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.

Delirium is a complex neuropsychiatric syndrome with multifactorial pathophysiology, encompassing a wide range of neuropsychiatric symptoms, and its management remains a significant challenge in critical care. Although often managed with antipsychotics, like haloperidol, current research has predominantly focused on dopamine dysregulation as the primary driver of delirium, overlooking its broader neuroanatomical and neurochemical underpinnings. This has led to a majority of research focusing on haloperidol as a treatment for intensive care unit (ICU) delirium. Our review critically evaluates the role of haloperidol in ICU delirium management, particularly in light of recent large-scale randomized controlled trials (RCTs) that have primarily focused on delirium-free days and mortality as the primary endpoints. These studies highlight an limited understanding of the true nature of delirium treatment, which requires a broader, neuropsychiatric approach. We argue that future research should shift focus to neuropsychiatric symptoms such as agitation and psychosis and explore the clinical and functional benefits of reducing these distressing symptoms. Additionally, the stratification of delirium by subtypes and etiology, the enhancement of detection tools, and the adoption of multi-intervention and multi-disciplinary care approaches should be prioritized. Despite the methodological flaws in these studies, the findings support the safety of haloperidol in the ICU setting, with minimal risk of adverse events, particularly cardiac and neuropsychiatric. Moving forward, delirium research must integrate modern neuroscientific understanding and adopt more multi-disciplinary input and nuanced, patient-centered approaches to truly advance clinical care and outcomes.