Catatonia Associated With Another Mental Disorder (Catatonia Specifier) 119
Catatonia
Catatonia can occur in the context of several disorders, including neurodevelopmental,
psychotic, bipolar, depressive disorders, and other medical cond itions (e.g., cerebral folate
deficiency, rare autoimmune and paraneoplastic disorders.  The manual does not treat
catatonia as an independent class but recognizes  a) catatonia associated with another men-
tal disorder (i.e., a neurodevelopmental, psychotic disord er, a bipolar disorder, a depres-
sive disorder, or other mental disorder), b)  catatonic disorder due to another medical
condition, and c) unspecified catatonia.
Catatonia is defined by the pres ence of three or more of 12 psychomotor features in the
diagnostic criteria for catatoni a associated with another mental disorder and catatonic dis-
order due to another medical condition. The es sential feature of cata tonia is a marked psy-
chomotor disturbance that may involve decr eased motor activity, decreased engagement
during interview or physical examination, or excessive and peculiar motor activity. The
clinical presentation of ca tatonia can be puzzling, as th e psychomotor disturbance may
range from marked unresponsiveness to marked  agitation. Motoric immobility may be se-
vere (stupor) or moderate (catalepsy and waxy flexibility). Similarly, decreased engage-
ment may be severe (mutism) or moderate  (negativism). Excessive and peculiar motor
behaviors can be complex (e.g.,  stereotypy) or simple (agitation) and may include echola-
lia and echopraxia. In extreme cases, the same individual may wax and wane between de-