Although catatonia may appear similar to delirium during a serious illness, Dr. Jo Ellen Wilson of Vanderbilt University Medical Center (VUMC)’s psychiatry and behavioral sciences department stresses the need to manage the two differently.
As lead author in a study titled “The Delirium and Catatonia (DeCat) Prospective Cohort Investigation” recently published in Critical Care Medicine, Wilson emphasized in a Vanderbilt article the importance of differentiating between the two conditions accurately due to the potential risks incurred by inadvertently prescribing the wrong medication.
Catatonic patients are usually treated with benzodiazepines, and those individuals should not take antipsychotic medications so symptoms aren't exacerbated, Wilson said in the article. Antipsychotics are commonly used for delirium, which is why it's important to correctly identify symptoms that can overlap and result in misdiagnosis, she said.
Catatonia is typically characterized by muscular rigidity and a trance-like affect; however, one form manifests as hyperactivity, with odd movements and gestures similar to delirium. Significantly, intensive care units (ICUs) screen for delirium as a rule, but they do not screen for catatonia, she said.
Wilson studied 136 patients and discovered that roughly one out of every three had both delirium and catatonia. The results indicate that criteria for diagnosis merited “reconsideration.”
“Our understanding of catatonia in the ICU is being hampered by a diagnostic dilemma,” she said.
Vanderbilt is now evaluating the relationship between catatonia in critically ill patients and brain dysfunction.
