Although DSM-5-TR cautions against diagnosing catatonia and delirium at the same time, real-world patients do not always fit neatly into one category. A prospective quality-improvement study of more than 700 medical inpatients found substantial overlap between the two syndromes, with implications for screening and treatment.

Antipsychotics offer remarkable, even lifesaving treatment for children and adolescents, however, their side effects include metabolic and neurologic problems, including neurotoxicity. This clinical update guides you through a rational process for employing these powerful medications when necessary but also reducing and discontinuing them when possible.

Catatonia is common in adult inpatient settings, where 6%–15% meet diagnostic criteria. In children and adolescents, prevalence estimates vary more widely, from 0.6% to 17%, perhaps because catatonia is often misdiagnosed or unrecognized. Like delirium, catatonia occurs as part of many conditions, including psychosis, mood disorders, substance use, autistic spectrum disorder, and medical conditions.

Catatonia is marked by a change from the person’s baseline state with distinct motor, vocal, and behavioral symptoms. Clinicians usually think of a catatonic person as being like a statue—immobile, unresponsive, staring, and with waxy flexibility.