Electrographic Features of Catatonia With or Without Comorbid Delirium

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OBJECTIVE: Catatonia is an underdiagnosed disorder characterized by speech and motor abnormalities. EEG examinations may improve the accuracy of a catatonia diagnosis, but clinical and electrographic correlations have not been established. The authors describe catatonic features and EEG findings in a large multisite retrospective cohort. METHODS: The clinical records in two health care systems were searched for patients with an EEG recording and a catatonia assessment with the Bush-Francis Catatonia Rating Scale conducted within 24 hours of each other. Included patients were retrospectively screened for delirium through a chart-based assessment. Augmented inverse propensity weighting (AIPW) was used to estimate the causal effects of delirium and catatonia on the presence of an abnormal EEG finding. RESULTS: Overall, 178 patients met inclusion criteria, 144 (81%) of whom had catatonia. Among the patients with catatonia, 43% also had delirium. EEG abnormalities were present among 43% of patients with catatonia, including 28% of patients with catatonia without delirium and 69% of the patients with co-occurring catatonia and delirium. Individual catatonic signs and EEG abnormalities showed only a weak correlation. In AIPW models, a delirium diagnosis was associated with significantly higher odds for an abnormal EEG finding (OR=6.75; 95% CI=2.83-16.14), whereas a diagnosis of catatonia was not (OR=1.83, 95% CI=0.79-4.24). CONCLUSIONS: EEG abnormalities are common among individuals with catatonia, but these are difficult to disentangle from abnormalities resulting from co-occurring delirium. Further research is needed to define the role of EEG examinations in the assessments of catatonia and delirium.

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