What is catatonia and which signs would you look for during the MSE?

• A. Catatonia is a mood disorder with anxious features.
• B. Catatonia is a cognitive impairment with memory loss.
• C. Catatonia is a psychomotor syndrome; signs include stupor or excitement, mutism, waxy flexibility, negativism, posturing, mannerisms, echolalia, and echopraxia.
• D. Catatonia is an anxiety disorder.

Answer: (C)

Catatonia is a psychomotor syndrome, meaning it centers on disturbances of movement, behavior, and responsiveness rather than mood, memory, or anxiety features. When you’re doing the mental status exam, you assess the patient’s motor activity and speech for classic catatonia signs: stupor or marked decrease in activity, excitement or agitation, mutism (little or no speech), waxy flexibility (maintenance of a raised or posed position), negativism (opposition or lack of response to instructions), posturing (spontaneous or imposed bizarre poses), mannerisms (odd, repetitive movements), echolalia (repeating others’ words), and echopraxia (imitating others’ movements). These signs form the characteristic cluster clinicians watch for in catatonia.

The other descriptors describe mood disorder, cognitive impairment, or anxiety disorders, which don’t capture the defining motor and behavioral syndrome of catatonia.