Suspected Delirium Predicts the Thoroughness of Catatonia Evaluation

Abstract

Although commonly linked to psychiatric disorders, catatonia is frequently identified secondary to neurological and general medical conditions (GMCs). The present study aimed to characterize the diagnostic workup of cases of catatonia in a general hospital setting. The authors performed a retrospective chart review of 54 cases of catatonia, over 3 years. Clinical suspicion of comorbid delirium was the strongest predictor of a more thorough general medical workup. Attribution of catatonia to a psychiatric etiology was associated with significantly less diagnostic workup. Prospective studies should help clarify the relationship between catatonia and delirium and standardize the diagnostic approach to patients presenting with catatonia.

Recognizing Catatonia in Medically Hospitalized Older Adults: Why It Matters

“…The frequency of catatonia attributed to general medical conditions is 21–46% of all catatonia cases [13,17,18]. Catatonia has also been reported to cause diagnostic dilemmas in unresponsive patients attending emergency departments [19], where its frequency due to a general medical condition is up to 41% of all cases [20].…”

“…On a retrospective chart review of adults with catatonia in a general hospital, 40% had a psychiatric history, 50% had suspected delirium, and 60% had dopamine antagonist exposure prior to catatonia onset [17]. In these patients, an older age, the presence of suspected delirium, and first episode of catatonia, were associated with a greater number of diagnostic tests during admission [17]. Patients with a psychiatric history were less likely to have suspected delirium, and they received less diagnostic tests [17].…”

“…In these patients, an older age, the presence of suspected delirium, and first episode of catatonia, were associated with a greater number of diagnostic tests during admission [17]. Patients with a psychiatric history were less likely to have suspected delirium, and they received less diagnostic tests [17].…”

<p>Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives</p>

“…14,31,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] Listed at the bottom of the figure are conditions widely recognized as presenting comorbidly with catatonia (and/ or for which catatonia is on the differential diagnosis), yet no systematic data regarding the prevalence of catatonia in these conditions were found. Studies have estimated that catatonia has a medical or neurological etiology in 21-46% of cases, 33 though precise and specific prevalence numbers are not available, and in some acute medical and surgical settings the rate may be even higher. 55 Potential causes are varied and numerous, and include metabolic derangements (eg, electrolyte disturbances, cardiac, renal, liver dysfunction, and vitamin deficiency), inflammatory states (infectious, autoimmune, or paraneoplastic), neurologic conditions (eg, vascular, structural, seizure, degenerative, and genetic/developmental disorders), toxidromes (eg, use of recreational substances, certain medications), and withdrawal phenomena.…”

“…The differential diagnosis of catatonia must include numerous conditions which can present similarly or comorbidly. 17 , 33 , 34 Here we provide several examples of how to consider catatonia and its differential diagnosis. However, this is by no means intended as a comprehensive list of all of the differential considerations, which must be tailored to the history and exam findings of each individual case.…”