The prevalence of the diagnosis of catatonic schizophrenia has decreased considerably over the last decades. The aim is to establish whether or not the perceived decline of catatonic schizophrenia is real or merely the result of underrecognition due to external factors.

Reviews of the literature on the epidemiology of catatonic schizophrenia can be divided into cross-sectional studies and data about change over time in one particular hospital.

The frequency of the diagnosis catatonic schizophrenia in a large sample of admitted psychiatric patients (n=19309) in The Netherlands dropped from nearly 8 percent in 1980-1989 to about 1 percent in 1990-2001.

Although a significant decrease of catatonic schizophrenia has been demonstrated, incidences and rates of decline vary a lot across investigations. Several explanations for this decline have been put forward. Changes in the diagnostic criteria and the diagnostic procedure itself, different populations and treatment options, as well as fluctuations in the frequency of underlying disorders have been considered responsible for this phenomenon.

Modern factor analytical studies have demonstrated the presence of the catatonic dimension in about ten percent of newly admitted patients with affective or schizophrenic psychoses.

The prevalence of catatonic schizophrenia is highly dependent on the applied diagnostic procedure. Until it is clear how many relevant symptom clusters and clinical characteristics are involved in catatonia, it is recommended to use catatonia rating scales systematically. Adequate recognition of catatonia is of clinical importance since it entails major pharmacological and other treatment implications and may disclose prognostic cues.