Catatonia associated with another mental disorder (catatonia specifier) may be used when criteria are met for catatonia during the course of a neurodevelopmental, psychotic, bipo- lar, depressive, or other mental disorder. The catatonia specifier is appropriate when the clinical picture is characterized by marked psychomotor disturbance and involves at least three of the 12 diagnostic features listed in Criterion A. Catatonia is typically diagnosed in an inpatient setting and occurs in up to 35% of individuals with schizophrenia, but the ma- jority of catatonia cases involve individuals with depressive or bipolar disorders. Before the catatonia specifier is used in neurodevelopmental, psychotic, bipolar, depressive, or other mental disorders, a wide variety of other medical conditions need to be ruled out; these conditions include, but are not limited to, medical conditions due to infectious, met- abolic, or neurological conditions (see ”Catatonic Disorder Due to Another Medical Con- dition”). Catatonia can also be a side effect of a medication (see the chapter ”Medication-
Induced Movement Disorders and Other Adverse Effects of Medication”). Because of the seriousness of the complications, particular attention should be paid to the possibility that the catatonia is attributable to 333.92 (G210) neuroleptic malignant syndrome.
Diagnostic Criteria 293.89 (F06.1)
A. The clinical picture is dominated by three (or more) of the following symptoms: 1. Stupor (i.e., no psychomotor activity; not actively relating to environment).
Catalepsy (i.e., passive induction of a posture held against gravity).
Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
Mutism (i.e., no, or very little, verbal response [Note: not applicable if there is an established aphasia]).
Negativism (i.e., opposition or no response to instructions or external stimuli).
Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
Mannerism (i.e., odd, circumstantial caricature of normal actions).
Stereotypy (i.e., repetitive, abnormally frequent, non-goaI-directed movements).
9. Agitation, not influenced by external stimuli.
10. Grimacing.
11. Echolalia (i.e., mimicking another’s speech).
12. Echopraxia (i.e., mimicking another’s movements).
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
. The disturbance is not better explained by another mental disorder (e.g., a manic episode).
. The disturbance does not occur exclusively during the course of a delirium.
. The disturbance causes clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning.
Coding note: Include the name of the medical condition in the name of the mental disor- der (e.g., 293.89 [F06.1]) catatonic disorder due to hepatic encephalopathy). The other medical condition should be coded and listed separately immediately before the cata- tonic disorder due to the medical condition (e.g., 572.2 [K7190] hepatic encephalopathy; 293.89 [F06.1] catatonic disorder due to hepatic encephalopathy).