Clinical features of catatonia
| Clinical feature | Phenomenology | DSM 5 | Bush-Francis |
| Catalepsy | Passive induction of postures held against gravity | · | · |
| Posturing | Spontaneous postures maintained against gravity | · | |
| Waxy flexibility | Slight, even resistance to passive movement | · | · |
| Stupor | Hypoactivity, minimal response to stimuli | · | · |
| Agitation/excitement | Hyperactivity, non-purposeful and not influenced by external stimuli | · | · |
| Mutism | No or minimal verbal response | · | · |
| Negativism | Resistance to instructions without obvious motive; tendency to contrary responses | · | · |
| Mannerisms | Odd, exaggerated caricatures of purposeful movement; abnormality inherent in act itself | · | · |
| Stereotypies | Repetitive, non-goal directed movements; abnormality not inherent in act but in its frequency | · | · |
| Grimacing | Maintained odd facial expressions | · | · |
| Echolalia | Repeating of words spoken by an examiner | · | · |
| Echopraxia | Mimicking of movements made by an examiner | · | |
| Staring | Fixed gaze, reduced environmental scanning, decreased blinking | · | |
| Verbigeration | Meaningless repetition of words and phrases | · | |
| Withdrawal | Refusal to eat, drink and make eye contact | · | |
| Impulsivity | Inappropriate behaviour without provocation | · | |
| Automatic obedience | Exaggerated cooperation with an examiner’s instructions | · | |
| Mitgehen (facilitatory paratonia) | Patient allows an examiner to induce a change in limb position with only light pressure, despite instruction to resist | · | |
| Gegenhalten (oppositional paratonia) | Patient resists passive movement of a limb to a new position | · | |
| Rigidity | Closely related to Gegenhalten, since recognisably extrapyramidal hypertonia is excluded | · | |
| Ambitendency | Indecisive, hesitant patterns of movement | · | |
| Perseveration | Of speech or actions | · | |
| Combativeness | Undirected and apparently without motivation | · | |
| Grasp reflex | Resembles the palmar grasp reflex of neurological disease states | · | |
| Autonomic abnormality | Cardiovascular, respiratory or thermoregulatory | · |
Three or more of the 12 features listed as Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria are required for a diagnosis of catatonia. The Bush-Francis Catatonia Rating Scale57 comprises 23 items, though posturing and muscle tone features show some overlap.