Exposure to Antipsychotic Medication Is Associated With Less Days Alive and Free From Catatonia in Critically Ill Patients.

Abstract

Objectives: Catatonia occurs in critical 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.

Design: The Delirium and Catatonia Prospective Cohort Investigation is a prospective cohort.

Setting: Single academic medical center's medical, surgical, and trauma ICUs.

Patients: Critically ill adult patients on mechanical ventilation or vasopressors without a major neurocognitive disorder, severe psychiatric disorder, or catatonia at baseline.

Interventions: The primary exposure was antipsychotic administration and cumulative dosage during the first 5 and 14 days from enrollment.

Measurements and main results: Catatonia was evaluated with the Bush-Francis Catatonia Rating Scale mapped to Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition criteria. The primary outcome was catatonia-free days (CFDs), 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 (OR) of outcome events. Patients ( n = 270) were enrolled with a median (interquartile range) age of 54.5 years (36.7-67.2 yr). Of patients who were exposed to antipsychotic medication ( n = 102), 27 (26%) experienced catatonia. Compared with patients who were never exposed to antipsychotics, those exposed in both the 5- and 14-day models had a 74% and 51% reduction in the odds of more CFD (OR, 0.2568; 95% CI, 0.1580-0.4173) and (OR, 0.4939; 95% CI, 0.3857-0.6325), respectively. Furthermore, those exposed to higher dosages had a 97% reduction in the odds of more CFD (OR, 0.0281; 95% CI, 0.0142-0.0556) and (OR, 0.0335; 95% CI, 0.0166-0.0673) compared with those exposed to lower dosages in both the 5- and 14-day models, respectively.

Conclusions: 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.