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DSM-IV

In DSM-IV, this disorder is called Catatonic Disorder Due to a General Medical Condition

For more information, see Mental Disorders Due to a General Medical Condition

Diagnostic Criteria

A. The presence of catatonia as manifested by motoric immobility, excessive motor activity (that is apparently purposeless and not influenced by external stimuli), extreme negativism or mutism, peculiarities of voluntary movement, or echolalia or echopraxia.

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.

C. The disturbance is not better accounted for by another mental disorder (e.g., a Manic Episode).

D. The disturbance does not occur exclusively during the course of a delirium.

Note: Include the name of the general medical condition, e.g., Catatonic Disorder Due to Hepatic Encephalopathy; also record the general medical condition.

Recording Procedures

In recording Catatonic Disorder Due to a Medical Condition, the clinician should note both the specific phenomenology of the disturbance and the identified general medical condition judged to be causing the disturbance (e.g., Catatonic Disorder Due to Malignant Neoplasm of Brain). The general medical condition (e.g., malignant neoplasm of brain) should also be noted.

Associated General Medical Conditions

A variety of general medical conditions may cause catatonia, especially neurological conditions (e.g., neoplasms, head trauma, cerebrovascular disease, encephalitis) and metabolic conditions (e.g., hypercalcemia, hepatic encephalopathy, homocystinuria, diabetic ketoacidosis). The associated physical examination findings, laboratory findings, and patterns of prevalence and onset reflect those of the etiological general medical condition.

Differential Diagnosis

Delirium

A separate diagnosis of Catatonic Disorder Due to a General Medical Condition is not given if the catatonia occurs exclusively during the course of a delirium.

Medication-Induced Movement Disorders

If the individual is currently taking neuroleptic medication, Medication-Induced Movement Disorders should be considered (e.g., abnormal positioning may be due to Neuroleptic-Induced Acute Dystonia).

Schizophrenia and Mood Disorders

Catatonic symptoms may also be present in Schizophrenia and Mood Disorders. Schizophrenia, Catatonic Type, is distinguished by the absence of evidence of a general medical condition that is etiologically related to the catatonia, and by the presence of other symptoms characteristic of Schizophrenia (e.g., delusions, hallucinations, disorganized speech, negative symptoms). A Mood Disorder With Catatonic Features is likewise differentiated by the absence of evidence of a general medical condition that is etiologically related to the catatonia, and by the presence of symptoms that meet the criteria for a Major Depressive or Manic Episode.

DSM-5

Diagnostic Criteria

A. The clinical picture is dominated by three (or more) of the following symptoms:

  1. Stupor (i.e., no psychomotor activity; not actively relating to environment).
  2. Catalepsy (i.e., passive induction of a posture held against gravity).
  3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
  4. Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).
  5. Negativism (i.e., opposition or no response to instructions or external stimuli).
  6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
  7. Mannerism (i.e., odd, circumstantial caricature of normal actions).
  8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).
  9. Agitation, not influenced by external stimuli.
  10. Grimacing.
  11. Echolalia (i.e., mimicking another's speech).
  12. Echopraxia (i.e., mimicking another's movements).

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

C. The disturbance is not better explained by another mental disorder (e.g., a manic episode).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Note: Include the name of the medical condition in the name of the mental disorder (e.g., catatonic disorder due to hepatic encephalopathy). The other medical condition should be listed separately immediately before the catatonic disorder due to the medical condition (e.g., hepatic encephalopathy; catatonic disorder due to hepatic encephalopathy).

Differential Diagnosis

A separate diagnosis of catatonic disorder due to another medical condition is not given if the catatonia occurs exclusively during the course of a delirium or neuroleptic malignant syndrome. If the individual is currently taking neuroleptic medication, consideration should be given to medication-induced movement disorders (e.g., abnormal positioning may be due to neuroleptic-induced acute dystonia) or neuroleptic malignant syndrome (e.g., catatonic-like features may be present, along with associated vital sign and/or laboratory abnormalities). Catatonic symptoms may be present in any of the following five psychotic disorders: brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, and substance/medication-induced psychotic disorder. It may also be present in some of the neurodevelopmental disorders, in all of the bipolar and depressive disorders, and in other mental disorders.