Distinct attentional deficits after catatonia in schizophrenia

Catatonia is a severe neuropsychiatric syndrome characterized by profound state-related abnormalities in sensorimotor and cognitive-behavioral function. Overt catatonia is usually successfully treated with benzodiazepines or electroconvulsive therapy, but preliminary studies indicate that subtle cognitive and sensorimotor deficits may persist. However, the literature characterizing these deficits has been inconsistent and limited by low sample sizes. Furthermore, no studies have been conducted in the low- and middle-income setting, where catatonia may be more prevalent.

We examined the relationships between neurocognitive performance and schizophrenia with and without catatonia in a large South African cohort of n = 2853 participants: controls (n = 1426), schizophrenia without catatonia (SCZ, n = 1314), and schizophrenia with a history of catatonia (CAT, n = 113). Participants completed tasks assessing executive function, complex cognition, episodic memory, social cognition and sensorimotor speed, using the University of Pennsylvania Computerized Neurocognitive test battery. Multivariable logistic regressions adjusted for age, age², sex and region of recruitment tested for associations between cognitive performance and study group.

Both patient groups performed worse on all domains versus controls (FDR-adjusted p < 0.05). Critically, in the pairwise comparison between SCZ and CAT, sustained attention accuracy was lower in CAT, with higher accuracy scores associated with reduced odds of catatonia (OR = 0.72 CI 0.57-0.91, FDR-adjusted p = 0.01).

These findings suggest that catatonia is associated with distinct and persistent attentional deficits beyond those seen in schizophrenia alone, which warrants confirmation in prospective samples and exploration across other diagnostic categories.