Dimensions of Psychosis in Delirious and Catatonic Trauma Critically Ill Patients.

Objective: We examined the effect of delirium and catatonia on psychosis symptom presentation in trauma intensive care unit (TICU) patients without previous history of serious psychiatric illness. Design: Prospective observational cohort study at a single academic medical center TICU, enrolling adult patients with critical illness secondary to traumatic injury excluding patients with significant psychiatric history. ICU patients received once-daily DSM-5 delirium and catatonia evaluations, and Clinician-Related Dimensions of Psychosis Severity Scale (CRDPSS) assessment. Patients were grouped by delirium and/or catatonia diagnosis with Kruskal-Wallis and Pearson's Chi-square testing of differences between groups in CRDPSS scores. Main Results: 74 patients were sorted into delirium and/or catatonia groups for the dimensions of psychosis analysis. Catatonia was common in this critically ill trauma population with 26% prevalence. Patients with delirium and/or catatonia diagnoses had differing severities of psychosis symptoms from those with neither condition. CRDPSS total scores were significantly different between the groups (p=0.011). Conclusions: Further investigation is needed to explore commonalities in the mechanisms underpinning ICU psychosis and to identify specific psychotic symptom manifestations suggestive of delirium versus catatonia.