Table 1

Clinical features of catatonia

Clinical featurePhenomenologyDSM 5Bush-Francis
CatalepsyPassive induction of postures held against gravity··
PosturingSpontaneous postures maintained against gravity·
Waxy flexibilitySlight, even resistance to passive movement··
StuporHypoactivity, minimal response to stimuli··
Agitation/excitementHyperactivity, non-purposeful and not influenced by external stimuli··
MutismNo or minimal verbal response··
NegativismResistance to instructions without obvious motive; tendency to contrary responses··
MannerismsOdd, exaggerated caricatures of purposeful movement; abnormality inherent in act itself··
StereotypiesRepetitive, non-goal directed movements; abnormality not inherent in act but in its frequency··
GrimacingMaintained odd facial expressions··
EcholaliaRepeating of words spoken by an examiner··
EchopraxiaMimicking of movements made by an examiner·
StaringFixed gaze, reduced environmental scanning, decreased blinking·
VerbigerationMeaningless repetition of words and phrases·
WithdrawalRefusal to eat, drink and make eye contact·
ImpulsivityInappropriate behaviour without provocation·
Automatic obedienceExaggerated 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·
(oppositional paratonia)
Patient resists passive movement of a limb to a new position·
RigidityClosely related to Gegenhalten, since recognisably extrapyramidal hypertonia is excluded·
AmbitendencyIndecisive, hesitant patterns of movement·
PerseverationOf speech or actions·
CombativenessUndirected and apparently without motivation·
Grasp reflexResembles the palmar grasp reflex of neurological disease states·
Autonomic abnormalityCardiovascular, 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.