title: Catatonia in the ICU: an important and underdiagnosed cause of altered mental status. a case series and review of the literature*.
abstract: OBJECTIVE
  Catatonia is a neuropsychiatric syndrome with motor and behavioral symptoms occurring in patients with or without a history of psychiatric illness. Although it is associated with significant morbidity and mortality, the prevalence of catatonia in the ICU setting is unknown. The diagnosis and management of catatonia in the critically ill patient raises unique challenges. Furthermore, the diagnosis and management are not included in most critical care curricula. The objective of this retrospective study is to increase the awareness of this clinically important condition among critical care providers.
  
  
  METHODS
  Retrospective case series study.
  
  
  METHODS
  Multiple critical care units at a university-affiliated tertiary care hospital.
  
  
  METHODS
  Five critically ill patients with catatonia, aged 17 to 78.
  
  
  METHODS
  None.
  
  
  RESULTS
  All notes, laboratory data, imaging results, other diagnostic studies, therapeutic interventions, and responses to treatment were reviewed for five critically ill patients with catatonia. No unifying cause of catatonia or predisposing conditions were identified for these patients. Currently available diagnostic criteria for catatonia were found to be nonspecific in the ICU setting. New diagnostic criteria for catatonia specific to the critically ill patient are proposed.
  
  
  CONCLUSIONS
  Catatonia can occur in a wide variety of critical care settings, with or without precedent psychiatric illness, and it may be exacerbated or induced by common intensive care practices. Psychomotor findings are imperative in examination of critically ill patients with altered mental status in order to diagnose catatonia.
authors.affiliation: 1Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA. 2Psychiatry Consultation Service, Division of Psychiatry and Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Saddawi-Konefka
authors.forename: Sheri M
authors.initials: SM
authors.lastname: Berg
authors.forename: Shamim H
authors.initials: SH
authors.lastname: Nejad
authors.forename: Edward A
authors.initials: EA
authors.lastname: Bittner
mesh_terms: D000293:Adolescent; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001774:Blood Chemical Analysis; D002389:Catatonia / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D042241:Early Diagnosis; D004569:Electroencephalography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008140:Lorazepam / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents; D008140:Lorazepam