Catatonia Under-Diagnosis in the General Hospital

Abstract

Catatonia is under-diagnosed in psychiatric settings. No studies have explored the under-diagnosis of catatonia in general hospitals. The authors conducted a retrospective chart review using DSM-5 criteria to diagnose catatonia in medical inpatients between 2011 and 2013. Of 133 case subjects meeting DSM-5 criteria for catatonia retrospectively, 79 had never been diagnosed and 54 had a documented diagnosis. Multiple logistic regression revealed that psychiatry consultation significantly decreased the odds of under-diagnosis of catatonia, whereas presence of agitation, grimacing, or echolalia increased the likelihood of under-diagnosis. Under-diagnosed case subjects received significantly lower doses of lorazepam, and increased mortality during admission and increased length of hospital stay both fell short of statistical significance in this group. Catatonia appears to be frequently under-diagnosed in the general hospital, and psychiatry consultation services play a crucial role in its detection and treatment. Strategies to improve recognition and treatment of catatonia should be implemented.

Keywords: Catatonia; Consultation/Liaison Neuropsychiatry; Diagnosis and Classification in Neuropsychiatry; Drug/Psychotherapy Treatment of Neuropsychiatric Disorders; Mental Status Assessment.