457: Delirium and Catatonia in Critically Ill Patients: The Decat Prospective Cohort Investigation

Wilson, Jo Ellen; Carlson, Richard H.; Duggan, Maria; Pandharipande, Pratik; Girard, Timothy D.; Wang, Li; Thompson, Jennifer; Chandrasekhar, Rameela; Francis, Andrew; Nicolson, Stephen E.; Dittus, Robert S.; Heckers, Stephan; Ely, E. Wesley

doi:10.1097/01.ccm.0000528475.97055.05

Cited by 16 publications

(35 citation statements)

References 22 publications

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“…Delirious patients can be further characterized as hyperactive, hypoactive or mixed forms, based on abnormalities of psychomotor behavior 34 . Catatonia is now recognized to frequently co-occur with delirium in the context of general medical and critical illnesses [35][36][37][38] , however the clinical relevance of this co-occurrence remains unknown.…”

Section: Catatonia Is a Psychomotor Syndromementioning

confidence: 99%

“…Catatonia is a frequent manifestation of many general medical conditions 64,[71][72][73] . Studies have suggested that perhaps as many as one third of patients with delirium secondary to a general medical condition will develop catatonia during their acute hospitalization 35,36 . Catatonia incidence ranged from 1•6% to 8•9% on medical services assessed by a psychiatry liaison service, with prevalence varying across age groups and associated medical conditions 74,75 .…”

Section: Nosology and Epidemiology Of Catatoniamentioning

confidence: 99%

“…The treatment of patients who present with signs of catatonia and delirium poses challenges (i.e., antipsychotic drugs are currently standard treatment for delirium but may worsen catatonia; benzodiazepines are first-line treatment for catatonia but may worsen delirium). One of us (JEW) is studying the overlap of delirium and catatonia 35 , but further research must be done before clear treatment recommendations can be made.…”

Section: Treatment Current Statementioning

confidence: 99%

See 2 more Smart Citations

Structure and neural mechanisms of catatonia

Walther

Stegmayer

Wilson

et al. 2019

The Lancet Psychiatry

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213

170

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Catatonia is a psychomotor syndrome associated with several psychiatric and medical conditions. Psychomotor signs range from stupor to agitation and include pathognomonic features such as verbigeration and waxy flexibility. Disturbances of volition led to the classification as a subtype of schizophrenia, but recent changes in nosology now recognize high prevalence in mood disorders, overlap with delirium, and comorbidity with medical conditions. Initial psychometric studies have revealed three behavioral factors, but the structure of catatonia is still unknown.Recent evidence from patients with psychotic disorders indicates increased neural activity in premotor areas in hypokinetic catatonia patients. It is unclear whether this localized hyperactivity is due to cortico-cortical inhibition or excess activity of inhibitory cortico-basal ganglia loops. Current treatment of catatonia relies on benzodiazepines and electroconvulsive therapy, both effective yet unspecific in their modes of action.Longitudinal and treatment studies, using neuroimaging and brain stimulation techniques, are needed to advance our understanding of catatonia.

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Section: Catatonia Is a Psychomotor Syndromementioning

confidence: 99%

Section: Nosology and Epidemiology Of Catatoniamentioning

confidence: 99%

Section: Treatment Current Statementioning

confidence: 99%

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Structure and neural mechanisms of catatonia

Walther

Stegmayer

Wilson

et al. 2019

The Lancet Psychiatry

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213

170

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“…[26,27] Some studies have suggested that catatonia due to medical illness can coexist with delirium in the ICU population at rates as high as 31%. [28]…”

Section: Clinical Featuresmentioning

confidence: 99%

Delirium in the Critically Ill

Gotur¹

2018

JMSH

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Delirium is a frame of mind characterized by transient and fluctuating cognitive incapacity and inattention due to a variety of illnesses. Intensive care unit (ICU)-delirium can present as hypoactive, hyperactive or mixed delirium types, hypoactive being the most common and often under-recognized. Prevalence of ICU-delirium is variable based on type of patient population but could be as high as 77%. Recent theory for the development of delirium is known as the systems integration failure hypothesis. Predisposing risk factors for ICU delirium are advanced age, baseline cognitive impairment, increased comorbid disease, frailty, alcohol and drug abuse, and high severity of illness. The ABCDEF bundle is a group of interventions developed by the Society of Critical Care Medicine that when applied collectively can help reduce delirium, improve pain management and reduce long-term consequences for adult ICU patients. Delirium outcomes range from mortality, variable degree of cognitive and functional deficits to full functional recovery.

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“…As exemplified by the patients in this case series and explored in the discussion, there is possible increased risk of catatonia in COVID-19 patients. Additionally, a study of critically ill patients has shown that an increased number of signs of catatonia in a patient were associated with a greater likelihood of concurrent delirium [11]. The pathophysiology of COVID-19 and its consequences on the central nervous system (CNS) may provide an explanation for increased risk of the aforementioned neuropsychiatric findings.…”

mentioning

confidence: 99%

Management of Agitation, Delirium, and Catatonia in Intubated COVID-19 Patients: A Case Series & Rationale for Valproate Sodium Use During Extubation

Schumaker¹,

Gomez²,

Rojasova³

et al. 2021

obm neurobiol

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The complete spectrum of neuropsychiatric effects of SARS-CoV-2 acute respiratory distress syndrome has yet to be fully appreciated, particularly in intubated patients. Manifestations including delirium and catatonia need to be considered in intubated COVID-19 patients. Medications known to exhibit neuroprotective effects, like valproate, can assist in agitation related to sedative withdrawal during extubation. This case series reports on the management of agitation, delirium, and catatonia in COVID-19 patients during and after extubation efforts. We present three cases in which Psychiatry was consulted for agitation in intubated COVID-19 patients. These patients were managed for severe agitation during weaning from extubation as well as for subsequent psychiatric challenges, including catatonia. Patient 1: 26-year-old female with bipolar I with psychotic features who was admitted for acute hypoxic respiratory failure from COVID-19 pneumonia. After an emergency C-section at 31 weeks’ gestation, she was intubated for 9 days and started on valproate 250 mg BID for agitation. She was extubated successfully and discharged home. Patient 2: 42-year-old female with bipolar I and PTSD who was intubated following COVID-19-related acute hypoxic respiratory failure. She received valproate 250mg BID and was extubated successfully. She became catatonic when home quetiapine was resumed and recovered following quetiapine discontinuation and lorazepam. She was discharged on valproic acid and alprazolam. Patient 3: 23-year-old female with bipolar I with psychotic features who was admitted for COVID-19 acute hypoxic respiratory failure and intubated. She received valproate 250 mg BID and was extubated successfully. She became catatonic when risperidone was re-initiated, but recovered following risperidone discontinuation and addition of lorazepam, gabapentin, and duloxetine. Quetiapine was added before discharge. Valproate was effective for managing delirium and agitation during extubation, as evidenced by normalizing Richmond Agitation and Sedation Scale scores. Additionally, valproate aided in managing catatonia post-extubation. This case series reports on the management of agitation in COVID-19 patients during extubation efforts with valproate sodium, due to its ability to manage delirium and catatonia. Valproate is known to exhibit neuroprotective effects, which possibly explains successful management of agitation during the extubation process.

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457: Delirium and Catatonia in Critically Ill Patients: The Decat Prospective Cohort Investigation

Cited by 16 publications

References 22 publications

Structure and neural mechanisms of catatonia

Structure and neural mechanisms of catatonia

Delirium in the Critically Ill

Management of Agitation, Delirium, and Catatonia in Intubated COVID-19 Patients: A Case Series & Rationale for Valproate Sodium Use During Extubation

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