Catatonia and Delirium in a General Medical Setting: Prevalence and Naturalistic Treatment Outcome

Catatonia is prevalent in the general hospital yet remains under-recognized. Of particular interest is the relationship between delirium and catatonia as recent studies have shown catatonia may co-occur with delirium. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision posits that catatonia does not exist in delirium, although studies have questioned this exclusion.

To assess the co-occurrence of catatonia and delirium in hospitalized general medical patients and to describe naturalistic treatment outcomes with lorazepam.

Data from a naturalistic quality improvement project were retrospectively analyzed. All consecutive admissions to 4 general medical units at the University Hospital at Stony Brook were screened within 48 h using the Bush-Francis Catatonia Screening Instrument and the Confusion Assessment Method. The diagnostic threshold on the Bush-Francis Catatonia Screening Instrument was set to 4 signs to increase specificity. The Bush-Francis Catatonia Rating Scale was utilized to monitor severity of positive screens. The quality improvement project included 718 consecutive patient admissions that are reviewed and analyzed in this report.

Approximately 2.2% of the 718 patients met criteria for catatonia. Of the patients with catatonia, 93% also met criteria for co-occurring delirium. The prevalence of delirium in the sample was 24.8%, and 8.4% of patients with delirium also had catatonia. Of those with catatonia and delirium, 43.8% received treatment for catatonia with benzodiazepines. Of those treated, the clinical features of catatonia and delirium remitted in 43% of cases, whereas the signs of catatonia responded to treatment (>50% reduction in Bush-Francis Catatonia Rating Scale) in 57% of cases. All 16 cases of catatonia had 5 or more signs of catatonia, while the majority of the remaining 702 patients had 0-2 signs.

These data provide further evidence that catatonia coexists with delirium, and may respond to lorazepam. We found a bimodal distribution in the number of catatonic signs, suggesting catatonia may be a distinct syndrome among medical patients. Our results suggest that prospective treatment studies are warranted.