Catatonia in people with developmental disability

Catatonia is a common, treatable and under-recognised condition in people with developmental disability. It commonly occurs in early adolescence.

Catatonia can occur as an adverse effect of medication, and in the context of:

psychiatric disorders (eg psychotic, depressive and bipolar disorder)
neurodevelopmental disorders (eg autism spectrum disorder, Down syndrome, Prader–Willi syndrome)
neurological, metabolic and rheumatological conditions (eg hepatic encephalopathy, encephalitis, vitamin B12 deficiency).

Catatonia can be difficult to diagnose; for observable features that may indicate catatonia in a person with developmental disability, see Observable features that may indicate catatonia in a person with developmental disability.

Some presentations of self-injurious behaviour are thought to be a manifestation of catatonia.

The Bush–Francis Catatonia Rating Scale is a free online resource that can assist in diagnosis of catatonia in people with developmental disability. Be aware of the person who has a quiet slowed catatonia or unexplained regression, as these features may be easily missed or carers may under-report symptoms (compared to the agitated person with self-injurious behaviour).

Table 1. Observable features that may indicate catatonia in a person with developmental disability
Core symptoms	Observable features
marked psychomotor disturbance	stupor, agitation, excitement catalepsy, waxy flexibility, mutism, negativism posturing, grimacing echolalia or echopraxia self-injurious behaviour extreme slowness or movement difficulty; may have difficulty initiating or completing the motor steps required reduced blinking, difficulty swallowing increase in repetitive behaviour; could appear to be compulsions, or that patient is ‘stuck in a motor loop’ parkinsonism disturbed sleep-wake cycles loss of baseline level of function (eg self-care, communication)

The presence of catatonia requires referral to a psychiatrist or tertiary mental health unit. Urgent management is required if oral intake is affected or there is severe decline in function. The primary treatments for catatonia are lorazepam and electroconvulsive therapy (ECT), and treatment of the underlying cause.

Malignant catatonia is a life-threatening condition encompassing autonomic instability, hyperthermia, altered consciousness, excitement and catatonic symptoms. Neuroleptic malignant syndrome (NMS) is considered to be a variant of malignant catatonia and is associated with antipsychotic use. Urgent referral and presentation to an emergency department is recommended.

See Principles of management of psychiatric disorders in people with developmental disability for general management considerations.