Skip to main content Accessibility help

Electroencephalography in Catatonic Disorders Due to General Medical Conditions and Psychiatric Disorders

  • Brendan T. Carroll, Harold W. Goforth, Nashaat N. Boutros, Theodore J. Anfinson and Lisa Werner...


In an effort to aid the clinician in the differential diagnosis of catatonic states, we assessed the nature of electroencephalography (EEG) findings in both medical and psychiatric forms of catatonia. An exhaustive review of the literature on catatonia due to a general medical condition (CDGMC) was performed in addition to a prospective review of catatonic patients at The Ohio State University Neuwpsychiatric Facility.

A total of 105 patients had documented, specific clinical and EEG information, with neurologic conditions accounting for 82.8% of case reports. Results from the case series of 31 episodes of catatonia indicate that there is an increased likelihood of diffuse slowing in patients with CDGMC versus psychiatric catatonia. Given the observed rate of abnormalities, EEG is an important but underutilized tool in the differential diagnosis of catatonic disorders.



Hide All
1.Kahlbaum, KL (1873); Levij, Y, Pridon, T, trans. Catatonia. Baltimore, Md: Johns Hopkins University Press; 1983.
2.Taylor, MA. Catatonia: a review of a behavioral neurologic syndrome. Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 1992;3:4872.
3.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.
4.Gelenberg, AJ. The catatonic syndrome. Lancet. 1976;1:13391341.
5.Barnes, MP, Saunders, M, Walls, TJ, et al.The syndrome of Karl Ludwig Kahlbaum. J Neurol Neurosurg Psychiatry. 1986;49:991996.
6.Carroll, BT. Catatonia on the consultation-liaison service. Psychosomatics. 1992;33:310315.
7.Fein, S, McGrath, MG. Problems in diagnosing bipolar disorder in catatonic patients. J Clin Psychiatry. 1990;51:203205.
8.Popkin, MK, Tucker, GJ. “Secondary” and drug-induced mood, anxiety, psychotic, catatonic, and personality disorders: a review of the literature. J Neuropsychiatry Clin Neurosci. 1992;4:369385.
9.Walter, WG. Electroencephalography in cases of mental disorder. J Ment Sci. 1942;88:110121.
10.Abenson, MH. EEGs in chronic schizophrenia. Br J Psychiatry. 1970;116:421425.
11.Small, JG, Small, IF. EEG spikes in non-epileptic psychiatric patients. Dis Nerv Syst. 1967;28:523525.
12.Rosebush, PI, Hildebrand, AM, Furlong, BG, et al.Catatonic syndrome in a general psychiatric inpatient population: frequency, clinical population, and response to lorazepam. J Clin Psychiatry. 1990;51:347362.
13.Ellington, RJ. The incidence of EEG abnormality among patients with mental disorders of apparently non-organic origin. Am J Psychiatry. 1954;11:263272.
14.Hughes, JR. EEG in Clinical Practice. Boston, Mass: Butterworths; 1982.
15.Lohr, JB, Wisniewski, AA. Catatonia. In: Lohr, JB, Wisniewski, AA, eds. Movement Disorders, A Neuropsychiatric Approach. Baltimore, Md: Guilford Press; 1987:201227.
16.Ainsworth, P. A case of “lethal eatatonia” in a 14-year-old girl. Br J Psychiatry. 1987;150:110112.
17.Arnott, G, Lehembre, MMP, Lambert, P, et al.Porphyrie aigue intermittente a manifestations cerebrales: convulsions generalisees avec anomalies E.E.G. focales dans un cas-etat catatonique dans un autre cas. Lille Med. 1972;17:857862.
18.Atri, PB, Julius, DA. Maprotiline hydrochloride associated with a clinical state of catatonic stupor and epileptic encephalogram. J Clin Psychopharmacol. 1984;4:207209.
19.Belfer, MI, d'Autremont, CC. Catatonia-like symptomatology. Arch Gen Psychiatry. 1971;24:119120.
