Prospective Study of Different Diagnostic Criteria for Catatonia and Delirium in Internal Medicine and Neurology Admissions

OBJECTIVE: The authors prospectively examined the relationship between catatonia and delirium in consecutive hospital admissions. Potentially confounding neuropsychiatric conditions for catatonia symptoms were also assessed. The Delirium Rating Scale-Revised-98 (DRS-R-98) and other tools were used to assess neuropsychiatric conditions. The BFCRS item relationships were analyzed with exploratory factor analysis (EFA) and correlation analyses. RESULTS: criteria, respectively, and significantly higher in the delirium group; no patient had catatonia per the RDCC. EFA identified three BFCRS factors, with immobility/stupor, mutism, and staring loading together onto the first factor. However, EFA explained only 48% of the variance, possibly attributable to catatonia symptom overlap with other conditions. EFA supported akinesia as a core catatonia feature. Many correlations between BFCRS items and scores for apathy, parkinsonism, dementia, depression, neuroleptic use, and drowsiness suggested confounding. Few correlations were observed between BFCRS and DRS-R-98 items, notably excitement with psychosis and motor agitation, as well as mitgehen with items representing the three core delirium domains and psychosis. CONCLUSIONS: criteria or the RDCC. The BFCRS criteria yielded a 10% catatonia rate, but BFCRS items were confounded by other conditions. Rigorous differential diagnosis of catatonia is needed among geriatric patients.