Phenomenology, comorbidity, and treatment response in patients with catatonia: a prospective study from northern India

Aim and Objectives: Catatonia is a transdiagnostic neuropsychiatric syndrome carrying substantial morbidity when unrecognised, and prospective data from Northern India are limited. This study characterised its phenomenology, diagnostic associations, treatment response and short-term outcome.Materials and Methods: Consecutive adult inpatients meeting DSM-5 criteria for catatonia with a positive Bush–Francis Catatonia Screening Instrument were enrolled prospectively and rated on the 23-item Bush–Francis Catatonia Rating Scale (BFCRS); diagnoses were established using MINI 7.0.2. Secondary causes were assessed by neurological examination and a protocolised investigation panel. Patients received a lorazepam challenge; modified electroconvulsive therapy (m-ECT) followed partial response or recurrence during tapering. Resolution was defined as a negative screen with BFCRS ≤2 sustained 48 hours.Results: Forty-six patients were enrolled (56.5% male; 56.5% aged 18–30 years). Bipolar disorder was commonest (33, 71.7%), then schizophrenia and major depressive disorder (5, 10.9% each). Mean baseline BFCRS total was 14.00 ± 4.12. Retarded signs predominated: mutism, posturing, rigidity, negativism and withdrawal each occurred in 100%. The lorazepam challenge was positive in 42 of 46 (91.3%), yet only 9 of these (21.4%) resolved without m-ECT; 36 of 46 (78.3%) required it. Catatonia resolved in 44 of 46 (95.7%) before discharge. At four weeks, 30 of 40 patients remained in remission.Conclusion: Catatonia was most often associated with bipolar disorder and presented predominantly with retarded signs. Although the lorazepam challenge was positive in over nine of ten patients, most still required m-ECT, indicating that challenge responsiveness did not predict sustained remission on lorazepam alone.