Clearly, it is difficult to distinguish delirium from Drs. Taylor and Fink’s view of malignant catatonia: "acute onset of excitement, delirium, fever, autonomic instability, and catalepsy" (1, p. 1236). There is also considerable overlap between their definition of regular catatonia, "motor abnormalities that occur in association with changes in thought, mood, and vigilance" (p. 1234), and delirium, as described. Drs. Taylor and Fink expound on malignant catatonia and its significant mortality by saying that "most patients died" in pre-ECT days. However, fever, confusion, and psychomotor abnormalities may simply have been manifestations of an underlying illness that was not diagnosed. Many of the references quoted are from the 1970s, before sophisticated diagnostic imagery was available, and do not include a comprehensive delirium workup that we would expect as standard in 2003. In our opinion, fever, confusion, psychomotor abnormalities, and autonomic instability in the presence or absence of delusions and hallucinations should be viewed as delirium and worked up and treated as such.