Catatonic Schizophrenia: Symptoms, Causes, Treatment and More

Written by Elizabeth Svoboda, Keri Wiginton
Medically Reviewed by Zilpah Sheikh, MD on January 14, 2025
9 min read

Catatonic schizophrenia is one feature of a serious mental illness called schizophrenia. Schizophrenia prevents you from separating what’s real from what’s not, a state of mind called psychosis.

Catatonic schizophrenia, which is an outdated term, is now referred to as schizophrenia with catatonic features or schizophrenia with catatonia. It affects the way you move in extreme ways, causing you to be completely still, not speak or make any sound, or become hyperactive for no reason. It’s also possible to experience a mix of these symptoms.

Schizophrenia usually starts in your late teens or young adulthood and is a lifelong condition. If you get catatonia, your episodes may come and go. But the right treatment will usually help ease your symptoms.

Catatonia can show up in many different ways. A core sign is that you don’t move normally, even though you are physically able. 

Common catatonia symptoms can include things such as:

  • Not moving
  • Saying only a few words or nothing at all
  • Sluggish response
  • Staring or not blinking very much
  • Grabbing someone’s hand if they touch your palm
  • Not making eye contact
  • Odd behaviors, such as suddenly running down a hall or taking off your clothes
  • Repeating certain words or phrases over and over
  • Tapping feet or other repeated movements
  • Doing something normal, like waving your hand, but at the wrong time

Symptoms of catatonia are grouped into 12 classic features. They can show up differently in each person, but doctors look for at least three of the following to make a diagnosis: 

  1. Mutism: You don’t talk, even if people ask you questions.
  2. Stupor: You stay still like a statue or react little to what’s happening around you.
  3. Mannerisms: You make over-the-top or odd gestures or movements.
  4. Catalepsy: You retain whatever position someone puts you in.
  5. Negativism: You ignore instructions, or do the opposite of what someone asks.
  6. Agitation: You move a lot for no reason. 
  7. Posturing: You sit or stand in ways that look like they’d be uncomfortable.
  8. Waxy flexibility: You hold a body position, even if someone tries to move you. 
  9. Echopraxia: You copy other people’s movements.
  10. Echolalia: You copy what someone else says.
  11. Stereotypy: You repeat a movement, such as tapping your fingers over and over. 
  12. Grimacing: You make tense or strange faces, such as smiling when you shouldn’t. 

Research shows that many people with catatonia are aware of what’s happening around them and can remember details, even if they can’t respond at the time. But you might not fully realize what’s going on or have memories of your catatonic state afterward.

Scientists don’t fully understand what causes schizophrenia with catatonia. But researchers have found that people with these symptoms have unusual activity in parts of the brain that control movement. This includes areas such as the forebrain, hypothalamus, and motor cortex.

If you have catatonia, certain brain chemicals may not work the right way. For example:

  • GABA, a chemical that helps calm the brain and body, may be underactive.
  • Glutamate, which boosts brain activity, might be too active.
  • Dopamine, which helps regulate movement and mood, may also be disrupted.

This suggests catatonia may be related to an imbalance between GABA, glutamate, and dopamine in the brain. Scientists are still studying the link between these brain signals and catatonia symptoms.

What triggers catatonic episodes? 

There’s no single event that leads to catatonia. It’s likely a complex mix of different things, including your genes, brain biology, and life stressors. Other health issues may also play a role.

You’re more likely to get catatonia if you:

  • Have a personal or family history of schizophrenia
  • Have another psychiatric condition, such as bipolar disorder, autism, or depression 
  • Use substances such as drugs and alcohol
  • Get serious side effects from antipsychotic drugs (neuroleptic malignant syndrome)
  • Have withdrawal when you stop taking benzodiazepines
  • Take other medications that affect your brain, such as dopamine blockers
  • Are sensitive to stress and face extreme fear

Medical conditions can sometimes trigger catatonia. Common ones include:

  • Stroke
  • Tumors
  • Autoimmune disorders, such as lupus
  • Brain disorders
  • Metabolism issues, such as thyroid disease
  • Low sodium levels (hyponatremia)
  • Blood clots in the brain (cerebral venous sinus thrombosis)

Conditions such as meningitis, encephalitis, or serious infections from bacteria, viruses, or fungi can also lead to catatonia. Experts aren’t sure why these or other medical conditions can trigger symptoms.

Catatonic schizophrenia is no longer considered a separate diagnosis anymore. Catatonia refers to a group of symptoms that can happen with schizophrenia, mood disorders, autism, and other conditions. It’s often mentioned with schizophrenia because around 35% of people with schizophrenia will get catatonia symptoms at some point.

There isn’t a blood test or brain scan for catatonia, but your doctor can do several things to find out if you have it.

To diagnose catatonia, your doctor may:

  • Look at your medical records to find out your mental and physical health history.
  • Give you a physical exam to check for abnormal movements or behaviors.
  • Find out about medications you’ve taken or stopped taking recently.
  • Check your blood for signs of substance use, infections, or other health issues.

Difference between catatonic schizophrenia and paranoid schizophrenia 

Doctors no longer use the term “paranoid schizophrenia” for diagnoses. But if your main symptoms are paranoia, delusions, and hallucinations, they might describe your schizophrenia that way.

Likewise, “catatonic schizophrenia” is an older term used to describe schizophrenia with catatonia as the main feature.

Schizophrenia with catatonia responds well to treatment. Here are the main things your doctor can do to help you get better: 

Medications 

These are often the first step to ease catatonic schizophrenia. A type of anti-anxiety drug called benzodiazepines, or “benzos,” is the go-to treatment. These drugs work by targeting the GABA system, which helps calm your brain and body.

