Catatonia Is not Schizophrenia: Kraepelin's Error and the Need to Recognize Catatonia as an Independent Syndrome in Medical Nomenclature

Abstract

Catatonia is a motor dysregulation syndrome described by Karl Kahlbaum in 1874. He understood catatonia as a disease of its own. Others quickly recognized it among diverse disorders, but Emil Kraepelin made it a linchpin of his concept of dementia praecox. Eugen Bleuler endorsed this singular association. During the 20th century, catatonia has been considered a type of schizophrenia. In the 1970s, American authors identified catatonia in patients with mania and depression, as a toxic response, and in general medical and neurologic illnesses. It was only occasionally found in patients with schizophrenia. When looked for, catatonia is found in 10% or more of acute psychiatric admissions. It is readily diagnosable, verifiable by a lorazepam challenge test, and rapidly treatable. Even in its most lethal forms, it responds to high doses of lorazepam or to electroconvulsive therapy. These treatments are not accepted for patients with schizophrenia. Prompt recognition and treatment saves lives. It is time to place catatonia into its own home in the psychiatric classification.

Catatonia in Psychotic Patients: Clinical Features and Treatment Response

“…Historically, catatonia has been classified as a subtype of schizophrenia but there is convincing evidence that catatonia is a syndrome that is not limited to patients with schizophrenia. 10,11 In our sample, only four out of the 25 subjects carried a diagnosis of schizophrenia. Moreover, improper treatment with antipsychotics can lead to clinical worsening and transition to lethal catatonia/neuroleptic malignant syndrome.…”

What We Have Learned about Electroconvulsive Therapy and its Relevance for the Practising Psychiatrist

“…42 Catatonia is common among chronically ill psychotic patients, but is more frequent in patients with mood disorders. [43][44][45] In pediatric populations, catatonia is reported among those with mental retardation and autistic spectrum disorder. 46,47 Recently, it was shown that most, if not all, patients with anti-N-methyl-D-aspartate-receptor encephalitis present with catatonic symptoms.…”

Development and validation of the Bush-Francis Catatonia Rating Scale – Brazilian version

“…Such an historical definition partially explains the lack of care regarding the catatonic syndrome and its dramatic underdiagnosis 10 . It has become clear, though, that catatonic symptoms can be observed not only in schizophrenia but also in several mental disorders, especially affective disorders 30,31 . Nowadays, many researchers consider since the term in the original language means ordinary.…”