Catatonia is a syndrome caused by psychiatric and other medical conditions. It is essential to identify underlying conditions before initiating its treatment. However, few psychiatrists in Japan actually regard the basic clinical procedure as important in the current treatment of catatonia. What had a great effect on Japanese clinical practice was a publication by a Japanese psychiatrist, Kazumasa Suzuki, who in 2007 translated "Catatonia: A Clinicians'Guide to Diagnosis and Treatment" written by Fink and Taylor in 2003. They mentioned that the most common underlying condition of catatonia was bipolar mood disorder rather than schizophrenia, and that central nervous system diseases also induced the syndrome. Moreover, they stressed that intravenous haloperidol, which had been used for catatonia as part of standard practice in Japan, was inappropriate, potentially inducing malignant syndrome, and benzodiazepine (BZ) therapy and electroconvulsive therapy (ECT) were deemed appropriate. Japanese psychiatrists were willing to go along with the proposal, but the problem was that, although Fink and Taylor considered it quite natural to differentiate underlying conditions prior to BZ therapy or ECT, they did not emphasize this in their text. As a result, an unfavorable trend toward operational diagnosis and treatment for catatonia has spread in the clinical setting in Japan. Based on the number of articles concerning the diagnosis criteria, instead of carefully observing patients' symptoms, the diagnosis of catatonia was reached quickly, and BZ therapy has often been initiated before detection of the underlying disorders, or ECT was prepared. Needless to say, the underlying disease causing catatonia must be identified and treated as the first priority. Should an acute central nervous system disease such as encephalitis be missed, the situation could have a fatal outcome. BZ therapy or ECT could possibly worsen patients' conditions, inviting early death. Psychiatrists should reconfirm that identification and treatment of any underlying disease should precede the treatment of catatonia, which is a syndrome, not a certain disease.
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