How do you differentiate catatonia from psychotic agitation?

• A. Catatonia presents with restlessness and aggression; lorazepam is never helpful.
• B. Catatonia is characterized by rapid speech and heightened activity; ECT is rarely considered.
• C. Catatonia is defined by delusions and hallucinations; agitation features are distinct.
• D. Catatonia features stupor, waxy mobility, mutism, and negativism; agitation is marked by restlessness; a lorazepam trial and consideration of ECT are used for catatonia.

Answer: (D)

Catatonia is a psychomotor syndrome marked by severe reduction or alteration in movement and responsiveness. The defining features include stupor or immobility, waxy mobility, mutism, and negativism, often with posturing or rigidity. In contrast, agitation involves increased motor activity and restlessness, with pace, fidgeting, or verbal/physical excitability. The best way to distinguish them is to look at the motor state: catatonia locks you into stillness or peculiar motor patterns, while agitation pushes toward vigorous, restless activity.

Treatment clues also help differentiate them. Catatonia often responds dramatically to a lorazepam trial, which can both confirm the diagnosis and rapidly relieve symptoms. If catatonia is present, ECT is a highly effective option, especially in severe or refractory cases. These treatment responses are not characteristic of psychotic agitation, where benzodiazepines are not used as diagnostic tests and ECT is not the primary treatment.