Catatonia and Delirium: Integrative Approaches to Phenomenology, Diagnosis, and Treatment

Thursday, November 7, 2024

10:55 AM – 12:10 PM EST

Location: Tuttle

Lead Speaker(s)

Can M. Kilciksiz, MD (he/him/his)

Clinical Assistant Professor
New York University School of Medicine
New York, New York

PDF

Speaker(s)

Dallas Hamlin, MD (he/him/his)

Resident
Penn State Health
Hershey, Pennsylvania
Jo E. Wilson, MD, PhD, MPH

Assistant Professor
Vanderbilt University
Nashville, Tennessee
Andrew FRANCIS, MD PhD

Professor
Penn State Medical School
Hershey, Pennsylvania

Abstract: Catatonia is increasingly recognized across treatment settings and clinical populations due to expanded education and wider use of screening tools (Heckers, 2023). Better recognition has benefited innumerable patients and may provide opportunities to further elucidate psychopathological and therapeutic mechanisms. These advances also have revealed complexity in medical settings with high prevalence of altered mental status, namely in overlap of catatonia with delirium. While the recognition of overlap between catatonia and delirium dates from early descriptive psychopathology, it is of current interest to consultation-liaison psychiatrists and has been revisited with modern diagnostic schemas and research tools. Catatonia and delirium may present independently, sequentially, or concurrently in varied clinical contexts, leading to important implications for diagnosis and treatment (Oldham, 2015).

This presentation combines didactic and interactive segments, building on participants' prior knowledge, to further develop a clinically relevant framework for co-morbid delirium and catatonia. We will start the session with introduction of presenters and a brief audience poll by Dr. Kilciksiz. In the first part after introduction, Dr. Hamlin will review the history of the overlap between catatonia and delirium, highlighting commonalities from descriptive psychopathology and a recent study of diurnal fluctuation in catatonia. This will reinforce the complexity of distinguishing these syndromes based on features and clinical course. In the second part, Dr. Wilson will highlight recent data and implications from the Delirium and Catatonia (DeCat) Prospective Cohort, including prevalence, risk factors, and prognosis associated with co-morbid delirium and catatonia (Wilson, 2017). In the third part, Dr. Kilciksiz will lead an interactive session using polling software and clinical vignettes to review diagnostic assessment for delirium and catatonia in medical settings, especially for special populations such as patients that are under sedation or are non-verbal. In the fourth part, Dr. Francis will conclude with an overview of available literature on benzodiazepine use for co-morbid delirium and catatonia, highlighting methodological limitations and goals of future research. The remainder of the session will afford participant and panelist interaction with Q&A. At the conclusion, attendees will be asked to write one key point from the session.

More than 40% of this 75-minute session will be interactive, including 5-minutes for audience polling, 15-minutes for audience interaction on diagnostic vignettes, and 10-minutes for panel discussion and the final writing task.

Learning Objectives:

Distinguish common clinical presentation of catatonia in the setting of delirium.
Propose an integrative diagnostic workup for common etiologies of catatonia and delirium.
Formulate an integrative treatment plan for catatonia and delirium in different clinical settings.