Adult catatonia: Prospective cohort study in a Spanish general hospital.

BACKGROUND

Catatonia is a psychomotor syndrome linked to psychiatric and somatic conditions. Recognized as an independent diagnosis, its rates remain insufficiently characterized. We examined its characteristics in an adult population in Bilbao.

METHODS

The study was registered at ClinicalTrials.gov (NCT07315386). Patients ≥18 years with DSM-5-TR catatonia were consecutively recruited across all services at a general hospital in Bilbao between 1/1/2024 and 31/12/2025. Sociodemographic and clinical data were collected at baseline and discharge. Instruments included were Bush-Francis Catatonia Rating Scale, Clinical Global Impression-Severity scale and Charlson Comorbidity Index. Analyses were conducted at episode and patient levels. The study was approved by the local research ethics committee.

RESULTS

The study included 49 catatonia episodes (38 patients). Catatonia rates were 6.7 episodes per 100,000 inhabitants/year, 53.3 per 100,000 hospitalizations, and 2.35% among adult psychiatric inpatients. Most patients were female (71.1%). Mean age was 55.9 ± 16.2 years. 85.7% episodes required psychiatric admission. 42.9% had mixed psychiatric and somatic aetiologies (44.9% schizophrenia spectrum disorders; 44.9% mood disorders; 26.5% infections; 16.3% dementia, 14.3% parkinsonism). 32.6% neuroimaging studies showed cerebral atrophy. Benzodiazepines resolved 67.3% episodes; 38.8% required electroconvulsive therapy (ECT). Length of hospital stay (median: 18 days; IQR 9.5-25.5) was only variable associated with catatonia severity (p = 0.02). 30.6% episodes had catatonia-related complications. No deaths occurred.

CONCLUSIONS

Catatonia rates in Bilbao were consistent with previous reports. Aetiology reflected complex comorbidity overlap. ECT clustered in older, medically complex episodes. Findings support a relatively stable catatonia clinical expression across underlying conditions.