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Although historically tied to schizophrenia, catatonia exhibits a diverse range of phenotypes and has been observed in various medical and neuropsychiatric conditions. Its intrinsic movement characteristics and association with hypokinetic and hyperkinetic phenomenologies place catatonia within the purview of movement disorders. Despite the presence of catatonia in psychiatry literature for over 150\u2009years, many gaps and controversies persist regarding its etiopathogenesis, phenomenology, diagnostic criteria, and treatment. The current versions of the International Classification of Diseases (ICD\u201011) and the Diagnostic and Statistical Manual of Mental Disorders (DSM\u20105) require clinicians to identify any three signs of 15 (ICD\u201011) or 12 (DSM\u20105) for the diagnosis of catatonia. Catalepsy and waxy flexibility are the only motor features with high specificity for the diagnosis. We highlight the gaps and controversies in catatonia as a movement disorder, emphasize the lack of a clear definition, and discuss the inconsistencies in the description of various catatonic signs. We propose the exploration of a bi\u2010axial classification framework similar to that used for dystonia and tremor to encourage the evaluation of underlying etiologies and to guide therapeutic decisions to improve the outcome of these patients. \u00a9 2024 International Parkinson and Movement Disorder Society.<\/jats:p>","DOI":"10.1002\/mds.29906","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T06:42:26Z","timestamp":1719384146000},"page":"1716-1728","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Gaps and Controversies in Catatonia as a Movement Disorder"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0725-636X","authenticated-orcid":false,"given":"Abhishek","family":"Lenka","sequence":"first","affiliation":[{"name":"Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal M.","family":"Perera","sequence":"additional","affiliation":[{"name":"Department of Neurology, Norman Fixel Institute for Neurological Diseases University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-136X","authenticated-orcid":false,"given":"Alberto J.","family":"Espay","sequence":"additional","affiliation":[{"name":"Department of Neurology, James J. and Joan A. 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