable-looking positions without attempting to shift into more comfortable or natural ones. In addition to a lack of mobility, erratic and extreme movement is possible in catatonic behavior. For example, a person might pace in a repeated pattern and make loud exclamations for no reason (i.e., not in response to an environmental stimulus or event). Parrot-like repetition or echoing of words, known as echolalia, is also a common catatonic behavior. While a person who is catatonic may not be able to speak or move, they are still conscious and aware. A person in a catatonic state may also experience intense emotions and feelings of anxiety but not be able to express what they are experiencing. Common Schizophrenia Symptoms People with this disorder may also display signs of schizophrenia, including: Cognitive problems Decreased ability to express emotions Delusions Disorganization Hallucinations Poor self-care Social difficulties Social withdrawal Signs and Symptoms of Schizophrenia How Is Catatonic Behavior Diagnosed? There are no labs or tests to diagnose catatonic symptoms. Catatonic behavior can also occur in conditions such as autism and mood disorders, so a doctor will evaluate symptoms to determine what is causing them. A doctor will perform a series of medical exams and psychological evaluations to assess the individual's physical and mental health, as well as rule out other conditions. Depending on the results, a doctor may order a magnetic resonance imaging (MRI) scan or an electroencephalogram (EEG) to check for any lesions or unusual brain wave patterns. A test may also be given to check for drugs and alcohol. During the psychiatric evaluation, the individual will be asked questions about their thoughts and behaviors. A psychiatrist will attempt to discover how long they have been experiencing the symptoms in question. If a patient is in a catatonic stupor and unable to talk, their family may be called in to provide information about the catatonic behavior. What Causes Catatonic Behavior? The exact causes of catatonic behavior are not clear. There is also no single cause of schizophrenia or other conditions that are sometimes accompanied by catatonic symptoms. Causes of Catatonic Behavior Brain abnormalities: These include unusual activity in the brain, including irregularities in neurotransmitter systems involving dopamine, glutamate, and gamma-aminobutyric acid (GABA). Brain imaging suggests that catatonic symptoms are associated with brain abnormalities in most cases. Psychiatric conditions: Catatonia or catatonic behavior is a serious psychiatric condition that has historically been associated with schizophrenia, but it can be present in various psychiatric conditions, including schizoaffective disorder, bipolar disorder, and major depressive disorder. Depression that includes catatonia as a symptom is sometimes referred to as catatonic depression. Substances and other medications: Catatonic behavior may also result from drugs, alcohol, and certain medications. Medical conditions: Some other medical conditions can cause catatonic behavior or behaviors that can be mistaken for catatonia. Dystonia, encephalopathy, HIV, and renal failure are conditions that can potentially cause catatonia. Catatonic symptoms like facial contortions, strange limb movements, or unusual body positions can lead to a misdiagnosis of tardive dyskinesia or other movement disorders. Similarly, Tourette's syndrome may be confused for catatonia due to some of the vocalizations that can be part of the syndrome. Causes of Schizophrenia While the exact causes of schizophrenia are not fully understood, it is believed that a combination of genetic and environmental influences may play a role. Genetics appear to make people more vulnerable to the condition, but other factors, including viral infections, exposure to toxins, neurochemical irregularities, stress, and trauma, can also play a role. Estimates suggest that between 9% and 17% of people with acute psychiatric illness experience catatonia. Treatment of Catatonic Symptoms Treatments for catatonic behavior can vary depending on the individual's needs and diagnosis. Schizophrenia is a lifelong, chronic condition, which means people must take steps to stay ahead of and manage their catatonic behaviors and schizophrenia. While there's no cure, there are treatment methods that can help people better manage their symptoms. