The epidemiology of catatonic schizophrenia is presented, based on 798 cases from a county-wide psychiatric register. The cases in this catatonic cohort represent 10 per cent of all patients ever to receive a diagnosis of schizophrenia in the Monroe County Psychiatric Case Register. The 7-year prevalence of catatonic schizophrenia, based on the span of this study, is close to 1 per 1,000 county inhabitants. Far from being a vanishing entity, the catatonic type of schizophrenia now represents 5 per cent of all first diagnoses of schizophrenia.
There are significantly more women than men in the catatonic cohort when compared to the register schizophrenics, the entire register population, or the Monroe County population (p <.02).
The age-adjusted rates for the catatonic cohort, and especially for those consistently diagnosed as catatonic schizophrenia, are 2 to 8 times higher in the lower socioeconomic classes than in the upper socioeconomic classes. The over-representation of the lower classes and under-representation of the upper classes are even more marked than they are in the register schizophrenics, where the lower-class rates are 2.3 times higher than the upperclass rates.
The relative risk of death is 2.6 to 3.6 times greater in the catatonic cohort than in the age-adjusted county population.
Multiple episodes requiring hospitalization occurred in 57 per cent of the catatonic cohort. Indeed, 68 per cent of the cases not in custodial care at the onset of the study had more than one hospitalization.
For the entire cohort, episodes longer than 180 days occurred for 49 per cent of the men and 35 per cent of the women. A significantly greater proportion of men than women had admissions lasting longer than 180 days (p <.01). Conversely, a significantly greater proportion of women than men had all their episodes lasting less than 45 days (p <.01).
The diagnostic outcome of a cohort with no psychiatric treatment prior to entry in the register and with a diagnosis of catatonic schizophrenia made at an acute treatment facility is presented. These 51 cases were followed for 3 to 6 years. Some other type of schizophrenia than catatonia was diagnosed more frequently for 22 cases. Six other cases were more frequently diagnosed as having nonschizophrenic psychiatric illnesses. Of the 23 cases who were most frequently called catatonic schizophrenia, two fatalities occurred. Both these cases had organic disease, proved at autopsy, which produced catatonic behavior.
Although catatonia was thought to have a relatively favorable outcome 100 years ago, those cases now that are so diagnosed do not appear to have a better prognosis than that of other types of schizophrenia. And a small percentage of cases with catatonic behavior mask potentially lethal organic disease.