Clinical predictors of short-term treatment response in stupor: a retrospective study

Stupor is a severe psychomotor syndrome with motor retardation and speech inhibition, that adversely affects outcomes. Benzodiazepines and electroconvulsive therapy (ECT) are standard treatments, yet individual responses vary considerably, highlighting the need for effective clinical predictors.

This study aimed to identify clinical predictors of therapeutic response in patients with stupor to facilitate individualized treatment.

We conducted a retrospective observational study including 45 patients with stupor hospitalized at Shandong Daizhuang Hospital between January 2010 and August 2024. Finally, 40 patients met the inclusion criteria and were retained for analysis. Patients were classified as responders or non-responders based on Clinical Global Impression-Improvement (CGI-I) scores at two weeks. Demographic characteristics, clinical variables, and medication regimens, including antipsychotics, benzodiazepines, and ECT use, were extracted from medical records. Peripheral blood inflammatory markers were also collected and analyzed. Mann-Whitney U tests, chi-square tests, logistic regression analyses, and receiver operating characteristic (ROC) curves were used to identify predictive factors and evaluate their diagnostic accuracy.

Among 40 patients, 24 (60.00%) responded favorably. Responders were more likely to receive ECT (χ² = 6.667, P = 0.010), higher chlorpromazine equivalent doses (|Z| = 3.418, P = 0.001), and olanzapine (χ² = 4.365, P = 0.037), while inflammatory markers showed no differences. Logistic regression identified chlorpromazine equivalent dose as an independent predictor (OR = 1.007, 95% CI: 0.998-1.017, P = 0.045). ROC analysis suggested a data-driven, exploratory optimal predictive chlorpromazine-equivalent dose of approximately 108 mg (about 100-110 mg) (AUC = 0.820, 95% CI: 0.677-0.963), corresponding to roughly 4.3-5.4 mg of olanzapine.

A higher chlorpromazine-equivalent dose and olanzapine use were associated with short-term therapeutic response in stupor, independent of ECT. ROC analysis suggested a data-driven, exploratory cut-off of approximately 108 mg (about 100-110 mg) chlorpromazine-equivalent, which should not be interpreted as a prescriptive clinical threshold. However, these findings are preliminary, limited to two-week outcomes in a modest retrospective sample. The role of inflammation in stupor remains inconclusive, and further studies are warranted to clarify its predictive value.