Your doctor might prescribe:

  • Alprazolam (Xanax), an anti-anxiety drug
  • Lorazepam (Ativan, Lorazepam Intensol), used to treat epilepsy (seizures) and anxiety.

You might take benzodiazepines by mouth or through an IV line (medication that goes through a vein in your arm). 

Your doctor may also prescribe other treatments to take at the same time, including antipsychotic drugs, such as memantine or lithium, or a type of brain stimulation called electroconvulsive therapy (ECT).

Brain stimulation 

This treatment uses electricity or magnets to target connections in your brain. The most common therapies used to treat catatonic schizophrenia include:

Electroconvulsive therapy (ECT)

Your doctor may suggest ECT if medications don’t help enough. It’s the first-choice treatment for serious forms of catatonia that need fast treatment, including malignant catatonia and delirious catatonia. 

ECT is a type of brain stimulation that sends short bursts of electricity through your brain while you’re asleep. It can cause side effects, such as confusion or temporary memory loss. 

Doctors think ECT helps with catatonia because it boosts blood flow to certain parts of the brain, including areas that control GABA activity. It’s around 80%-100% effective at easing symptoms, but you may need at least six sessions before you feel totally better.

Transcranial magnetic stimulation (TMS)

During a TMS session, you wear a special cap that sends magnetic pulses to your brain. Like ECT, this process targets nerve cells to help ease symptoms. 

Your doctor might suggest TMS or repetitive transcranial magnetic TMS (rTMS) if:

  • Medication doesn’t work.
  • You can’t handle ECT side effects.
  • You need ongoing treatment for catatonia symptoms.

Since TMS doesn’t use electricity, you get fewer thinking and memory problems afterward. But TMS is newer than ECT. More research is needed to know how well it works for catatonia.

Psychotherapy

Medication and brain stimulation are the first-choice treatments for catatonia, no matter the cause. Once you recover, your doctor might suggest you try talk therapy. This can help you work through hidden emotional triggers behind your symptoms.

Scientists think catatonia may be a protective response that kicks in during extreme fear or anxiety. It may be part of the body’s fight-or-flight response, which also includes “freezing” and “fawning.”

Here’s how this might show up in catatonia:

  • Freeze: Staying still or silent
  • Fight: Refusing to follow instructions or arguing
  • Fawn: Being overly passive or obedient

Talk therapy could help calm an overactive fear response, though more research is needed to understand which types work best to prevent or treat catatonia.

If your catatonic symptoms are severe, you may need to be hospitalized for a while. This decision will be based on your safety. Catatonic symptoms sometimes can disrupt your heart rate, temperature, and blood pressure. You can leave the hospital once your symptoms are under control and you have a long-term treatment plan in place.

Catatonia is very treatable. But without medical care, ongoing symptoms can lead to serious health problems that affect your physical and mental health. 

If you have schizophrenia with catatonia, you may get:

  • Malnutrition (if you don’t eat enough) 
  • Skin sores (from sitting and putting pressure on the skin)
  • Blood clots on your legs or lungs (from not moving)
  • Infections
  • Painful or stiff muscles

Rarely, catatonia can cause life-threatening problems that affect how your body works. This is called malignant catatonia. It affects automatic processes such as your heart rate, breathing, and blood pressure. Malignant catatonia can be fatal. You’ll need treatment right away.

With the right medical care, you can manage catatonia symptoms and live a full life. Early detection and treatment are key to avoiding long-term health issues.

If you have schizophrenia, these steps can lessen your chances of catatonia:

  • Stick to your treatment plan.
  • See your doctor regularly.
  • Tell someone when you notice unusual mental or physical symptoms.
  • Avoid drugs or alcohol.
  • Join a support group.
  • Surround yourself with people you trust.

If you have a family member with schizophrenia, use these tips:

  • Learn about catatonia symptoms and how to spot them.
  • Urge your loved one to take their medications and treat other health conditions.
  • Let them know they can talk to you openly about their symptoms.
  • Help them feel safe and supported when they’re scared.
  • Know the number of your local mobile crisis unit (if available).
  • Plan for emergencies together.

A Wellness Recovery Action Plan (WRAP) can also be helpful. This is a tailored crisis plan that lists key contacts, like doctors, psychiatrists, or supportive friends and family members. Work with your loved one’s doctor to create a plan specific to their needs.

Schizophrenia with catatonia (formerly catatonic schizophrenia) affects how you move and behave. You might stay still for long periods, copy the movements or words of others, or not speak at all. These symptoms can be serious, but recovery is possible with the right medical care and support.

If you or someone you love shows signs of catatonia, talk to a doctor right away. Early diagnosis and treatment with medication or brain stimulation are key to getting better and preventing major health issues.

What does a catatonic episode look like?

Catatonia affects people in different ways. But if you have it, you may move or act in ways that seem odd, uncomfortable, or inappropriate. You may not talk at all or repeat what you hear other people say. You could hold strange body positions for a long time or resist movement when someone tries to adjust your position.

Is catatonic schizophrenia fatal?

Most of the time, catatonia is not deadly. Rarely, you may develop a life-threatening form that affects body processes, such as your heart rate and blood pressure. It’s called malignant catatonia (MC), and around 20% of people who get MC don’t survive.

What is it like living with catatonic schizophrenia?

Catonia affects your ability to move or communicate, and symptoms may come and go. During episodes, some people say it’s like being trapped or paralyzed. They describe feeling as if their arms are “made of rubber” and their eyes are “glued shut.” Others say catatonia can cause overwhelming anxiety, fear, and depression.

What is an example of catatonic schizophrenia?

People with catatonia have several different symptoms, but the most common one is not moving. You may hold positions that look uncomfortable, even if someone tries to move you. You may also not speak at all, copy what other people say, or repeat the same phrase over and over.