20.Bruni, B, Carlini, M, Gamba, S, et al.Catatonia with high CSF lactate in a case of diabetes with associated conditions. Acta Diabeta Lat. 1980;17:273276.
21.Cairns, H. Disturbances of consciousness with lesions of the brain-stem and diencephalon. Brain. 1952;75:814.
22.Campbell, R, Schaffer, CB, Tupin, J. Catatonia associated with glutethimide withdrawal. J Clin Psychiatry. 1983;44:3233.
23.Contamin, F, Escourelle, R, Nick, J, et al.Atrophie pallidonigro-luysienne syndrome akinetique avec palilalie, rigidite oppositionelle et catatonie. Rev Neurol (Paris). 1971;124:107120.
24.Cooper, AF, Schapira, K. Case report: depression, catatonic stupor, and EEG changes in hyperparathyroidism. Psychol Med. 1973;3:509515.
25.Cravioto, H, Silberman, J, Feigin, I. A clinical and pathological study of akinetic mutism. Neurology. 1960;10:1021.
26.Daradkeh, TK, Nasrallah, NS. Lupus catatonia: a case report. Pharmacotherapy. 1987;5:142144.
27.Doherty, M, Garstin, I, McClelland, RJ, et al.A steroid stupor on the surgical ward. Br J Psychiatry. 1991;158:125127.
28.Douglass, AB, Hays, P, Pazderka, F, et al.Florid refractory schizophrenia that turns out to be variants of HLA associated narcolepsy. J Nerv Ment Dis. 1991;179:1217.
29.Drake, ME, Coffey, CE. Complex partial status epilepticus simulating psychogenic unresponsiveness. Am J Psychiatry. 1983;140:800801.
30.Evrard, E, Molders, V, DeBruyn-Mottard, AM, et al.Syndrome catatonique tardif symptomatique d'une encephalopathie degenerative. Acta Psychiatr Belg. 1977;77:429445.
31.Fisher, CM. ‘Catatonia’ due to disulfiram toxicity. Arch Neurol. 1989;46:798804.
32.Freeman, JM, Finkelstein, JD, Mudd, SH. Folate-responsive homocystinuria and “schizophrenia.” A defect in methylation due to deficient 5,10-methylenetetrahydrofolate reductase activity. N Engl J Med. 1975;292:491496.
33.Fricchione, GL, Kaufman, LD, Gruber, BL, et al.Electroconvulsive therapy and cyclophosphamide in combination for severe neuropsychiatric lupus with catatonia. Am J Med. 1990;88:442443.
34.Glaser, GH, Pincus, JH. Limbic encephalitis. J Nerv Ment Dis. 1969;149:5967.
35.Gomez, EA, Comstock, BS, Rosario, A. Organic versus functional etiology in catatonia: case report. J Clin Psychiatry. 1983;43:200201.
36.Good, MI. Catatonic symptomatology and withdrawal diskinesias. Am J Psychiatry. 1976;133:14541455.
37.Hanson, GD, Brown, MJ. Waxy flexibility in a postpartum woman. A case report and review of the catatonic syndrome. Psychiatr Q. 1973;47:95103.
38.Hauser, P, Devinsky, O, DeBellis, M, et al.Benzodiazepine withdrawal delirium with catatonic features. Occurrence in patients with partial seizure disorders. Arch Neurol. 1989;6:696699.
39.Himmelhoch, J, Pincus, J, Tucker, G, et al.Sub-acute encephalitis: behavioral and neurological aspects. Br J Psychiatry. 1970;116:531538.
40.Hockaday, TDR, Keynes, WM, McKenzie, JK. Catatonic stupor in elderly woman with hyperparathyroidism. Br Med J. 1966:1:8587.
41.Hoenig, J, Toakley, JG. The diagnosis of stupor. Psychiatrica Neurologica Basel. 1959;137:128144.
