Recognizing and Diagnosing Catatonia: Clinical Features Explained
In this comprehensive episode, Dr. Mark Oldham—Associate Professor of Psychiatry at the University of Rochester Medical Center, President of the American Delirium Society, and Deputy Editor of the Journal of the Academy of Consultation-Liaison Psychiatry—offers an in-depth exploration of catatonia, a complex and often misunderstood neuropsychiatric syndrome.
Catatonia is not a rare phenomenon—it is underrecognized. This episode is designed to clarify what catatonia is, how to identify it, and how clinicians can improve diagnostic accuracy using validated tools and a structured approach. Whether you're a medical student, psychiatry resident, or practicing clinician, this episode provides essential insights that will elevate your clinical understanding and sharpen your diagnostic skills.
🔍 What You’ll Learn:
🔹 Definition and Overview of Catatonia
Dr. Oldham introduces the condition by breaking down the historical and modern definitions of catatonia. We explore its conceptualization over time and how it manifests across various psychiatric and medical conditions.
🔹 Signs and Symptoms
Using real-world clinical examples, Dr. Oldham walks through common and subtle signs of catatonia—ranging from stupor and mutism to waxy flexibility and echolalia. He breaks down the DSM-5 criteria as well as the Bush-Francis Catatonia Rating Scale, highlighting the strengths and limitations of each.
🔹 Diagnostic Tools
Learn how to differentiate catatonia from similar syndromes like severe depression, schizophrenia, or even delirium. Dr. Oldham emphasizes structured assessments and observational techniques that help clinicians avoid diagnostic overshadowing.
🔹 Clinical Impact and Importance
Catatonia is a psychiatric emergency. Untreated, it can progress to life-threatening conditions such as malignant catatonia or lead to long-term morbidity. The episode outlines the importance of timely diagnosis and effective intervention.
🔹 Pathophysiology and Theoretical Models
While the pathophysiology of catatonia remains complex, Dr. Oldham provides an evidence-informed explanation of neurobiological models that involve GABA, glutamate, and dopamine dysfunction.
📚 References and Resources:
British Association for Psychopharmacology Guidelines
Read the full guidelines on catatonia management including treatment and pharmacological strategies.
Rochester Catatonia Assessment Resources
Access the Bush-Francis Catatonia Rating Scale and training.
NEJM Review on Catatonia
An authoritative overview of catatonia from the New England Journal of Medicine View PDF.
Nature Review on Catatonia
Recent scientific advances in understanding catatonia’s pathophysiology and treatment approaches Read here.
Schizophrenia Research Volume on Catatonia
A special issue compiling latest research findings Explore issue.
Oldham’s Research Article:
Describing the Features of Catatonia – a core article by Dr. Oldham providing practical clinical insights.
💡 Why This Episode Matters:
Catatonia often hides in plain sight. Misdiagnosis can delay treatment and increase patient risk. Through this episode, learners will gain the confidence to:
Perform accurate bedside assessments
Understand the neuropsychiatric basis of catatonia
Make timely decisions regarding lorazepam trials and ECT referrals
Advocate for patient safety and interdisciplinary understanding
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