background   Catatonia is characterised by disorganisation of the motor system and manifests itself in medical disorders such as catalepsy, mutism or negativism. In modern psychiatric practice catatonia often is under-diagnosed and under-treated partly because psychiatrists are unfamiliar with the symptoms.
aim   To further the diagnosis and effective treatment of catatonia.
method   A literature search extending to July 2004 was conducted using books, PubMed, Embase and the Cochrane Library and based on the key word 'catatonia'.
results   Catatonia has a multiplicity of symptoms; these can be divided into symptoms relating to: the motor system, withdrawal behaviour, agitation, and bizarre, repetitive behaviour. There are four sub-types of catatonia: stuporous catatonia, catatonia with a state of agitation, lethal catatonia and periodic catatonia. Catatonia can be caused by several psychiatric (mainly affective disorders) and somatic syndromes and by various toxins and medicines. The estimated prevalence of catatonia in patients admitted to psychiatric hospital wards is 10%. The differential diagnosis includes patients with neuroleptic malignant syndrome. Treatment is directed towards the prevention of complications and consists of the administration of benzodiazepines and/or ect, and is particularly effective in catatonia that has developed only recently. Antipsychotics can aggravate the symptoms of catatonia and are therefore, sometimes on the whole, contra-indicated. Antipsychotics, however, are given to patients with schizophrenia and who have had a chronic and persistent form of catatonia. Such patients hardly react to any treatment.
conclusion   Catatonia is not a rare condition, often under-diagnosed, and can often be treated effectively. It is essential that catatonia be properly recognized so that effective treatment can be given.