Luccarelli, James; Kalinich, Mark; Rogers, Jonathan P; Donovan, Abigail L; Smith, Felicia; Beach, Scott R; Smith, Joshua R; (2025) Emergency Department Presentations for Catatonia: a 2019-2021 National Emergency Department Sample Study. Journal of the Academy of Consultation-Liaison Psychiatry 10.1016/j.jaclp.2025.08.006. (In press).

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Abstract

OBJECTIVE: Catatonia is a neuropsychiatric disorder characterized by motor, affective, cognitive, and behavioral disturbances. Despite its association with significant healthcare costs, morbidity, and preventable mortality, catatonia remains underdiagnosed, particularly in emergency department (ED) settings. Limited data exist on the demographics, diagnostic patterns, and outcomes of catatonia in the ED. This study aims to characterize the epidemiology and healthcare utilization of ED visits associated with catatonia using the National Emergency Department Sample (NEDS). METHODS: We analyzed the NEDS for ED visits with a discharge diagnosis of catatonia between 2019 and 2021, with visits weighted to provide national estimates. RESULTS: An estimated 51,671 visits (0.013% of all ED presentations) included a diagnosis of catatonia. ED presentations with a diagnosis of catatonia had a bimodal age distribution, with peaks for patients aged 20-29 and 55-64 years, although there were presentations for patients as young as 2 and as old as 90+. Catatonia was disproportionately diagnosed in Black patients (27.6%). Psychiatric conditions including schizophrenia spectrum disorders, depressive disorders, and bipolar disorder, were the most common primary diagnoses (55.5%). Catatonia-related ED visits had an 82.6% hospital admission rate. Physical restraints were documented in 5.6% of ED presentations involving catatonia. CONCLUSIONS: Catatonia is rarely diagnosed in the ED setting but is identified in patients of all ages and results in a strikingly high rate of hospital admission, similar to those of well recognized life-threatening medical conditions. The high utilization of inpatient resources underscores the need for improved recognition and management of catatonia in the ED.

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