Clinical management of catatonic syndromes. Part I: diagnosis, clinical setting and treatment principles

La gestione clinica delle sindromi catatoniche. Parte I: diagnosi, setting clinico e principi di trattamento

A. Callari, N. Bartolommei, L. Lattanzi, M. Mauri

Dipartimento di Medicina Clinica e Sperimentale, Sezione di Psichiatria, Università di Pisa, Azienda Ospedaliero-Universitaria Pisana



The authors review the main literature on the clinical-diagnostic definition as well as the implications of clinical and therapeutic management of catatonic syndromes.

Materials and methods

A PubMed search was done using the keywords catatonia treatment, antipsychotics, neuroleptic malignant syndrome, electroconvulsive therapy. The evidence from the literature was integrated with the authors’ clinical experience.


Whereas the current diagnostic classification (DSM-IV) does not recognize catatonia as an independent mental disorder, the new DSM-V proposes a nosographic replacement in order to consider this syndrome as a specifier of all 10 clinical diagnoses, and to eliminate the catatonic schizophrenia subtype, breaking the unbreakable bond catatonia-schizophrenia since the historical descriptions of Kraepelin. In therapeutic terms, this would reduce the risk of treating catatonia with antipsychotics, with high risk for evolution in the malignant variant, namely SMN. Clinical management of catatonia requires timely recognition and diagnosis in order to implement appropriate prophylactic and therapeutic measures to prevent the onset of serious complications (hydroelectric disorders and fatal arrhythmias, pulmonary thromboembolism, aspiration pneumonia, systemic infection, cachexia), which is associated with a a high risk of mortality, especially in the malignant subtype/MNS.


The correct and early diagnostic classification of catatonia in its specific variants represents the first major step towards adequate clinical management, with initiation of appropriate supportive measures and prophylactic preparation for the next proper treatment.

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