title: Catatonic syndrome: From detection to therapy.
abstract: BACKGROUND
  Catatonia is a psychomotor syndrome which can include motor, mental, behavioral and vegetative symptoms. Exclusively associated with schizophrenia until the 1970s, catatonia still remains an under-diagnosed syndrome with significant morbidity and mortality.
  
  
  RESULTS
  As a result of its different forms and developments, catatonic syndrome can be associated with many organic and psychiatric etiologies and confused with a variety of diagnoses. In addition to its organic complications, malignant catatonia can also be extremely severe. Several diagnostic scales are described, those of Bush and Peralta being the most widely used. Despite the recent development of the DSM-5, we can regret the lack of progress in the international classifications concerning both the recognition of the etiological diversity of this syndrome and in the clinical and therapeutic approaches to it. The diagnosis is based solely on clinical data, and needs to be completed by information from paraclinical settings, particularly with respect to detecting organic etiology. The first-line treatment is still based on the use of certain benzodiazepines or benzodiazepine-like agents such as lorazepam, diazepam and zolpidem. If the first or second line fails, or in case of malignant catatonia, electroconvulsive therapy is recommended. For the periodic form, no large-sample study has been performed on long-term treatment. A few case reports suggest the use of lithium in periodic catatonia, specifically to prevent recurrent episodes or at least to extend the inter-episode intervals. Other studies are in favor of the use of benzodiazepines, with disagreement between gradual discontinuation and long-term treatment. Concerning the management of catatonia in patients with schizophrenia, for whom first-line benzodiazepines are often insufficient, certain atypical antipsychotics such as clozapine or quetiapine appear efficient. These data are also applicable to children and adolescents.
  
  
  CONCLUSIONS
  Often neglected by practitioners, catatonic syndrome remains a common entity of which it is important to be aware, especially in case of rapid installation of the symptoms. Diagnostic scales should be used and a lorazepam test should be performed to avoid delaying the diagnosis. Second-line therapy requires further study. This concerns in particular diazepam, anti-NMDA (N-methyl-D-aspartate) and rTMS (repetitive transcranial magnetic stimulation). Some specificities of catatonia, such as the periodic form and cases in patients with schizophrenia, also require further evaluations.
authors.affiliation: Service universitaire de psychiatrie, centre Esquirol, CHU de Caen, avenue Côte-de-Nace, CS 30001, 14000 Caen cedex, France; CNRS, UMR 6301, ISTCT, équipe ISTS, GIP Cyceron, 14074 Caen, France.
authors.forename: J
authors.initials: J
authors.lastname: Madigand
authors.affiliation: Service universitaire de psychiatrie, centre Esquirol, CHU de Caen, avenue Côte-de-Nace, CS 30001, 14000 Caen cedex, France. Electronic address: lebain-p@chu-caen.fr.
authors.forename: P
authors.initials: P
authors.lastname: Lebain
authors.affiliation: Établissement public de santé mentale, 14000 Caen, France.
authors.forename: G
authors.initials: G
authors.lastname: Callery
authors.affiliation: Service universitaire de psychiatrie, centre Esquirol, CHU de Caen, avenue Côte-de-Nace, CS 30001, 14000 Caen cedex, France; CNRS, UMR 6301, ISTCT, équipe ISTS, GIP Cyceron, 14074 Caen, France; UFR de médecine, université de Caen Basse-Normandie, 14000 Caen, France.
authors.forename: S
authors.initials: S
authors.lastname: Dollfus
mesh_terms: D000293:Adolescent; D000328:Adult; D002389:Catatonia / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D008140:Lorazepam / Q000494:pharmacology; D011569:Psychiatric Status Rating Scales; D013577:Syndrome
chemical_list: D006993:Hypnotics and Sedatives; D008140:Lorazepam
keywords: Adolescent; Adolescents; Antipsychotics; Antipsychotiques; Benzodiazepines; Benzodiazépines; Catatonia; Catatonia rating scales; Catatonie; Catatonie périodique; Children; Classification diagnostique; Diagnostic classification system; Diazepam; Diazépam; Electroconvulsive therapy; Enfant; Lorazepam; Periodic catatonia; Schizophrenia; Schizophrénie; Zolpidem; Échelles d’évaluation de la catatonie; Électroconvulsivothérapie