Catatonia and severe psychomotor syndromes

Covers catatonia, hypoactive delirium, neuroleptic malignant syndrome, serotonin toxicity, and autoimmune encephalitis.

Malignant catatonia, NMS and serotonin toxicity are life-threatening; catatonia risks dehydration, VTE and autonomic instability.

Safety snapshot

Emergency

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

2 of 6 diagnoses compared

CriteriaComparison detail	Catatonia in psychotic disorderEmergency

2 of 6 comparedEdit

Emergency

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

+4 not selected

Open a selected differential to review its clinical record.

Based on current selection

Emergency

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

Why it fits	Psychosis plus marked motor syndrome	Quiet, staring, slowed, withdrawn, inattentive	Mutism, staring, posturing, negativism, waxy flexibility, stupor	Rigidity, hyperthermia, diaphoresis, autonomic instability, recent antipsychotic start/increase	Agitation, tremor, hyperreflexia, clonus, diaphoresis after serotonergic exposure	Catatonia with psychosis, seizures, dyskinesia, autonomic instability
What argues against	Applies to the whole presentationReview locally.
Must-not-miss	Violence in excited catatonia, profound immobility, refusal of intake, autonomic instability	Sepsis, metabolic derangement, hypoxia, drug toxicity	Refusal of intake, immobility complications, dehydration, autonomic change, hyperthermia, DVT/PE, rhabdomyolysis
Bedside question	Applies to the whole presentationCharacteristic motor syndrome rather than simple low mood, psychosis, or "behavioural refusal". Mood disorders are a very common substrate.
Immediate action	Applies to the whole presentationUse 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
Investigations	Applies to the whole presentationVitals, oxygen saturation, Creatine kinase, Neuroimaging (CT/MRI), EEG, Lumbar puncture / CSF studies
Mimics / overlap	Applies to the whole presentationReview overlap locally.