Do patients of delirium have catatonic features? An exploratory study

The aim of this study was to determine the prevalence of catatonic symptoms, as per the Bush Francis Catatonia Rating Scale (BFCRS), in patients with delirium and to evaluate the prevalence of catatonia as defined by the Bush Francis Catatonia Screening Instrument and DSM-5 criteria in patients with delirium.

Two hundred five consecutive subjects with delirium were assessed on the Delirium Rating Scale-Revised 98 version, the amended Delirium Motor Symptom Scale and the BFCRS.

On the BFCRS, two-fifths (n = 80; 39%) of the study participants had two or more catatonic symptoms. When the diagnosis of catatonic syndrome was considered, 32% and 12.7% were observed to have catatonia as per the Bush Francis Catatonia Screening Instrument and proposed DSM-5 criteria, respectively. Delirium with catatonic syndrome was more common in women and in those who had onset of delirium prior to hospitalization. Amongst the delirium subtypes, hypoactive delirium was more commonly associated with catatonic syndrome.

The present study suggests that a substantial number of patients with delirium have catatonic symptoms and a significant proportion have catatonic syndrome. This high prevalence makes the concurrent diagnosis of delirium and catatonia plausible. The association of catatonia with a specific motor subtype of delirium could encourage the expansion or even modification of the existing subtypes of delirium.