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Ramirez-Bermudez J, Medina-Gutierrez A, Gomez-Cianca H, Arias P, Pérez-Gonzalez A, Lebrija-Reyes PA, Espinola-Nadurille M, Aguilar-Venegas LC, Ojeda-López C, Restrepo-Martínez M, Bayliss L, Juárez-Jaramillo CA, Peñaloza G, Rivas-Alonso V, Flores-Rivera J, Gómez-Amador JL, Rios C, Sachdev PS. Clinical Significance of Delirium With Catatonic Signs in Patients With Neurological Disorders. J Neuropsychiatry Clin Neurosci 2022; 34:132-140. [PMID: 35040665 DOI: 10.1176/appi.neuropsych.18120364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE According to DSM-5, catatonia and delirium are mutually exclusive clinical syndromes. The investigators explored the co-occurrence of delirium and catatonia (i.e., catatonic delirium) and the clinical significance of this syndrome with a sample of neurological patients. METHODS This prospective study with consecutive sampling included patients diagnosed with delirium at the National Institute of Neurology and Neurosurgery of Mexico. DSM-5 criteria for delirium, the Confusion Assessment Method, and the Delirium Rating Scale-Revised-98 were used to select and characterize patients. Catatonia was assessed using the Bush-Francis Catatonia Rating Scale and DSM-5 diagnostic criteria. Logistic regression analysis was performed to identify etiological factors associated with catatonic delirium. RESULTS A total of 264 patients with delirium were included, 61 (23%) of whom fulfilled the criteria for catatonia and delirium simultaneously. Brain tumors, subarachnoid hemorrhage, acute hydrocephalus, and ischemic stroke were associated with delirium without catatonic signs. Catatonic delirium was observed among patients with encephalitis, epilepsy, brain neoplasms, and brain tuberculosis. After multivariate analysis, the association between catatonic delirium and encephalitis (both viral and anti-N-methyl-d-aspartate receptor [NMDAR]) was confirmed. CONCLUSIONS Delirium is a common complication of neurological diseases, and it can coexist with catatonia. The recognition of catatonic delirium has clinical significance in terms of etiology, as it was significantly associated with viral and anti-NMDAR encephalitis.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Angela Medina-Gutierrez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Heraclides Gomez-Cianca
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Patricia Arias
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Andres Pérez-Gonzalez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Paulina Angélica Lebrija-Reyes
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Mariana Espinola-Nadurille
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Luis Carlos Aguilar-Venegas
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Carmen Ojeda-López
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Miguel Restrepo-Martínez
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Leo Bayliss
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Cynthia Areli Juárez-Jaramillo
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Guillermo Peñaloza
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Verónica Rivas-Alonso
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - José Flores-Rivera
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Juan Luis Gómez-Amador
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Camilo Rios
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
| | - Perminder S Sachdev
- Neuropsychiatry Department (Ramirez-Bermudez, Medina-Gutierrez, Gomez-Cianca, Arias, Pérez-Gonzalez, Lebrija-Reyes, Espinola-Nadurille, Restrepo-Martinez, Juárez-Jaramillo, Peñaloza), Neurology Department (Aguilar-Venegas, Ojeda-López, Bayliss, Rivas-Alonso, Flores-Rivera), Neurosurgery Department (Gómez-Amador), and Neurochemistry Department (Rios),the National Institute of Neurology and Neurosurgery of Mexico; and the Prince of Wales Hospital and Center for Healthy Brain Ageing, University of New South Wales, Sydney, Australia (Sachdev)
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