42.Kim, CH, Perlstein, MA. Encephalitis with catatonic schizophrenic symptoms. Ill Med J. 1970;138:503507.
43.Kirubakaran, V, Sen, S, Wilkinson, CB. Catatonic stupor, unusual manifestation of temporal lobe epilepsy. Psychiatric J Univ Ott. 1977;12:244246.
44.Koehler, K, Jakumeit, U. Subacute sclerosing panencephalitis presenting as Leonhard's speech-prompt catatonia. Br J Psychiatry. 1976;129:2931.
45.Kramer, MS. Menstrual epileptoid psychosis in an adolescent girl. Am J Dis Child. 1977;131:316317.
46.Kronfol, Z, Schlesser, M, Tsuang, M. Catatonia and systemic lupus erythematosus. Dis Nerv Sys. 1977;38:729731.
47.Johnson, J, Lucey, PA. Encephalitis lethargica, a contemporary cause of catatonic stupor. A report of two cases. Br J Psychiatry. 1987;151:550552.
48.Lanham, JG, Brown, MM, Hughes, GRV. Cerebral systemic lupus erythematosus presenting with catatonia. Postgrad Med J. 1985:61:329330.
49.Lee, CH, Lance, JW. Migraine stupor. Headache. 1977;17:3238.
50.Leigh, H, Callahan, WA, Einhorn, D. Good outcome in a catatonic patient with enlarged ventricles. J Nerv Merit Dis. 1978;166:139141.
51.Levine, Y, Gaoni, B. The hypoparathyroid syndrome: psychiatric observations and case description. Isr J Psychiatry Relat Sci. 1990;27:242246.
52.Lim, J, Yagnik, P, Schraeder, P, et al.Ictal catatonia as a manifestation of nonconvulsive status epilepticus. J Neurol Neurosurg Psychiatry. 1986;49:833836.
53.Mac, DS, Pardo, MP. Systemic lupus erythematosus and catatonia: a case report. J Clin Psychiatry. 1983;44:155156.
54.Malamud, N. Psychiatric disorder with intracranial tumors of the limbic system. Arch Neurol. 1967;17:113123.
55.Matthews, WB. Multiple sclerosis presenting with acute remitting psychiatric symptoms. J Neurol Neurosurg Psychiatry. 1979;42:859863.
56.Micheels, LJ. Catatonic syndrome in a case of subdural hematoma. J Nerv Ment Dis. 1953;117:123129.
57.Misra, PC, Hay, GG. Encephalitis presenting as acute schizophrenia. Br Med J. 1971;1:532533.
58.Morrant, JCA. A catatonic syndrome resulting in death. Can J Psychiatry. 1984;29:147150.
59.Offenstadt, G, Bienvenu, MP, Hericord, PH, et al.Catatonie grave, schizophrenic et coproporphyrie hereditaire. Sem Hop Paris. 1980;56:17271730.
60.Orland, RM, Daghestani, AN. A case of catatonia induced by bacterial meningoencephalitis. J Clin Psychiatry. 1987;48:489490.
61.Pichot, P, Samuel-Lajeunesse, B, Guelfi, J-D. Problemes etiologiques par un syndrome catatonique. Ann Med Psychol (Paris). 1969;127:133139.
62.Prins, JM, DeGlas-Vos, JW. Cerebrale lupus erythematosus disseminatus: hoofdbrekens voor patient en arts. Ned Tijdschr Geneeskd. 1990;134:22522256.
63.Raskin, DE, Frank, SW. Herpes encephalitis with catatonic stupor. Arch Gen Psychiatry. 1974;31:544546.
64.Reimer, DR, Nagaswami, S. Catatonic schizophrenia associated with cerebral arterial malformations and with membranous glomerulonephritis. Psychosomatics. 1974;15:3940.
65.Rubin, RL. Adolescent infectious mononucleosis with psychosis. J Clin Psychiatry. 1978;39:773775.
