Toward precision psychiatry in catatonia: A scoping review of its factor structure and clinical implications

Catatonia is a complex, heterogeneous syndrome that challenges current diagnostic boundaries. While recent studies consistently propose a three-factor structure, no systematic synthesis has comprehensively mapped these dimensions to their clinical correlates. Therefore, a scoping review was performed to analyze the factor-analytic evidence and propose a framework for precision psychiatry in catatonia.

We conducted a scoping review in adherence to JBI methodology and PRISMA-ScR guidelines. Three databases (PubMed, Scopus and Web of Science) were searched until September 2025 for studies in which catatonia factor structure was estimated through any statistical method.

Sixteen studies were identified, with participants ranging from 34 to 1456. Studies consistently supported the three-factor model: (1) Hypokinetic (inhibitory/oppositional), associated with depression, negative symptoms, male sex, and favorable lorazepam response; (2) Hyperkinetic (excitement/impulsivity), linked to mania and psychosis; and (3) Parakinetic (odd/iterative/volitional), associated with neurodevelopmental disorders and treatment resistance.

The findings of our study support the three-factor model structure of catatonia, and propose sub-factors with specific correlations. This supports a move toward precision psychiatry, where motor profiling may guide therapeutic selection more effectively than categorical diagnosis alone.