Recognizing Catatonia Beyond Psychiatry: From Underdiagnosis to Routine Screening
Gustavo Correa Emerick,
Theo Fetsch Werner Silva
Background: Catatonia is a potentially life-threatening but highly treatable neuropsychiatric syndrome
that remains frequently underrecognized across clinical settings. Although historically linked to
schizophrenia, it is now understood as a transdiagnostic condition that may occur in psychiatric,
neurological, autoimmune, infectious, metabolic, systemic, and critical care contexts. Objective: This
mini review discusses why catatonia continues to be missed in contemporary practice and highlights
routine bedside screening as a practical strategy to improve recognition. Methods: A narrative mini
review was developed from recent clinical reviews, consensus resources, diagnostic frameworks, and
studies addressing catatonia prevalence, diagnostic criteria, screening instruments, and medical
complications. Discussion: Detection rates vary substantially according to clinical setting and
assessment method. Structured instruments such as the Bush-Francis Catatonia Screening Instrument
identify more cases than routine clinical assessment or DSM-based criteria alone. Underdiagnosis is
sustained by historical misconceptions, heterogeneous clinical presentations, overlap with delirium
and encephalopathy, and limited routine screening outside psychiatric services.Delayed recognition
may lead to severe complications, prolonged hospitalization, and increased mortality, whereas timely
treatment with benzodiazepines and electroconvulsive therapy is often highly effective. Conclusion:
Catatonia should be considered a treatable neuropsychiatric emergency across hospital medicine.
Clinician education and systematic bedside screening may reduce preventable morbidity and mortality.
