Abstract Details

Title Delirium With Catatonic Signs: A Neuropsychiatric Phenotype Associated With Autoimmune Encephalitis?

Topic Autoimmune Neurology

Presentation(s) S39 - Autoimmune and Paraneoplastic Neurological Disorders: Clinical Characteristics and Diagnosis (2:12 PM-2:24 PM)

Poster/Presentation
Number 007

Objective To determine etiological factors related to delirium with catatonic features

Background According to DSM-V, catatonia and delirium are mutually exclusive. This concept is changing as autoimmune encephalitis undergoes detailed clinical description.

Design/Methods

A prospective, longitudinal study was done with patients with delirium attended at the National Institute of Neurology and Neurosurgery. Non-probabilistic sampling of consecutive cases (2015 - 2019) was done, according to inclusion criteria (delirium diagnosis according to DSM-V). Demographic and clinic variables (hospital staying days, etiologic diagnosis, complications) were obtained. Confussion Assessment Method was used to evaluate delirium, and Bush and Francis Catatonia Rating Scale for catatonia assessment. Catatonia diagnosis was established with the DSM-V A, B, C and E criteria, and a score of 3 or more on Bush and Francis Screening Instrument. Multivariate analysis, through logistic regression, was done.

Results We included 250 patients with delirium. 83 (33%) had catatonia. Bivariate analysis showed that patients with delirium and catatonia were younger (p<0.001), had viral encephalitis, anti-NMDA encephalitis (p <0.05), and autoimmune encephalitis NMDAR (-). They showed neuroleptic malignant syndrome, epileptic seizures and vasculitis (p <0.05) more frequently, and require more in-hospital days. Brain neoplasms, subarachnoid hemorrhage, hydrocephalus, epilepsy and cerebral vascular disease were observed in patients with delirium without catatonia (p<0.05). Multivariate analysis confirmed that age, viral and anti-NMDAR encephalitis are factors significantly associated to delirium with catatonic signs.

Conclusions Unlike the American Psychiatry Association criteria, our study shows that there is a subgroup of delirium patients with catatonia, which have etiological, prognostic and therapeutic peculiarities. In particular, logistic regression analysis shows that viral encephalitis and anti-NMDA encephalitis significantly increase the likelihood of finding these mixed states of catatonia and delirium, which could be designated "delirium with catatonic signs".

Authors/Disclosures
Cynthia Arely Juarez Jaramillo (UNAM) PRESENTER	No disclosure on file
Jesús Ramírez-Bermúdez	No disclosure on file
	No disclosure on file
	No disclosure on file
Mariana Espinola-Nadurille	No disclosure on file
	No disclosure on file
	No disclosure on file

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