Warren TeltserMedical University of Lublin Student, United States of America
Title: The Importance of Diagnosing Concomitant Delirium and Catatonia: A Case Report
Catatonia syndrome is characterized by motor, behavioral and affective abnormalities in association with psychiatric and medical illnesses, and delirium syndrome is defined as acute brain dysfunction caused by an underlying medical condition or toxic exposure. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) contains a caveat that limits diagnosing catatonia in patients during delirium. However, the literature has shown that up to 31% of patients have co-occurring catatonia and delirium when using the Bush Francis Catatonia Rating Scale and 12.7% of patients with delirium meet DSM-5 criteria for catatonia. The authors present a case of a patient with concomitant delirium and catatonia. Diagnosing catatonia in this patient, even in the setting of delirium, was necessary for appropriate treatment and clinical improvement. Typical treatment for patients with delirium, antipsychotic medication, contributes to the worsening of catatonia while first-line treatment for catatonia, benzodiazepines, has been shown to exacerbate delirium. Delayed recognition of the patient’s catatonia resulted in inadequate treatment that worsened her catatonic symptoms and prolonged hospitalization. The potential contraindications to treatment interventions call for an appropriate diagnosis of catatonia when co-occurring with delirium despite the DSM-5 limitation. The World Health Organization (WHO) ICD-11 code for catatonia allows for less exclusivity in assessing for clinical catatonia in that the limitations to diagnosis only include harmful effects of drugs, medicaments or biological substance, not elsewhere classified - a more collaborative definition for catatonia criteria in the DSM-5 and the ICD-11 codes can provide a way forward with more flexibility in symptom interpretation and treatment.
Warren Teltser completed his accelerated Master of Science in Pharmacology from Georgetown University at the age of 26. Prior to his master’s, he completed research with the National Institute of Health at the University of Florida on the attentional blink. During his master’s, he completed research on the TRPA1 receptor’s role in post-operative neurogenic pain and presented the research to senior faculty at Georgetown University’s Department of Pharmacology. He went on to pursue his medical degree at the Medical University of Lublin, while concurrently pursuing his Master’s of Business Administration. He also has well over a decade of experience teaching.