The American Psychiatric Association Resource Document for Catatonia was prepared by the Catatonia Work Group of the Council on Consultation-Liaison Psychiatry, with the goal of supporting psychiatrists, trainees and other mental healthcare workers and to provide a useful framework for understanding catatonia. This document is not intended to be comprehensive or completely systematic in nature, nor is it a practice guideline. In 2023, the American Psychiatric Association Council on Consultation-Liaison (C-L) Psychiatry convened a work group to develop a resource document on Catatonia. A draft of this document was reviewed by the Council in December 2024, and a revised version was approved by this Council in January 2025. The accepted version was subsequently reviewed by the American Psychiatric Association Council on Women's Mental Health, Council on Geriatric Psychiatry, Council on Research, Council on Quality Care, Committee on Practice Guidelines, and Committee on Ethics in December 2024. The final version was approved by the Joint Reference Committee on March 12th, 2025, and posted to the APA website. In this Resource Document we review the history of the catatonia, its epidemiology including prevalence and risk factors. We review the common evaluation methods including rating scales, diagnostic criteria and clinical evaluation of medical causes of catatonia and its complications, with a focus on the physical examination, laboratory studies, neuroimaging and electroencephalography. We review the differential diagnosis of catatonia across the medical and psychiatric context of care including: abulia / akinetic mutism, delirium, major neurocognitive disorders, locked in syndrome, late stage Parkinsons disease, Stiff Person Syndrome, Akathisia, mania, malignant catatonia / Neuroleptic Malignant Syndrome, autoimmune encephalitis, and Serotonin Syndrome. In this Resource Document we additionally review the pathophysiology of catatonia and highlight common interventions and treatment recommendations, with a focus on benzodiazepines and electroconvulsive therapy (ECT). We additionally highlight considerations in specific populations including pediatrics, the medically complex, pregnancy and postpartum period and dementia. We conclude the document with a review of ethical and legal considerations and provide some suggestions for educational resources.

Background: Many hospitals do not have regular access to psychiatry consult services. This is well understood as a common shortage at nonacademic community hospitals (especially in rural environments, and may also be a problem at noncontiguously located smaller hospitals that are affiliated with academic medical centers in urban settings. The authors sought to deliver timely inpatient psychiatric consultation–liaison services via telemedicine to a local but physically separated hospital affiliated with an academic medical center. Materials and Methods: The authors collaborated with an office dedicated to the advancement of telemedicine technology at their academic medical center. They developed a telemedicine-based care model to deliver inpatient consultation–liaison psychiatry consultations to an affiliated (but physically separate) small academic hospital that did not have its own on-site consultation–liaison psychiatry team. Results: The authors were able to successfully complete 30 consultations, each within 24 h. Only 1 patient was ultimately unwilling to participate in the telemedicine interview. As consultations were accomplished on same day as request, patient length of stay was unaffected. Conclusions: This pilot study suggests that telemedicine is a viable model for inpatient consultation–liaison psychiatry services to hospitals without on-site psychiatry resources and represents a viable alternative model of service delivery.

Fragile X-associated disorders are a group of disorders caused by expansion of noncoding CGG repeat elements in the fragile X (FMR1) gene. One of these disorders, fragile X syndrome, is the most common heritable cause of intellectual disability, and is caused by large CGG repeat expansions (>200) resulting in silencing of the FMR1 gene. An increasingly recognized number of neuropsychiatric fragile X-associated disorders have recently been identified that are caused by ‘premutation’ range expansions (55–200). These disorders are characterized by a spectrum of neuropsychiatric manifestations ranging from an increased risk of neurodevelopmental, mood and anxiety disorders to neurodegenerative phenotypes, such as the fragile X-associated tremor ataxia syndrome. This article reviews the advances in the clinical understanding of neuropsychiatric disorders in premutation carriers across the lifespan and offers guidance for the detection of such disorders by practicing psychiatrists and neurologists.

Fragile-X-associated tremor/ataxia syndrome (FXTAS) is a progressive neurodegenerative disorder associated with the FMR1 gene premutation, characterized by the presence of 55 to 200 CGG triplet repeat expansions. Although the initial symptoms of FXTAS typically manifest in males around the age of 60 with motor symptoms and cognitive deficits, the presentation and progression in females differ. Women, in fact, exhibit a higher prevalence of neuropsychiatric symptoms, with an earlier onset compared to the motor symptoms observed in men. The following article reports on ten cases of women with a diagnosis of FMR1 gene premutation, originating from two medical centers. All the women in the study exhibited neuropsychiatric symptoms and subtle neurological signs as common features. Symptoms typically observed in the male population, such as tremors and cerebellar ataxia, were either absent or significantly reduced in the female cohort. Conversely, there was a higher prevalence of neuropsychiatric symptoms among the women. Neurocognitive impairment was only minimally evident, with mild executive dysfunction and memory complaints noted in a subset of cases. For this reason, we propose the terminology preFXTAS or prodromic FXTAS to define a clinical presentation in women characterized by early manifestations of FXTAS that do not entirely fulfill the established diagnostic criteria but exhibit MRI evidence of white matter alterations suggesting the initiation of the disease process. The study underscores the importance of establishing new diagnostic criteria for FXTAS and, at the same time, developing new biomarkers and interview checklists/assessment scales dedicated to females.