Abstract
Catatonia is a complex syndrome characterized by behavioral and psychomotor abnormalities and is commonly associated with various medical and psychiatric conditions including schizophrenia, bipolar disorder, depression, stroke, and encephalitis. Lorazepam is widely considered the first-line treatment for catatonia, but the drug's effectiveness in preventing recurrence remains unclear. This study examines whether lorazepam reduces the risk of recurrent catatonia in patients with bipolar disorder. Methods: We conducted a retrospective cohort study using the TriNetX database, including patients who were diagnosed with bipolar disorder and catatonia between 2000 and 2024. Patients were divided into two groups: those treated with lorazepam (n = 15,674) and those who did not receive lorazepam (n = 12,045). Kaplan-Meier survival analysis and hazard ratios were used to assess recurrence risk and long-term outcomes. Results: Overall, the catatonia recurrence rate was similar between groups (p = 0.086). However, the group that did not receive lorazepam had a statistically significantly fewer total number of recurrent episodes of catatonia than the lorazepam treatment group (p = 0.005). Additionally, Kaplan-Meier analysis showed a significantly higher survival probability in the no lorazepam group (p = 0.011), indicating a longer duration of time before recurrence in this cohort. Conclusion: Lorazepam effectively treats catatonia acutely but does not significantly reduce the risk of recurrence compared to other management options. Future studies should explore individualized treatment approaches to optimize catatonia management for patients with bipolar disorder.