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Exposure to Antipsychotic Medication is Associated with Incident Catatonia in Critically Ill Patients
Importance: Catatonia occurs in critically illness however underlying causal mechanisms are unknown. We aim to determine if exposure to antipsychotic medication is associated with less days alive and free from catatonia in critically ill adults.
Methods: The Delirium and Catatonia (DeCat) Prospective Cohort Investigation is a cohort of critically ill adults from a single academic medical center’s medical, surgical and trauma intensive care units. Patients were on mechanical ventilation or vasopressors without a major neurocognitive disorder, severe psychiatric disorder or catatonia at baseline. The primary exposure was antipsychotic administration and cumulative dosage during the first 14- and 5-days from enrollment. Catatonia was evaluated with the Bush-Francis Catatonia Rating Scale mapped to DSM-5 criteria. The primary outcome was Catatonia Free Days (CFD), defined as the number of days the patient was alive and free from catatonia. Adjusted proportional odds logistic regression was used to estimate the odds ratio of outcome events.
Outcomes: 270 patients were enrolled with a median (IQR) age of 54·5 (36·7, 67·2) years. 102 patients were exposed to antipsychotic medication, 27 (26%) of whom experienced catatonia. Compared to patients who were never exposed to antipsychotics, those exposed had a lower odds of more CFD (OR, 0·49 [95% CI, 0·39-0·63]). Furthermore, those exposed to higher dosages had a lower odds of more CFD compared to those exposed to lower dosages (OR, 0·03 [95% CI, 0·02-0·07]).
Interpretation: This study may influence how intensivists approach the use of antipsychotic medications and may build upon existing evidence that dopamine blockade is an underlying biologic mechanism underlying catatonia.
Funding: Drs. Wilson, Ely, and Dittus received support from the Tennessee Valley Healthcare System Geriatric Research, Education, and Clinical Center (GRECC). Drs. Patel received support from R01GM120484. Dr. Brummel received support from K76AG054864. Data were collected and stored in REDCap from NIH grant UL1 TR000445.
Declaration of Interest: None to declare.
Ethical Approval: The Institutional Review Board at Vanderbilt University Medical Center (Nashville, Tennessee; USA) approved this study.
Keywords: catatonia, antipsychotics, delirium, critical illness, intensive care unit, consultation-liaison psychiatry
Mina, Gloria Nashed and McGonigle, Trey and Liu, Jinyuan and Brummel, Nathan E. and Patel, Mayur B. and Smith, Joshua R. and Pandharipande, Pratik P. and Dittus, Robert S. and Ely, E. Wesley and Wilson, Jo Ellen, Exposure to Antipsychotic Medication is Associated with Incident Catatonia in Critically Ill Patients. Available at SSRN: https://ssrn.com/abstract=5061264 or http://dx.doi.org/10.2139/ssrn.5061264
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