Dimensions of Psychosis in Delirious and Catatonic Trauma Critically Ill Patients

We examined the effect of delirium and catatonia on psychosis symptom presentation in trauma intensive care unit (TICU) patients without previous history of serious psychiatric illness.

Prospective observational cohort study at a single academic medical center TICU, enrolling adult patients with critical illness secondary to traumatic injury excluding patients with significant psychiatric history. ICU patients received once-daily DSM-5 delirium and catatonia evaluations, and Clinician-Related Dimensions of Psychosis Severity Scale (CRDPSS) assessment. Patients were grouped by delirium and/or catatonia diagnosis with Kruskal-Wallis and Pearson's Chi-square testing of differences between groups in CRDPSS scores.

74 patients were sorted into delirium and/or catatonia groups for the dimensions of psychosis analysis. Catatonia was common in this critically ill trauma population with 26% prevalence. Patients with delirium and/or catatonia diagnoses had differing severities of psychosis symptoms from those with neither condition. CRDPSS total scores were significantly different between the groups (p=0.011).

Further investigation is needed to explore commonalities in the mechanisms underpinning ICU psychosis and to identify specific psychotic symptom manifestations suggestive of delirium versus catatonia.