Catatonia is common, and has an incidence in psychiatric inpatients from the USA, UK and other western countries of 10%. Half of the patients with catatonia suffer from bipolar disorder and approximately 10% have a diagnosis of schizophrenia. With multiple possible etiologies, a unifying pathogenesis of catatonia that explains all motor and autonomic symptoms remains elusive. Early recognition is of utmost importance in order to provide optimal treatment and to decrease morbidity and mortality. Benzodiazepines are the first treatment of choice and yield high response rates, especially in the context of mood disorders. Should a treatment with benzodiazepines fail, electroconvulsive therapy should be started without delay.