Clinical Significance of Delirium With Catatonic Signs in Patients With Neurological Disorders

Ramı́rez-Bermúdez, Jesús; Medina-Gutierrez, Angela; Gomez-Cianca, Heraclides; Arias, Patricia; Pérez-González, Andrés Felipe; Lebrija-Reyes, Paulina Angélica; Espínola-Nadurille, Mariana; Aguilar-Venegas, Luis Carlos; Ojeda-López, Carmen; Restrepo-Martínez, Miguel; Bayliss, Leo; Juárez-Jaramillo, Cynthia Areli; Peñaloza, Guillermo; Rivas‐Alonso, Verónica; Flores-Rivera, José; Gómez-Amador, Juan Luis; Rı́os, Camilo; Sachdev, Perminder S.

doi:10.1176/appi.neuropsych.18120364

Cited by 5 publications

(9 citation statements)

References 46 publications

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“…If the patient fulfills the case definition for catatonic delirium, there is a higher probability of finding an underlying neurological disease, most frequently a state of acute encephalopathy. 17,30 Our hypothesis is that our patient presented with an acute neuropsychiatric disturbance, with features of psychosis, delirium, and catatonia, as the result of cerebral venous thrombosis. This disease has an incidence of 3 to 4 cases per 1 million in the adult population and accounts for 0.5% to 1% of all strokes.…”

Section: Discussionmentioning

confidence: 96%

“…[13][14][15] Also, the severe cognitive abnormalities that appeared in the context of the psychotic features should warrant a search for a neurological disease, as this type of presentation may be seen in acute encephalopathy. [16][17][18] Alternatively, the initial cognitive features of the case might be interpreted as the onset of delirium. Perceptual disturbances may be present in the early or prodromal phases of this cognitive disorder.…”

Section: Discussionmentioning

confidence: 99%

“…40 Catatonia and rapidly progressive dementia could be regarded among the clinical phenotypes that may be observed in patients with acute or subacute encephalopathy. 17,[41][42][43] The treatment of cerebral venous thrombosis combines causal treatment if there is a definitive cause, antithrombotic treatment, and symptomatic treatment. 44 Although isolated case reports are weak in terms of the scientific inferences that can be established regarding causal relationships, the resolution of the psychiatric features after the use of anticoagulant treatment supports the relationship between the psychopathology and the neurological conditions.…”

Section: Discussionmentioning

confidence: 99%

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The Neuropsychiatric Side of Cerebral Venous Thrombosis: A Case of Delirium and Catatonia

Calva-González,

Tello-Gerez,

Serrano-Arias

et al. 2023

Journal of Psychiatric Practice

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We report a patient with cerebral venous thrombosis who initially presented with psychosis and who then progressed to delirium and catatonia within a few days. Upon treatment and resolution of the thrombosis, she presented complete remission of the psychiatric disturbances. This case highlights a specific neuropsychiatric presentation of cerebral venous thrombosis involving psychosis, catatonia, and delirium, which, to our best knowledge, has not been reported in the neurological or psychiatric literature. However, it reminds us of mental status and behavioral abnormalities which are not infrequent features of cerebral venous thrombosis. This leads to a discussion regarding the psychopathology, etiology, and pathophysiology of the case.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Neuropsychiatric Side of Cerebral Venous Thrombosis: A Case of Delirium and Catatonia

Calva-González,

Tello-Gerez,

Serrano-Arias

et al. 2023

Journal of Psychiatric Practice

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“…Firstly, EEG slowing may reflect an undiagnosed medical condition. There is a substantial overlap between catatonia and delirium, 58 which has an encephalopathic EEG correlate, and older reports would not have recognised NMDA receptor encephalitis. 59 Moreover, ictal slowing can occur, 60 , 61 although the absence of evidence for epilepsy in most of these case reports means that this is unlikely to be a major explanation.…”

Section: Discussionmentioning

confidence: 99%

The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracy

Hosseini¹,

Whincup²,

Devan³

et al. 2023

eClinicalMedicine

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“…60 Decreased GABA-ergic inhibition may lead to abnormal hyperactivity within the SMA and pre-SMA, which are responsible for initiation, inhibition, and control of motor activity as well as aberrant hyperconnectivity between the thalamus and M1 and SMA. 40,60,62 Dysfunctional GABA signaling could explain both the motor and emotional symptoms of catatonia.…”

Section: Neurotransmitter Alterationsmentioning

confidence: 99%

Malignant Catatonia: A Review for the Intensivist

Connell

Oldham

Pandharipande

et al. 2022

J Intensive Care Med

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Catatonia is a clinical syndrome characterized by psychomotor, neurological and behavioral changes. The clinical picture of catatonia ranges from akinetic stupor to severe motoric excitement. Catatonia can occur in the setting of a primary psychiatric condition such as bipolar disorder or secondary to a general medical illness like autoimmune encephalitis. Importantly, it can co-occur with delirium or coma. Malignant catatonia describes catatonia that presents with clinically significant autonomic abnormalities including change in temperature, blood pressure, heart rate, and respiratory rate. It is a life-threatening form of acute brain dysfunction that has several motoric manifestations and occurs secondary to a primary psychiatric condition or a medical cause. Many of the established predisposing and precipitating factors for catatonia such as exposure to neuroleptic medications or withdrawal states are common in the setting of critical illness. Catatonia typically improves with benzodiazepines and treatment of its underlying psychiatric or medical conditions, with electroconvulsive therapy reserved for catatonia refractory to benzodiazepines or for malignant catatonia. However, some forms of catatonia, such as catatonia secondary to a general medical condition or catatonia comorbid with delirium, may be less responsive to traditional treatments. Prompt recognition and treatment of catatonia are crucial because malignant catatonia may be fatal without treatment. Given the high morbidity and mortality associated with malignant catatonia, intensivists should familiarize themselves with this important and under-recognized condition.

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Clinical Significance of Delirium With Catatonic Signs in Patients With Neurological Disorders

Cited by 5 publications

References 46 publications

The Neuropsychiatric Side of Cerebral Venous Thrombosis: A Case of Delirium and Catatonia

The Neuropsychiatric Side of Cerebral Venous Thrombosis: A Case of Delirium and Catatonia

The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracy

Malignant Catatonia: A Review for the Intensivist

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