Section - Quick Takes

01. Catatonia: Can Antipsychotics Prevent Relapse?

Published on July 17, 2026 Certification expiration date: July 17, 2029

Scott R. Beach, M.D.

Associate Professor of Psychiatry - Harvard Medical School

Key Points

In a recent retrospective cohort of 303 patients with catatonia, nearly half relapsed during follow-up, with risk highest in the first two years. Relapse rates were similar across schizophrenia-spectrum and affective disorders.
Antipsychotic prescription at discharge was associated with longer time to relapse and a 41% lower risk of recurrence. A longer index episode of the underlying psychiatric illness (not the duration of catatonia itself) predicted higher relapse rates. This finding should not be read as support for routine antipsychotic use in acute catatonia; rather, relapse prevention may depend on more proactive treatment of the primary psychiatric disorder after catatonia stabilizes.
Benzodiazepine prescription at discharge and robust lorazepam-challenge response were paradoxically linked to faster relapse, but these associations likely reflect confounding rather than causation. These findings should not change the core approach: acute catatonia still warrants benzodiazepines, slow tapering, and consideration of maintenance treatment in selected patients, especially those with prior episodes.

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Can Antipsychotics Prevent Catatonia Relapse?

What can we do to prevent relapse in catatonia? This is one of the most frequent questions I hear from patients, family members and providers.

Relapse is common in catatonia. In patients with schizophrenia and catatonia, for example, more than 50% of individuals will experience a relapse of their catatonia. We also think that each episode of catatonia increases the risk for future episodes, perhaps similar to the kindling phenomenon seen with seizures.

Historically, we haven’t had much in terms of evidence-based recommendations to prevent relapse. Very few longitudinal studies of catatonia have been conducted. Most experts tend to believe that maintenance benzodiazepines likely reduce recurrence but the actual evidence for that is pretty thin.

Now, for the first time, we have a well-designed retrospective cohort study published in JAMA Psychiatry examining risk factors for relapse in catatonia and the take-home finding may surprise you.

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02. Which Adjunctive Antipsychotic Is Best for Major Depression?

Learning Objectives:
After completing this activity, the learner will be able to:

Describe the evidence for antipsychotic use in preventing catatonia relapse and apply current recommendations for treating the underlying psychiatric illness after catatonia stabilizes.
Compare the efficacy, tolerability, and cost of FDA-approved adjunctive antipsychotics for major depressive disorder to guide evidence-based selection in clinical practice.
Evaluate the clinical utility and limitations of network meta-analyses for antipsychotic selection in acute schizophrenia and apply principles of shared decision-making and patient-centered sequential trials.
Summarize the current preclinical and clinical evidence on GLP-1 receptor agonists and anxiety to counsel patients with comorbid metabolic and anxiety disorders.
Identify pharmacological and psychosocial interventions with evidence for nicotine vaping cessation and apply a stepwise treatment approach in clinical practice.

Original Release Date: July 17, 2026
Expiration Date: July 17, 2029

Experts: Scott Beach, M.D., James Phelps, M.D., Oliver Freudenreich, M.D., Derick E. Vergne, M.D. & David A. Gorelick, M.D., Ph.D., D.L.F.A.P.A., F.A.S.A.M.
Medical Editors: Flavio Guzmán, M.D. & Sebastián Malleza M.D.

Relevant Financial Disclosures:
Oliver Freudenreich declares the following interests:
– Karuna: Research grant to institution
– Medscape: Speaker honorarium
– Psychopharmacology Institute: Speaker honorarium
– Wolters-Kluwer: Royalties for medical writing

David A. Gorelick declares the following interests:
– Wolters-Kluwer: Royalties for writing articles about cannabis and cocaine
– Springer Nature: Honoraria for editing the Journal of Cannabis Research
– PleoPhmarma, Inc.: Research funding for conducting a clinical trial on cannabis withdrawal

All the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

None of the other faculty, planners, and reviewers for this educational activity has relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement
Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Artificial Intelligence (AI) Use DisclosureArtificial intelligence (AI) tools may have been used in limited stages of developing this activity (e.g., drafting or language refinement). The specific tool, version, and date of use are documented internally.AI does not determine clinical recommendations. All content is reviewed, verified, and approved by the listed faculty and medical editors, and reflects independent human clinical judgment consistent with ACCME Standards for Integrity and Independence in Accredited Continuing Education.

Scott R. Beach, M.D.

Key Points

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Text version

Can Antipsychotics Prevent Catatonia Relapse?

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