• Jo E Wilson, Richard Carlson, Maria C Duggan, Pratik Pandharipande, Timothy D Girard, Li Wang, Jennifer L Thompson, Rameela Chandrasekhar, Andrew Francis, Stephen E Nicolson, Robert S Dittus, Stephan Heckers, E Wesley Ely, and Delirium and Catatonia (DeCat) Prospective Cohort Investigation.
• 1Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN. 2Veteran's Affairs Tennessee Valley Healthcare System, Geriatrics, Research, Education and Clinical Center (GRECC), Nashville, TN. 3Division of General Internal Medicine and Public Health, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN. 4Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. 5Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, Pittsburgh, PA. 6Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN. 7Department of Psychiatry, Penn State Medical School, Hershey Medical Center, Hershey, PA. 8Department of Psychiatry, Beth Israel Deaconess Hospital-Plymouth, Plymouth, MA. 9Division of Pulmonary and Critical Care, Department of Medicine, and the Institute for Medicine and Public Health, the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN.
• Crit. Care Med. 2017 Nov 1; 45 (11): 1837-1844.

ObjectivesCatatonia, a condition characterized by motor, behavioral, and emotional changes, can occur during critical illness and appear as clinically similar to delirium, yet its management differs from delirium. Traditional criteria for medical catatonia preclude its diagnosis in delirium. Our objective in this investigation was to understand the overlap and relationship between delirium and catatonia in ICU patients and determine diagnostic thresholds for catatonia.DesignConvenience cohort, nested within two ongoing randomized trials.SettingSingle academic medical center in Nashville, TN.PatientsWe enrolled 136 critically ill patients on mechanical ventilation and/or vasopressors, randomized to two usual care sedation regimens.Measurements And Main ResultsPatients were assessed for delirium and catatonia by independent and masked personnel using Confusion Assessment Method for the ICU and the Bush Francis Catatonia Rating Scale mapped to Diagnostic Statistical Manual 5 criterion A for catatonia. Of 136 patients, 58 patients (43%) had only delirium, four (3%) had only catatonia, 42 (31%) had both, and 32 (24%) had neither. In a logistic regression model, more catatonia signs were associated with greater odds of having delirium. For example, patient assessments with greater than or equal to three Diagnostic Statistical Manual 5 symptoms (75th percentile) had, on average, 27.8 times the odds (interquartile range, 12.7-60.6) of having delirium compared with patient assessments with zero Diagnostic Statistical Manual 5 criteria (25th percentile) present (p < 0.001). A cut-off of greater than or equal to 4 Bush Francis Catatonia Screening Instrument items was both sensitive (91%; 95% CI, 82.9-95.3) and specific (91%; 95% CI, 87.6-92.9) for Diagnostic Statistical Manual 5 catatonia.ConclusionsGiven that about one in three patients had both catatonia and delirium, these data prompt reconsideration of Diagnostic Statistical Manual 5 criteria for "Catatonic Disorder Due to Another Medical Condition" that preclude diagnosing catatonia in the presence of delirium.

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