Catatonia in psychiatric illnesses

Increased interest in the demarcation of catatonia from other conditions such as schizophrenia and autism is shown in the new DSM-5 category Catatonia Not Elsewhere Classified (NEC) encompassing catatonia of uncertain origin or associated with developmental conditions. Catatonia NEC is an imminently relevant diagnosis in patients who meet criteria for catatonia but without clearly defined associated psychotic, affective, or medical disorders. Catatonia NEC should be considered when catatonic symptoms present in patients with autism spectrum disorders, developmental disorders such as Prader-Willi Syndrome and Down Syndrome, tic disorders and Tourette Syndrome, Kleine-Levin Syndrome, aseptic encephalitis such as Anti-N-methyl-D-aspartate Receptor encephalitis, Pervasive Refusal Syndrome, or complex posttraumatic conditions. Current experiences continue to support the use of benzodiazepines and ECT in catatonia as safe and effective treatments without the risk of worsening catatonia or precipitating Neuroleptic Malignant Syndrome as opposed to when antipsychotic medications are used as first-line or sole treatment Historical and contemporary clinical and experimental catatonia models are available for future research, focusing on motor circuitry dysfunction, abnormal neurotransmitters, epileptic discharges, genetics, neuroendocrine and immune abnormalities, fear reactions akin to the animal defense strategy of tonic immobility, and developmental risk factors. There have been advances in demarcating catatonia in a wide variety of patients as a treatable condition that requires prompt identification. Catatonia NEC in DSM-5 is likely to improve proper diagnosis and treatment of catatonia and to intensify research of this condition.