Treatment of schizophrenia with catatonic symptoms

What is it about?

While catatonia is a nonspecific neuropsychiatric syndrome, the significance of catatonic symptoms occurring in schizophrenia remains unclear. We review whether antipsychotics are as effective and safe in acute and chronic schizophrenia with catatonic symptoms compared to other treatments and compared to schizophrenia without catatonia.

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Why is it important?

The validity of catatonia in schizophrenia is clinically significant only insofar as it predicts prognosis and response to treatment. Most contemporary clinical trials of antipsychotics have targeted schizophrenia as an overly broad unitary psychosis neglecting any differential response defined by phenomenology or course. However, early naturalistic studies showed that catatonia predicted poor response to first-generation antipsychotics in chronic schizophrenia and case reports cautioned against the risk of triggering neuroleptic malignant syndrome. More recent studies suggest that second-generation antipsychotics, particularly clozapine, may be effective in schizophrenia with catatonic symptoms, while several small randomized controlled trials that have not received sufficient coverage before have found that the short-term response to ECT may be faster and more significant. Conclusions are limited as to whether antipsychotics are effective and safe in schizophrenia with catatonic symptoms.

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