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Catatonia in the ICU: An Important and Underdiagnosed Cause of Altered Mental Status. A Case Series and Review of the Literature*

Saddawi-Konefka, Daniel MD, MBA1; Berg, Sheri M. MD1; Nejad, Shamim H. MD2; Bittner, Edward A. MD, PhD1

doi: 10.1097/CCM.0000000000000053
Online Case Report

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.

Design: Retrospective case series study.

Setting: Multiple critical care units at a university-affiliated tertiary care hospital.

Patients: Five critically ill patients with catatonia, aged 17 to 78.

Interventions: None.

Measurements and Main 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.

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.

* See also p. 760.

Dr. Bittner consulted for Roche Diagnostics. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Daniel Saddawi-Konefka, MD, MBA, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, WHT 437, Boston, MA 02114. E-mail:

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins