Les travaux de nombreux auteurs depuis une quinzaine d’années ont conduit à amener la catatonie au rang d’une entité dans le DSM-V, paru en 2013. Ceux-ci mettent l’accent sur une clinique riche avec des tableaux variés (stuporeux mais aussi agités), et un diagnostic simplifié : 2 critères sur 5 du DSM-V, de nombreuses échelles diagnostiques et le test au zolpidem. La recherche étiologique a une importance capitale dans la mesure où des causes organiques, notamment neurologiques, doivent être écartées. En psychiatrie, l’étiologie la plus fréquente est la manie. Aux deux lignes de traitement symptomatique, benzodiazépines et électroconvulsivothérapie, s’ajoutent sur quelques récents case reports les neuroleptiques atypiques, ceci remettant en cause la contre-indication formelle des neuroleptiques dans la catatonie.

In the new classification of the DSM-V, catatonia is individualized as a disease of its own. It is defined by presence of at least two out of five criteria: motor immobility, negativism, echolalia or echopraxia, sterile motor activity, atypical movements. The priority is to look first for organic causes: the main ones are neurologic disorders. Intoxication may also be found (illegal drugs or medication), and the role of neuroleptic malignant syndrome in catatonia remains unclear. Among the psychiatric causes, first come bipolar disorders, especially mania; then schizophrenia. Idiopathic forms can also be observed. Epidemiological work on catatonia show highly variable results, highlighting a possible underestimation of the diagnosis. Among the differential diagnoses, which are rare motor syndromes, neuroleptic malignant syndrome and serotonin syndrome are also discussed. The diagnosis of catatonia is clinical and can be obtained using standardized diagnostic scales. The use of zolpidem provides both a diagnostic and therapeutic guidance for the degree of response to drug treatment. The physiopathological hypotheses describe an intracerebral GABAergic, dopaminergic and glutamatergic dysfunction in catatonic patients. The complete mechanisms are still partly unknown. Benzodiazepines are the first treatment of choice. Electroconvulsive therapy is used secondarily or in severe cases. First-generation antipsychotics are prohibited, at the risk of worsening the catatonia in becoming malignant and lethal. The renewed interest in the catatonic syndrome during the past recent years has expanded research on the mechanisms of this syndrome and opened the way to new therapeutic options. The latest works tend to modulate the strict prohibition of antipsychotic in a catatonic patient.