66.Ruff, RL, Russakoff, LM. Catatonia with frontal lobe atrophy. J Neurol Neurosurg Psychiatry. 1980;43:185187.
67.Salam, SA, Kilzieh, N. Lorazepam treatment of psychogenic catatonia: an update. J Clin Psychiatry. 1988;49(suppl):1621.
68.Sackallares, JC, Lee, SI, Dreifuss, FE. Stupor following administration of valproic acid to patients receiving other antileptic drugs. Epilepsia. 1979;20:697703.
69.Scamvougeras, A, Rosebush, PI. AIDS-related psychosis with catatonia responding to low dose lorazepam. J Clin Psychiatry. 1992;53:414415.
70.Schmuecker, JD, Meloy, JR, Williams, DJ. Disulfiram toxicity and catatonia in a forensic outpatient. Am J Psychiatry. 1992;149:12751276.
71.Sevlever, G, Taratuto, AH, de las Carreras, MC, et al.Catatonia secondary to acute Chaga's encephalitis. J Neurol Neurosurg Psychiatry. 1987;50:1244.
72.Shah, P, Kaplan, SL. Catatonic symptoms in a child with epilepsy. Am J Psychiatry. 1980;137:738739.
73.Snyder, S, Prenzlauer, S, Maruyama, N, et al.Catatonia in a patient with AIDS-related dementia. J Clin Psychiatry. 1990;53:414.
74.Sobin, A, Ozer, MN. Mental disorders in acute encephalitis. Mount Sinai Hospital Journal. 1966;33:7382.
75.Solomon, JG. Distinguishing catatonia: a case report. Psychosomatics. 1978;19:299307.
76.Sours, JA. Akinetic mutism simulating catatonic schizophrenia. Am J Psychiatry. 1962;119:451455.
77.Steinman, TI, Yager, HM. Catatonia in uremia. Ann Intern Med. 1978;89:7475.
78.Steriade, M, Botez, MI, Petrovici, I. On certain dissociations of consciousness levels within the syndrome of akinetic mutism. Psychiatrica Neurologica Basel. 1961;141:3858.
79.Sternbach, H, Yager, J. Catatonia in the presence of midbrain and brainstem abnormalities. J Clin Psychiatry. 1981;42:352353.
80.Sutter, JM, Barnedat, C, Pheline, C, et al.La catatonie posttraumatique ses rapports avec les “etats de decerebration” et les “coma prolonges.” Rev Neurol (Paris). 1959;101:524535.
81.Tandon, R, Walden, M, Falcon, S. Catatonia as a manifestation of paraneoplastic encephalopathy. J Clin Psychiatry. 1988;49:121122.
82.Thompson, SW, Greenhouse, AH. Petit mal status in adults. Ann Intern Med. 1968;68:12711279.
83.Tippin, J, Dunner, FJ. Biparietal infarctions in a patient with catatonia. Am J Psychiatry. 1981;138:13861387.
84.Volkow, ND, Harper, A, Munnisteri, D, et al.AIDS and catatonia. J Neurol Neurosurg Psychiatry. 1987;50:104.
85.Weddington, WW, Marks, RC, Verghese, JP. Disulfiram encephalopathy as a cause of the catatonia syndrome. Am J Psychiatry. 1982;137:12171219.
86.Wilson, LG. Viral encephalopathy mimicking functional psychosis. Am J Psychiatry. 1976;133:165170.
87.Zlotow, M, Kleiner, S. Catatonic schizophrenia associated with tuberous sclerosis. Psychiatr Q. 1965;39:466475.
88.Boutros, NN. A review of the indications for routine EEG in clinical psychiatry. Hosp Community Psychiatry. 1992;43:716719.
89.Gibbs, F, Novick, R. Electroencephalographic findings among adult patients in a private psychiatric hospital. Clin Electroencephalogr. 1977;8:7988.
90.Carroll, BT, Boutros, NN. Clinical electroencephalograms in patients with catatonic disorders. Clin Electroencephalogr. 1994;26:6064.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed