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Sexton MT, Kim A, McGonigle T, Mihalko S, Vandekar SN, Brummel NE, Patel MB, Dittus RS, Heckers S, Pandharipande PP, Ely EW, Wilson JE. In-hospital catatonia, delirium, and coma and mortality: Results from the delirium and catatonia prospective cohort investigation. Schizophr Res 2024; 263:223-228. [PMID: 37580182 PMCID: PMC10843668 DOI: 10.1016/j.schres.2023.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Catatonia, a form of acute brain dysfunction typically linked with severe affective and psychotic disorders, occurs in critical illness with delirium and coma. Delirium and coma are associated with mortality, though catatonia's relationship with mortality is unclear. We aim to describe whether catatonia, delirium, and coma are associated with mortality. METHODS We enrolled a convenience cohort of critically ill adults (N = 378) at an academic medical center. We assessed catatonia, delirium, and coma using the Bush-Francis Catatonia Rating Scale, the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation-Sedation Scale, respectively. We tested the associations between previous day brain dysfunction state occurrence with in-hospital and one-year mortality using multivariable time-dependent risk models. Additionally, we tested the association between brain dysfunction duration and one-year mortality. RESULTS Catatonia was not associated with death on the day after diagnosis during hospitalization, and neither previous catatonia occurrence nor duration was associated with one-year mortality. Delirium was not associated with death on any day following diagnosis during hospitalization, and neither previous delirium occurrence nor duration was associated with one-year mortality. The occurrence of coma was associated with death on any day after diagnosis during hospitalization (HR 2.30,CI 1.19-4.44,p = 0.014), as well as through one year following hospital discharge (HR 1.68,CI 1.09-2.59,p = 0.02). CONCLUSIONS Coma, but neither catatonia nor delirium, was associated with future day in-hospital and one-year mortality. More research is needed to understand catatonia's clinical impact. Delirium results differ from existing literature likely due to cohort demographics and size. Coma results highlight the prognostic significance of suppressed arousal while critically ill.
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Affiliation(s)
- Morgan T Sexton
- Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States of America; Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Ahra Kim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Sarasota Mihalko
- Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States of America
| | - Simon N Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Nathan E Brummel
- Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Mayur B Patel
- Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States of America; Division of Acute Care Surgery, Departments of Surgery, Neurosurgery, and Hearing and Speech Sciences, Section of Surgical Sciences, Vanderbilt Brain Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America; Geriatric Research, Education, and Clinical Center Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States of America
| | - Robert S Dittus
- Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States of America; Geriatric Research, Education, and Clinical Center Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States of America; Department of Medicine, Division of General Internal Medicine and Public Health, Center for Health Services Research and Quality Aging, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Stephan Heckers
- Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States of America; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Pratik P Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States of America; Division of Anesthesiology Critical Care, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States of America; Geriatric Research, Education, and Clinical Center Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States of America; Division of Allergy, Pulmonary and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Jo Ellen Wilson
- Critical Illness, Brain Dysfunction, and Survivorship Center, Center for Health Services Research, Nashville, TN, United States of America; Geriatric Research, Education, and Clinical Center Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, United States of America; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America.
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Beavers D, Beavers K, Newman J, Nicklas B, Mihalko S, Miller G, Messier S. HETEROGENEITY OF GAIT SPEED RESPONSE TO INTENTIONAL WEIGHT LOSS IN OLDER ADULTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D.P. Beavers
- Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina,
| | - K.M. Beavers
- Wake Forest University, Winston-Salem, North Carolina
| | - J.J. Newman
- Wake Forest University, Winston-Salem, North Carolina
| | - B.J. Nicklas
- Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina,
| | - S. Mihalko
- Wake Forest University, Winston-Salem, North Carolina
| | - G.D. Miller
- Wake Forest University, Winston-Salem, North Carolina
| | - S.P. Messier
- Wake Forest University, Winston-Salem, North Carolina
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Messier SP, Mihalko S, Loeser RF, Legault C, Jolla J, Pfruender J, Prosser B, Adrian A, Williamson JD. Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study. Osteoarthritis Cartilage 2007; 15:1256-66. [PMID: 17561418 DOI: 10.1016/j.joca.2007.04.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 04/09/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This preliminary study sought to determine whether using 1500/1200mg of glucosamine hydrochloride and chondroitin sulfate (GH/CS) is effective, both separately and combined with exercise, compared to a placebo plus exercise program in improving physical function, pain, strength, balance, and mobility in older adults with knee osteoarthritis (OA). METHODS This double-blind, placebo-controlled, randomized clinical trial lasted 12 months. Participants included 89 older adults (age>/=50 years) with knee OA randomized to either GH/CS or placebo group. Phase I was a 6-month trial comparing the effects of assignment to either GH/CS or placebo. Phase II added 6 months of exercise for both groups. The primary outcome measure was Western Ontario and McMaster University Osteoarthritis Index (WOMAC) function, and secondary outcome measures included WOMAC pain, 6-min walk, balance, and knee strength. RESULTS Of the 89 randomized participants, 72 (81%) completed the study. The median pill compliance was 94% and 95% in Phase I, and, in Phase II, 97% and 91% for the GH/CS and placebo groups, respectively. Median exercise compliance during Phase II was 77% for the GH/CS group and 78% for the placebo group. WOMAC function and pain did not differ significantly between the groups at 6- or 12-month follow-up. There were also no significant differences between the groups in 6-min walk or knee strength; however, balance was better in the placebo group with approximately a 10% difference compared to the GH/CS group. CONCLUSIONS The GH/CS group was not superior to the placebo group in function, pain, or mobility after both phases of the intervention (pill only and pill plus exercise).
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Affiliation(s)
- S P Messier
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, United States.
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