Unveiling the prognosis of adult Catatonia: A systematic review

INTRODUCTION: Catatonia is a neuropsychiatric syndrome observed in psychiatric and physical conditions. Linked to neuroinflammation, schizophrenia spectrum disorders remain its principal diagnostic context. Short-term outcomes are favourable with prompt treatment. Long-term prognosis remains poorly understood. This systematic review aimed to evaluate long-term outcomes and mortality rates in individuals with catatonia. METHODS: We conducted a PRISMA-compliant systematic review (PROSPERO: CRD420251027945) searching PubMed, Web of Science, EMBASE, SCOPUS, PsycINFO, and non-peer-reviewed sources from database inception to July 12, 2025. We included studies of adults diagnosed with catatonia with a minimum 6-month follow-up. Catatonia diagnosis was based on criteria, scales, or clinical judgment. One-year mortality was estimated and compared to general population. Methodological quality was assessed using validated tools (NOS, JBI). Findings were synthesized narratively. RESULTS: Of 6431 records screened, 29 studies met inclusion criteria, encompassing 30,694 patients with catatonia and 11,830 controls. Mean follow-up was 8.1 years. Seventeen studies focused on schizophrenia. Quality of studies was heterogeneous; 58 % showed moderate concerns and 41 % were at high risk of bias. Post-1970s studies reported more episodes, readmissions, and chronicity in catatonic schizophrenia versus other schizophrenia subtypes. Poorer psychiatric outcomes were found when catatonia co-occurred with intellectual disability, depression, or physical illness. Catatonia associated with baseline suicidal ideation (>35 % patients) and follow-up autoimmunity. In 75 % of post-1970s studies, one-year mortality in catatonia cohorts was lower than adjusted population rates. CONCLUSION: Catatonia is a marker of poor psychiatric long-term prognosis, without clear link to higher mortality. Early use of effective treatments preventing suicide or psychosis relapses may be considered.