Lessons on catatonia with or without delirium on the consultation-liaison psychiatry service in a Lebanese tertiary care center: a retrospective chart review of 36 cases of catatonia

Background Catatonia in the physically ill is an under-investigated topic and its diagnosis remains challenging, especially when it presents with comorbid delirium. In this study, we described the presentations and correlates of confirmed cases of catatonia stratified by the presence or absence of comorbid delirium. Methods We examined the electronic health records of 36 patients with catatonia due to general medical condition using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria seen on the consultation-liaison Psychiatry service in a Lebanese tertiary care center. We collected variables pertaining to demographic and diagnostic information, past medical history, Bush-Francis Scale, catatonia signs and symptoms, as well as diagnostic investigations when performed. Results The mean age was 55.5 ± 19.1 years, and 52% were males. 27% of patients had a history of a non-psychiatric brain disease, and 36% had a history of psychiatric diagnoses. 22% had a history of thrombotic disorders. 50% of the participants had comorbid delirium with catatonia (DeliCat syndrome). Patients with DeliCat were significantly older (64.3 ± 14.8 vs. 46.6 ± 19.1) and had significantly higher rates of history of thrombotic disorders (38% vs. 5%) compared to catatonia-only patients. Other paraclinical investigations did not differ statistically between the groups. Conclusions The study highlights the overlap between delirium and catatonia. Based on existing literature, we propose a model that conceptualizes catatonia and delirium as maladaptive sickness responses related to neuroinflammation and the defense cascade. This model has the potential to explain the shared pathophysiology of the two syndromes, offering a framework for future investigations.