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

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.