Catatonia

Catatonia is a severe neuropsychiatric syndrome characterized by abnormal motor behavior, changes in speech or responsiveness, and disturbances in volition and affect. It may occur in the context of mood disorders, psychotic disorders, medical or neurological conditions, and substance-related illnesses. Catatonia can be life-threatening if not recognized and treated promptly, and requires timely, specialized care.

Patients with catatonia may present with:

• Marked immobility, stupor, or unresponsiveness
• Mutism or minimal verbal output
• Posturing, rigidity, or abnormal movements
• Echolalia or echopraxia
• Agitation, excitement, or autonomic instability

Our Approach to Catatonia

At the UTHealth Houston Center for Interventional Psychiatry, catatonia is treated as a psychiatric emergency requiring rapid evaluation and intervention. Care is guided by a multidisciplinary, matched-care approach that prioritizes safety, diagnostic clarity, and timely treatment response.

Evaluation includes:

• Careful assessment of catatonic signs and symptom severity
• Identification of underlying psychiatric, medical, or neurological contributors
• Review of current medications and potential precipitating factors
• Assessment of medical stability and need for inpatient care

Patients with suspected or confirmed catatonia are typically managed in inpatient settings, where close monitoring and rapid treatment initiation are possible. Level-of-care decisions are based on symptom severity, medical risk, and response to initial interventions.

Treatment Options

Treatment for catatonia is evidence-based and may include:

• Benzodiazepine treatment, often as first-line therapy
• Electroconvulsive Therapy (ECT) for patients with severe, refractory, or malignant catatonia, or when rapid response is required
• Management of underlying psychiatric or medical conditions contributing to catatonic symptoms

ECT is a highly effective treatment for catatonia and may be lifesaving in cases that do not respond to medication or when symptoms worsen rapidly.

Continuity and Recovery

Following stabilization, care focuses on treating the underlying condition, preventing recurrence, and transitioning to the appropriate level of ongoing psychiatric care. Patients may step down to partial hospitalization, intensive outpatient, or outpatient services as clinically relevant.

Through rapid recognition, evidence-based treatment, and coordinated care, the Center aims to improve outcomes and reduce morbidity associated with catatonia.