Abstract
BACKGROUND: Catatonia is a recurrent neuropsychiatric syndrome affecting approximately 9% of psychiatric inpatients, yet the impact of acute treatment strategies on long-term recurrence risk remains poorly understood. This study examined how treatments administered during acute catatonic episodes influence recurrence risk. METHODS: We conducted a retrospective cohort study of 205 adults hospitalized with catatonia at a tertiary care center between 2001 and 2021. Catatonia diagnoses were confirmed by chart review using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The primary outcome was time to a new catatonic episode, with patients censored at last follow-up if no recurrence was observed. Treatment exposure was ascertained from the Latest Catatonia Episode (LaCE) for non-recurrent patients and from the Nearest Antecedent Catatonia Episode (NACE) for those with recurrence. Cox proportional hazards models estimated adjusted hazard ratios for benzodiazepines, antipsychotics, electroconvulsive therapy, and mood stabilizers, controlling for age and. RESULTS: Overall, 31% of patients experienced recurrence over a median follow-up of 6.4 years. Benzodiazepines, used in 88% of patients, were consistently protective against recurrence (adjusted hazard ratio 0.50, 95% confidence interval 0.27-0.94, p = 0.03). Antipsychotics demonstrated a biphasic effect: lower hazard of recurrence within 60 days (adjusted hazard ratio 0.36, 95% confidence interval 0.13-1.00, p = 0.05) but associated with increased hazard thereafter (adjusted hazard ratio 2.14, 95% confidence interval 1.08-4.254, p = 0.08). CONCLUSIONS: Benzodiazepines use was associated with sustained protection against catatonia recurrence. The time-dependent antipsychotic effect warrants careful consideration in maintenance treatment planning. While our retrospective design limits causal inference, these findings emphasize the need for prospective studies to optimize maintenance strategies and prevent recurrence.