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BACKGROUND:Catatonia is prevalent in the general hospital yet remains under-recognized. Of particular interest is the relationship between delirium and catatonia as recent studies have shown catatonia may co-occur with delirium. The DSM-5-TR posits that catatonia does not exist in delirium, although studies have questioned this exclusion. We assessed the occurrence of catatonia and delirium in hospitalized general medical patients and report naturalistic treatment outcomes with lorazepam. METHODS:Data from a naturalistic quality improvement (QI) project were retrospectively analyzed. All consecutive admissions to four general medical units at the University Hospital at Stony Brook were screened within 48 hours using the Bush-Francis Catatonia Screening Instrument (BFCSI) and the Confusion Assessment Method (CAM). The diagnostic threshold on the BFCSI was set to 4 signs to increase specificity. The Bush-Francis Catatonia Rating Scale (BFCRS) was utilized to monitor severity of positive screens. The QI project included 718 consecutive patient admissions that are reviewed and analyzed in this report. RESULTS:Approximately 2.2% of the 718 patients met criteria for catatonia. Of the patients with catatonia, 93% also met criteria for co-occurring delirium. The prevalence of delirium in the sample was 24.8%, and 8.4% of patients with delirium also had catatonia. Of those with catatonia and delirium, 43.8% received treatment for catatonia with benzodiazepines. Of those treated, the clinical features of catatonia and delirium remitted in 43% of cases, while the signs of catatonia responded to treatment (>50% reduction in BFCRS) in 57% of cases. All 16 cases of catatonia had 5 or more signs of catatonia, while the majority of the remaining 702 patients had 0-2 signs. CONCLUSIONS:These data provide further evidence that catatonia co-exists with delirium, and may respond to lorazepam. We found a bimodal distribution in the number of catatonic signs, suggesting catatonia may be a distinct syndrome among medical patients. Our results suggest that prospective treatment studies are warranted.