Catatonia is seen more often in mood disorders than in psychotic disorders, and DSM even carries a catatonia specifier for autism. When you see it, use a benzodiazepine, and do not be surprised if it takes doses that sound high. ECT is given three times a week until the catatonia is gone, which can take one treatment or twelve.
What it gets confused with
Catatonia is actually seen more often in mood disorders than in psychotic disorders, so think of it in mood cases too.
“that case makes me think about Catatonia. because that's actually more frequently seen in mood disorders than psychotic disorders”
37:01Bipolar Misunderstandings, Integrating Biology & Personality, & Broader ConceptualizationsSep 2024 DSM includes a catatonia specifier for autism spectrum disorder, which most people do not know. Most people link catatonia to psychotic disorders, even though it is more frequent in bipolar disorder.
“It's the catatonia specifier. I don't know if most people know that they specifically included a catatonia specifier with catatonic features for autism spectrum disorder. I think most people think of the psychotic disorders when it comes to catatonia, even though they're more frequent in bipolar disorder”
18:19Autism Diagnosis Explained: DSM-5 Criteria, Autistic Traits & the Difficult DifferentialSep 2026
Treatment
When you see catatonia, you should probably be using a benzodiazepine. Benzodiazepines reduce the brain's excitability (a full shutdown medication), and catatonia is one of the few places we reserve them for, along with refractory sleep-wake cycle disorders and bipolar disorder.
“I do think they are basically a mood stabilizer. They function to reduce the excitability of the brain. It's just that they're a full shutdown medication, and it's not good for those reasons. But when you see catatonia, you should probably be using it”
59:35Mood Stabilizers for Bipolar Disorder: Lithium, Lamotrigine, Depakote & MoreJul 2026 Also said in 1 more episode
“Personally, I reserve the benzodiazepines for Basically, refract. Refractory The sleep -wake cycle. Cycle disorders, catatonia And, uh... And Bipolar Disorder. Disorders”
17:47Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026 A benzodiazepine dose that looks large can be nothing for some catatonia cases, and younger patients, even adolescents, sometimes need still higher doses.
“that's nothing for some catatonia cases, by the way. Also, if he was younger, depending on how young we're talking about, even to adolescents, sometimes people need even higher doses”
37:32Bipolar Misunderstandings, Integrating Biology & Personality, & Broader ConceptualizationsSep 2024 With ECT for catatonia, treatments go three times a week until the person is no longer catatonic. That might be one treatment, or it might be twelve.
“in a disease like catatonia, the answer is you're going to do ECT treatments three times a week until you're not catatonic. That might be one treatment. That might be 12”
49:00ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen EllerJun 2026Guest episode
It also comes up on
- PsychosisIn the DSM, psychosis is more than delusions and hallucinations: it includes disorganized speech, disorganized behavior and negative symptoms. Catatonia sits nearby but is not only seen in psychosis.
- SchizophreniaDSM psychosis is more than delusions and hallucinations: it includes disorganized speech, disorganized behavior and negative symptoms, and catatonia, which is not seen only in psychosis.
From these episodes
- Autism Diagnosis Explained: DSM-5 Criteria, Autistic Traits & the Difficult DifferentialSep 2026 · 1 point
- Mood Stabilizers for Bipolar Disorder: Lithium, Lamotrigine, Depakote & MoreJul 2026 · 1 point
- Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026 · 1 point
- ECT Treatment: When to Refer, Who It Helps, and What Actually Happens with Dr. MaryEllen EllerJun 2026 · 1 point
- Bipolar Misunderstandings, Integrating Biology & Personality, & Broader ConceptualizationsSep 2024 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.