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.
A total of 203 consecutive patients were assessed on a delirium experience questionnaire 24 hours after recovery from delirium. One third (35%) of the patients could recollect their experiences during the delirium, and the majority (86%) of them were distressed by these experiences. The level of distress was moderate in most of the subjects (52.5%). Fear and visual hallucination were the most common distressing themes recollected. When the patients who could recall their experience of delirium were compared with those who could not recall, the authors noted that recall of delirium experience was associated with a higher prevalence of perceptual disturbances and language disturbances and a higher severity of delirium.
Findings of the present study suggest that although only few antipsychotic naïve patients diagnosed with schizophrenia have MS, a significantly large proportion of patients have subsyndromal MS. Awareness of this in clinicians can have implications in the selection of antipsychotic medication.
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