REVIEW OF: Mormando C et al, J Acad Consult-Liaison Psychiatry 2026;67(1):26–34

STUDY TYPE: Retrospective analysis of a prospective quality improvement project

Catatonia is common but often missed in medical settings, especially when delirium is present. The DSM-5-TR discourages diagnosing both simultaneously, on the assumption that symptoms such as mutism, rigidity, immobility, and withdrawal may be better explained by delirium alone. This study challenges that assumption by showing frequent overlap between the two syndromes.

Researchers screened 718 consecutive medical inpatients at Stony Brook using the Bush-Francis Catatonia Screening Instrument and the Confusion Assessment Method. Sixteen patients (2.2%) met criteria for catatonia, and nearly all (93%) of those also had delirium. Among the 178 patients with delirium, about 8% also had catatonia. Only 7 of the 15 patients with both syndromes received lorazepam (0.5–3 mg/day). Of those treated, three had full remission of catatonia and delirium within about five days, and four had partial improvement. In contrast, none of the patients treated with antipsychotics improved. These numbers are too small to draw firm conclusions about efficacy, but they do suggest that benzodiazepines may help when catatonia is part of the picture.

CARLAT TAKE
These findings highlight a blind spot in hospital psychiatry: Catatonia can coexist with delirium and may be missed if the symptoms are attributed to delirium alone. If your “delirious” patient shows immobility, mutism, rigidity, staring, or marked withdrawal, screen for catatonia before reflexively reaching for haloperidol. The lorazepam data here are preliminary and uncontrolled, but the clinical point is still important: When catatonia is present, lorazepam may be a more reasonable and safer first step than antipsychotics, which can worsen catatonia.