Catatonia is defined by the presence of three or more of 12 psychomotor features in the diagnostic criteria for catatonia associated with another mental disorder and catatonic dis- order due to another medical condition. The essential feature of catatonia is a marked psy- chomotor disturbance that may involve decreased motor activity, decreased engagement during interview or physical examination, or excessive and peculiar motor activity. The clinical presentation of catatonia can be puzzling, as the 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- creased and excessive motor activity. The seemingly opposing clinical features and variable manifestations of the diagnosis contribute to a lack of awareness and decreased recognition of catatonia. During severe stages of catatonia, the individual may need care- ful supervision to avoid self—harm or harming others. There are potential risks from mal- nutrition, exhaustion, hyperpyrexia and self—inﬂicted injury.
293.89 (F06.1)
A. The clinical picture is dominated by three (or more) of the following symptoms:
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 [exclude if known aphasial).
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-goal-directed movements).
Agitation, not influenced by external stimuli.
10. Grimacing.
11. Echolalia (i.e., mimicking another‘s speech).
12. Echopraxia (i.e., mimicking another’s movements).
Coding note: Indicate the name of the associated mental disorder when recording the name of the condition (i.e., 293.89 [F06.1] catatonia associated with major depressive dis- order). Code first the associated mental disorder (e.g., neurodevelopmental disorder, brief psychotic disorder, schizophreniform disorder. schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, or other mental disorder) (e.g., 295.70 [F251] schizoaffective disorder, depressive type; 293.89 [F06.1] catatonia associated with schizoaffective disorder).