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Observed signs of catatonia

Observed signs of catatonia
Feature Description and examples
Immobility Hypokinetic or akinetic behavior that is not influenced by external stimuli.
Stupor Decreased alertness, hypoactivity, and diminished responses to voice and painful stimuli.
Excitement Impulsive, frantic, and stereotypic behavior that may include sudden outbursts of talking, singing, dancing, and tearing of clothes. Patients may be irritable and damage objects or injure themselves or others. Excitement may suddenly alternate with stupor.
Mutism Patients are awake but verbally unresponsive. Mutism is not always associated with immobility and may appear elective. Less severe forms of mutism include lack of spontaneous speech, sluggish responses to questions with automatic answers such as "I don't know" (speech-prompt), and speaking with progressively less volume until speech is an inaudible mumble (prosectic speech).
Posturing (catalepsy) Voluntarily maintaining a position of the body or a body part for a long time; eg, standing or lying down in the same position, an exaggerated pucker, lying in bed with the head elevated and unsupported as if on a pillow, holding arms above the head or raised in a prayer-like manner, and holding fingers and hands in odd positions.
Echophenomena Echolalia (senseless repetition of another person's utterances) and echopraxia (senseless repetition of another person's movements).
Speech mannerisms Robotic speech, feigned foreign accent, palilalia or verbigeration (involuntary repetition of words or phrases).
Behavioral mannerisms Odd, purposeful movements, such as holding hands as if they were handguns or saluting passersby, or exaggerated or stilted caricatures of mundane movements.
Stereotypy Non-goal-directed, repetitive movements that often are awkward or stiff; examples include grimacing, teeth/tongue clicking, rocking, sniffing, biting, or automatically touching or tapping.
Staring Fixed gaze with little or no scanning of the environment and decreased blinking.
Adapted from:
  1. Fink M, Taylor MA. The catatonia syndrome: Forgotten but not gone. Arch Gen Psychiatry 2009; 66:1173.
  2. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
  3. Bush G, Fink M, Petrides G, et al. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand 1996; 93:129.
  4. Greenhalgh J, Knight C, Hind D, et al. Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modelling studies. Health Technol Assess 2005; 9:1.
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