Catatonic Behavior Symptoms and Complications

Pensive woman looking into distance
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Catatonic behavior is scary for bipolar disorder sufferers to experience. For those witnessing an episode, it's important to understand what catatonia is, and how to respond to catatonic symptoms. Catatonia is a psychomotor disturbance since it involves psychiatric and physical or motor manifestations. It may be characterized by a marked decrease in, increase in, or peculiar motor activity. Mentally, its expression can range from unresponsiveness to agitation.

Diagnosis and Prevalence

Catatonic features occur most often in schizophrenia, schizoaffective disorder, and similar conditions, but can occur with bipolar spectrum disorders and major depressive disorder. In some cases, catatonia may also be an extreme side effect of a medication or manifestation of another medical condition.

Research shows over 50 percent of people who experience catatonic episodes have bipolar disorder, and about 28 percent of bipolar patients experiencing catatonia had them in mixed mood states of depression and mania at the same time.

For this reason, scientists believe anywhere from 20 percent to 30 percent of bipolar patients will experience catatonia during their illness.

There are no lab or clinical tests to diagnose catatonia. Instead, behavior rating scales are used. These include Bräunig-Catatonia Rating Scale, Bush-Francis Catatonia Screening Instrument, Bush-Francis Catatonia Rating Scale, Rogers Scale, Northroff Scale and Catatonia Rating Scale. Additionally, patients being screened for catatonia may be asked about their family medical history, have their vital signs checked, and be subject to a neurological exam.


Catatonia presents in two forms: one of excited delirium and one of stuporous behavior marked by unresponsive behavior that renders the sufferer mute, immobile, and responsive only to pain or visual stimuli.


These are possible symptoms of catatonia:

  • Stupor: lack of response to external stimuli — e.g., no response to being spoken to or prodded.
  • Catalepsy: muscular rigidity, so that the limbs remain in whatever position they are placed.
  • Excessive motor activity with no purpose.
  • Extreme negativism: resistance to movement or instruction.
  • Mutism: being unable or unwilling to speak.
  • Inappropriate postures and grimacing.
  • Echolalia: parrotlike repetition of a word or phrase just spoken by another person.
  • Echopraxia: repetitive imitation of the movements of another person.

Complications of Catatonia

Untreated severe catatonia can be fatal. Some of the complications may be:

  • Malnutrition
  • Exhaustion
  • Blood clots
  • Muscle breakdown
  • Self-inflicted injury


There is no cure for catatonia, however, pharmaceuticals and electroconvulsive treatment (ECT) may be employed to treat symptoms of catatonia. Drugs such as benzodiazepines, muscle relaxants, antidepressants, and neuroleptics have all been used to treat catatonic symptoms.

People who experience catatonic symptoms may also be admitted to psychiatric, medical, or neurological inpatient observation and treatment. Regular follow-up visits may be urged to stay ahead of catatonic episodes or to ensure re-admittance is not warranted for the patient.

In severe cases, catatonia patients may be placed in an intensive care unit (ICU). The ICU might be suggested as a restrictive environment where the intravenous nutrition can be provided, as well as protecting the patient from self-injury and others from possible physical violence during the catatonic episode.

If you are bipolar, be sure you educate your close friends and loved ones about how catatonia may affect you.

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  1. Wilcox JA, Reid duffy P. The Syndrome of Catatonia. Behav Sci (Basel). 2015;5(4):576-88. doi:10.3390/bs5040576

  2. Mckeown NJ, Bryan JH, Horowitz BZ. Catatonia associated with initiating paliperidone treatment. West J Emerg Med. 2010;11(2):186-8.

  3. Bhati MT, Datto CJ, O'reardon JP. Clinical manifestations, diagnosis, and empirical treatments for catatonia. Psychiatry (Edgmont). 2007;4(3):46-52. 

  4. 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

  5. Dar MA, Rather YH, Shah MS, Wani RA, Hussain A. Rapid Response of Long-Standing, Treatment-Resistant Non-Catatonic Mutism in Paranoid Schizophrenia with Single ECT session. N Am J Med Sci. 2014;6(11):591-4. doi:10.4103/1947-2714.145480

  6. Ramdurg S, Kumar S, Kumar M, Singh V, Kumar D, Desai NG. Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study. Ind Psychiatry J. 2013;22(1):32-6. doi:10.4103/0972-6748.123612

  7. Doran E, Sheehan JD. Acute catatonia on medical wards: a case series. J Med Case Rep. 2018;12(1):206. doi:10.1186/s13256-018-1714-z

  8. Luchini F, Medda P, Mariani MG, Mauri M, Toni C, Perugi G. Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response. World J Psychiatry. 2015;5(2):182-92. doi:10.5498/wjp.v5.i2.182