Catatonia in mood disorder

Mutism, staring, posturing, negativism, waxy flexibility, stupor

EmergentReview due

Compare (6)

At a glance

High risk: Yes
Onset: Days
Course: Persistent
Treatable: Yes

Safety snapshot

Refusal of intake, immobility complications, dehydration, autonomic change, hyperthermia, DVT/PE, rhabdomyolysis.

Watch forRefusal of intakeimmobility complicationsdehydrationautonomic change

Presentation hinge

Characteristic motor syndrome rather than simple low mood, psychosis, or "behavioural refusal". Mood disorders are a very common substrate.

Separates the Catatonia / Psychomotor Shutdown / Malignant Syndromes group. It is not specific to Catatonia in mood disorder.

Do now

1Score the Bush-Francis Catatonia Rating Scale and record which signs are present, so response can be measured later
2Check temperature, pulse, blood pressure, hydration and CK, because malignant catatonia and NMS sit on the same spectrum
3Review the chart for dopamine antagonists and for abrupt benzodiazepine cessation
4Discuss a lorazepam challenge with the treating consultant, and record the response
5Escalate urgently if there is fever, autonomic instability or a rising CK, and consider ECT referral early in malignant or non-responsive presentations

Locally authored, reviewed by PsychSift on 27 September 2026

Clinical review

Rows marked “Whole group”: Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group — not specific to Catatonia in mood disorder

Why it fits

Mutism, staring, posturing, negativism, waxy flexibility, stupor

Key features

Must-not-miss

Refusal of intake, immobility complications, dehydration, autonomic change, hyperthermia, DVT/PE, rhabdomyolysis.

High-risk causes7 causes

Refusal of intake
immobility complications
dehydration
autonomic change
hyperthermia
DVT/PE
rhabdomyolysis

Bedside question

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group.

Characteristic motor syndrome rather than simple low mood, psychosis, or "behavioural refusal". Mood disorders are a very common substrate.

Helpful clues

Immediate action

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group.

Use structured screen (Bush-Francis), examine motor signs, check vitals/hydration/CK, think benzodiazepine challenge early Catatonia is more often mood-linked than many clinicians expect Treat the catatonia specifically Benzodiazepines and/or ECT are first-line Run a full delirium workup Hypoactive delirium is a major mimic

Priority steps6 steps

1Use structured screen (Bush-Francis), examine motor signs, check vitals/hydration/CK, think benzodiazepine challenge early
2Catatonia is more often mood-linked than many clinicians expect
3Treat the catatonia specifically
4Benzodiazepines and/or ECT are first-line
5Run a full delirium workup
6Hypoactive delirium is a major mimic

Investigations

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group.

Vitals, oxygen saturation, Creatine kinase, Neuroimaging (CT/MRI), EEG, Lumbar puncture / CSF studies

Core tests5

Vitals, oxygen saturation
Creatine kinase
Neuroimaging (CT/MRI)
EEG
Lumbar puncture / CSF studies

Mimics / overlap

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group.

None listed

Consider

Do now

1Score the Bush-Francis Catatonia Rating Scale and record which signs are present, so response can be measured later
2Check temperature, pulse, blood pressure, hydration and CK, because malignant catatonia and NMS sit on the same spectrum
3Review the chart for dopamine antagonists and for abrupt benzodiazepine cessation
4Discuss a lorazepam challenge with the treating consultant, and record the response
5Escalate urgently if there is fever, autonomic instability or a rising CK, and consider ECT referral early in malignant or non-responsive presentations

Locally authored, reviewed by PsychSift on 27 September 2026

First-line tests

Applies to the Catatonia / Psychomotor Shutdown / Malignant Syndromes group — not specific to Catatonia in mood disorder

Vitals, oxygen saturation
Creatine kinase
Neuroimaging (CT/MRI)
EEG
Lumbar puncture / CSF studies

Watch for

Refusal of intake
immobility complications
dehydration
autonomic change

Also consider

Source and review

Review due· Unverified

v10 · exported 2026-07-11

Clinical reference — not validated decision support. Review before use.