Catatonia: Diagnosis, Features, and Clinical Nuance with Dr. Mark Oldham

When a patient stops moving, stops speaking, or stares through you like you’re not there, it’s easy to miss what’s really happening.

In this episode, I’m joined again by Dr. Mark Oldham, one of the leading voices on catatonia, to break down what this strange, often misunderstood syndrome actually looks like in the real world. We walk through the diagnostic features step-by-step, how to assess, what to ask, and what’s too often overlooked.

From the history of the disorder to modern DSM confusion, from the meaning of “waxy flexibility” to the haunting truth about patients who are fully aware but trapped inside their bodies, this conversation will completely change the way you think about motor symptoms and psychiatric emergencies.

Takeaways:

• Catatonia is common, but underrecognized. It’s not just “psychiatric immobility.” It spans a spectrum from stupor to hyperactivity.

• Diagnosis starts with curiosity. Learn to test for features like mutism, posturing, and negativism systematically.

• Many patients are aware. Always treat them with dignity and assume comprehension, even when they can’t respond.

• It’s treatable and rapidly reversible. A single dose of lorazepam can sometimes unlock a frozen mind and body.

• Malignant catatonia kills. When autonomic instability appears, it’s a medical emergency that demands immediate escalation and often ECT.

Selected references:

1. British Association for Psychopharmacology Guidelines
2. ⁠Rochester Catatonia Assessment Resources⁠
3. NEJM Review on Catatonia
4. Nature Review on Catatonia
5. Schizophrenia Research Volume on Catatonia
6. Describing the Features of Catatonia (Oldham)

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