Do patients of delirium have catatonic features? An exploratory study

Abstract

Aim 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. Method 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. Results 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. Conclusion 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.

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

“…This finding is consistent with Grover et. al.’s, report of 12.7–30.2% prevalence of catatonia in critically ill patients with delirium (2). …”

“…Criterion D for “Catatonic Disorder Due to Another Medical Condition” (medical catatonia) disallows this diagnosis exclusively in the presence of delirium. Because of this, there is a virtual absence of data concerning the prevalence of catatonic signs in delirious patients and many believe that catatonia is under-recognized in the medically ill (1, 2, 20, 21). Some have even suggested that despite the DSM exclusionary criteria, delirium can co-exist with catatonic features in medical illness (22).…”

Persistent catatonia following epileptic seizures: a case report and systematic literature search

“…Another important distinction that must be made in this case is between postictal delirium (occurring in 35% of seizure cases and reported to last sometimes up to 10 days) [ 25 – 27 ] and postictal catatonia as it may substantially influence treatment decision-making [ 28 – 30 ]. Whereas benzodiazepines are used first in cases of catatonia, in delirium such compounds may aggravate symptoms [ 28 – 30 ]. The distinction between the two may be cumbersome given clinical overlap.…”

A Case Report of Intramuscular Lorazepam in Catatonia of a Parkinson's Disease Patient After Deep Brain Stimulation

“…In terms of demographic data, all three cases were females around their 60s, and they all presented with decreased activities or consciousness disturbance prior to catatonia. A clinical trial, which enrolls 205 patients, reports predominantly female patients in those with catatonia (37.1% vs 21.7%) and patients with delirium prior to hospitalization (32.3% vs 16.7%) (Grover et al 2014). The three cases show similar result, but the mechanism of phenomenon is unclear.…”