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Medication Benzodiazepines like Ativan (lorazepam) are perhaps the most common approach to treatment. These drugs act as depressants on the central nervous system, which is why they are often used to treat anxiety. Because these drugs are fast-acting, they can often relieve catatonic symptoms quite quickly. However, they can be habit-forming when used as a long-term treatment. There is some debate around the use of antipsychotics in catatonia. In some cases, antipsychotics can worsen catatonia and are often discontinued in its acute management. However, they are generally reintroduced to treat and prevent the symptoms of schizophrenia. How Schizophrenia Is Treated Electroconvulsive Therapy (ECT) ECT, formerly known as electroshock therapy, is increasingly used to effectively treat catatonia in schizophrenia and other psychiatric conditions. Research has shown that ECT has an 80% to 100% efficacy rate in treating catatonia. Despite the high efficacy rates, access is often limited due to stigma and other factors, so it is often only utilized when people have not responded to benzodiazepines. Coping With Catatonic Behavior Witnessing someone experience catatonic behavior with schizophrenia is certainly scary. Steps people can take to help cope: Stay Informed Perhaps the best thing friends and family members can do is to stay educated about diagnosis, symptoms, and effective treatment. By staying informed, loved ones can get help immediately if they notice any signs of catatonia like rigidity or stupor, or erratic extreme movements. Be Prepared to Describe Symptoms Depending on the severity and type of symptoms, people may need to step in to describe the catatonic behaviors to their loved one's doctor. Offer Encouragement and Support People can also help by doing their best to encourage someone experiencing catatonic behavior to work with their mental health professionals. Sticking to the treatment plan will help ensure that schizophrenia is well-managed and controlled. Care for Yourself Self-care is also essential for sustaining the mental energy required to support someone with a mental illness. Caregivers should try to get ample sleep, eat right, exercise, and make time for relaxation and fun. Living With Schizophrenia Takeaways Getting a proper diagnosis and complying with treatment is key to coping with catatonic behavior. While schizophrenia is a lifelong disease, catatonia can be controlled. With appropriate treatment, people suffering from catatonic symptoms as part of schizophrenia and other psychiatric conditions can find significant relief from their symptoms. 13 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Csihi L, Ungvari GS, Caroff SN, Gazdag G. First 150 years of catatonia: Looking back at its complicated history and forward to the road ahead. World J Psychiatry. 2024;14(5):600-606. doi:10.5498/wjp.v14.i5.600 American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022. Dawkins E, Cruden-Smith L, Carter B, et al. Catatonia psychopathology and phenomenology in a large dataset. Front Psychiatry. 2022;13:886662. doi:10.3389/fpsyt.2022.886662 National Institute of Mental Health. Schizophrenia. Rasmussen SA, Mazurek MF, Rosebush PI. Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology. World J Psychiatry. 2016;6(4):391-398. doi:10.5498/wjp.v6.i4.391 Haroche A, Rogers J, Plaze M, Gaillard R, Williams SC, Thomas P, Amad A. Brain imaging in catatonia: systematic review and directions for future research. Psychol Med. 2020;50(10):1585-1597. doi:10.1017/S0033291720001853 Walther S, Strik W. Catatonia. CNS Spectr. 2016;21(4):341-348. doi:10.1017/S1092852916000274 Carroll BT, Anfinson TJ, Kennedy JC, Yendrek R, Boutros M, Bilon A. Catatonic disorder due to general medical conditions. J Neuropsychiatry Clin Neurosci. 1994;6(2):122-33. doi: 10.1176/jnp.6.2.122 Rasmussen SA, Mazurek MF, Rosebush PI. Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology. World J Psychiatry. 2016;6(4):391-398. doi:10.5498/wjp.v6.i4.391 Rahman T, Lauriello J. Schizophrenia: An overview. Focus (Am Psychiatr Publ). 2016;14(3):300-307. doi:10.1176/appi.focus.20160006 Drug Enforcement Administration (DEA). Benzodiazepines. In: Drugs of Abuse: A DEA Resource Guide. 2017 ed. Huang MW, Gibson RC, Jayaram MB, Caroff SN. Antipsychotics for schizophrenia spectrum disorders with catatonic symptoms. Cochrane Database Syst Rev. 2022;7(7):CD013100. doi:10.1002/14651858.CD013100.pub2 Lloyd JR, Silverman ER, Kugler JL, Cooper JJ. Electroconvulsive therapy for patients with catatonia: Current perspectives. Neuropsychiatr Dis Treat. 2020;16:2191-2208. doi:10.2147/NDT.S231573 By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book." See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Helpful Report an Error Other Submit