Editing Catatonia (section)

==Signs and symptoms==
As discussed previously, the ICD-11 and DSM-5 both require 3 or more of the symptoms defined in the table below in order to diagnose catatonia. However, each person can have a different set of symptoms that may worsen, improve, and change in appearance throughout a single episode.<ref name="Heckers 2023">{{cite journal |last1=Heckers |first1=Stephan |last2=Walther |first2=Sebastian |date=9 November 2023 |title=Catatonia |journal=New England Journal of Medicine |volume=389 |issue=19 |pages=1797–1802 |doi=10.1056/NEJMra2116304 |pmid=37937779 |s2cid=265673511}}</ref> Symptoms may develop over hours or days to weeks.
{| class="wikitable"
|+
!Symptom
!Definition
|-
|Stupor
|A marked lack of psychomotor activity; the individual appears immobile and unresponsive
|-
|Catalepsy
|Passive induction of a posture held against gravity
|-
|Waxy Flexibility
|Slight resistance to positioning by the examiner, allowing limbs to remain in imposed positions
|-
|Mutism
|Lack of verbal response despite apparent alertness
|-
|Negativism
|Resistance or no response to external instructions or stimuli
|-
|Posturing
|Voluntary assumption of inappropriate or bizarre postures
|-
|Mannerism
|Odd, exaggerated movements or behaviors
|-
|Stereotypy
|Repetitive, non-goal-directed movements or gestures
|-
|Agitation
|Restlessness or excessive motor activity without external stimulus
|-
|Grimacing
|Facial contortions or expressions unrelated to emotional context
|-
|Echolalia
|Mimicking or repeating another person's speech
|-
|Echopraxia
|Mimicking or imitating another person's movements
|}
Because most patients with catatonia have an underlying psychiatric illness, the majority will present with worsening depression, mania, or psychosis followed by catatonia symptoms.<ref name="Catatonia StatPearls" /> Even when unable to interact, it should not be assumed that patients presenting with catatonia are unaware of their surroundings as some patients can recall in detail their catatonic state and their actions.<ref name="Rasmussen Mazurek Rosebush 2016">{{cite journal |last1=Rasmussen |first1=Sean A |last2=Mazurek |first2=Michael F |last3=Rosebush |first3=Patricia I |date=2016 |title=Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology |journal=World Journal of Psychiatry |volume=6 |issue=4 |pages=391–8 |doi=10.5498/wjp.v6.i4.391 |pmc=5183991 |pmid=28078203 |doi-access=free}}</ref>

=== Subtypes ===
There are several subtypes of catatonia which are used currently: stuporous catatonia, excited catatonia, malignant catatonia, and periodic catatonia. Subtypes are defined by the group of symptoms and associated features that a person is experiencing or displaying. Notably, while catatonia can be divided into various subtypes, the appearance of catatonia is often dynamic and the same individual may have different subtypes at different times.<ref>{{Cite book |last1=Shorter |first1=Edward |url=https://books.google.com/books?id=K_tdDwAAQBAJ&q=fink+catatonia+%22alternation%22&pg=PA119 |title=The Madness of Fear: A History of Catatonia |last2=Fink |first2=Max |date=2018 |publisher=Oxford University Press |isbn=978-0-19-088119-1 |language=en}}</ref>

'''Stuporous catatonia''': This form of catatonia is characterized by immobility, mutism, and a lack of response to the world around them.<ref name="Fink & Taylor 2009" /><ref name="Catatonia StatPearls" /> They may appear frozen in one position for long periods of time unable to eat, drink, or speak.

'''Excited catatonia''': This form of catatonia is characterized by odd mannerisms and gestures, purposeless or inappropriate actions, excessive motor activity, restlessness, stereotypy, impulsivity, agitation, and combativeness. Speech and actions may be repetitive or mimic another person's.<ref name="Fink & Taylor 2009" /><ref name="Catatonia StatPearls" /><ref name="Rasmussen Mazurek Rosebush 2016" /> People in this state are extremely hyperactive and may have delusions and hallucinations.<ref>{{cite book |last1=Nolen-Hoeksema |first1=Susan |title=Abnormal Psychology |date=2014 |publisher=McGraw-Hill Education |isbn=978-1-259-06072-4 |page=224 }}</ref>

'''Malignant catatonia''': This form of catatonia is life-threatening. It is characterized by fever, dramatic and rapid changes in blood pressure, increased heart rate and respiratory rate, and excessive sweating.<ref name="Fink & Taylor 2009" /><ref name="Catatonia StatPearls" /> Laboratory tests may be abnormal.

'''Periodic catatonia:''' This form of catatonia is characterized by a person having recurrent episodes of catatonia. Individuals will experience multiple episodes over time, without signs of catatonia in between episodes. Historically, the Wernicke-Kleist-Leonhard School considered periodic catatonia a distinct form of "non-system schizophrenia" characterized by recurrent acute phases with hyperkinetic and akinetic features and often psychotic symptoms, and the build-up of a residual state in between these acute phases, which is characterized by low-level catatonic features and [[aboulia]] of varying severity.