For screening, items are marked as absent 0 or present 3. The presence of two or more of the screening items for 24 hours or longer meets the diagnosis for catatonia proposed by Bush et al. For severity, items are rated using a scale of The rating scale is accompanied by a standardised examination procedure consisting of nine steps. Sample procedures are: To assess for Echopraxia, the examiner scratches his head in an exaggerated way.
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Catatonia is a complex neuropsychiatric syndrome that occurs with primary psychiatric disorders or secondary to general medical conditions.
Catatonia is often neglected when screening and examining psychiatric patients. Undiagnosed catatonia can increase morbidity and mortality, illustrating the need to effectively screen patients for presence of catatonia as well as their response to treatment. There are many barriers to the diagnosis of catatonia that may explain the low rates of diagnosis in modern psychiatry.
This article will review the many barriers that exist in the detection, recognition, and diagnosis of catatonia. Various criteria and rating scales have been applied to catatonia. The lack of precise definitions and validity of catatonia has hindered the detection of catatonia, thus delaying diagnosis and appropriate treatment.
This review article will illustrate the need for a new rating scale to screen and detect catatonia as it occurs in a variety of healthcare settings. This article will also review the characteristics such a scale should possess to produce a quality instrument to aid in the appropriate care of the catatonic patient.
Catatonia has been identified in a variety of psychiatric, medical and neurological disorders, and drug-induced states. The word catatonia is Greek for tension insanity, a concept developed by Kahlbaum to describe a new illness.
His concept of catatonia was later marginalized by Kraepelian psychiatry to a subtype of schizophrenia and was largely ignored in most medical and psychiatric settings. The modern classification must include catatonia as it occurs on acute and chronic psychiatric units, emergency departments, intensive care units, nursing home settings, and outpatient clinics. The practical issue for a clinician in modern times is to determine whether the patient presents with catatonia.
In most clinical settings, systematic screening for depression, anxiety, suicidal risk, and substance abuse are commonly performed. However, scales to screen for catatonia in neuropsychiatric settings are often neglected. There is a practical value in detecting catatonia because lorazepam, electroconvulsive therapy ECT , and other treatments have continued to demonstrate improvement in response and outcome.
Failure to identify catatonia may result in increased morbidity and mortality. The problems with the detection and measurement of catatonia have been summarized by Caroff and Ungvari. Catatonic signs must be elicited by examination but are usually not observed nor detected by a routine clinical interview. Treatment for catatonia is effective, but response to treatment in catatonia is hard to measure.
The catatonia rating scales were developed to detect and measure the severity of catatonia but they may lack the sensitivity necessary to measure improvement. A search for newer treatment approaches to catatonia will require a rating scale that is sensitive to clinical improvement in catatonia without contaminating the rest of psychopathology.
We have identified the following barriers to the detection of catatonia. First, behavior problems are overemphasized in deference to motor disorders signs. Consequently, patients who present with catatonia to a clinic or hospital will be treated as if they have a behavioral problem that is more important than the motor syndrome. Second, motor signs related to volition will are subject to psychological interpretations instead of careful observation and description i.
Catatonic signs are often regarded as attention-seeking behavior. Longer periods of observation are necessary for some catatonic signs to emerge, making it difficult to detect or identify catatonia during a clinic visit or a short hospital stay.
And finally, psychiatric educators rarely include catatonic signs as an important component of their curriculum. While there are several catatonia rating scales, these scales are not routinely taught or included in educational programs as valuable diagnostic instruments.
Many clinicians believe that catatonia is not seen anymore. Consequently, those clinicians who are not familiar with the concept of catatonia do not diagnose nor treat catatonia.
The diagnosis of schizophrenia with catatonic features may be avoided in research settings. The recognition of catatonic features by criteria used to define catatonia has been found to be inadequate. Recognition of catatonia requires application of a rating scale for catatonia. Patients presenting with the following catatonic signs would not be admitted or treated if one followed DSM-IV-TR criteria; these include echopraxia, peculiarities of speech, stereotypies, mannerisms, and grimacing.
It is important to remember that clinicians' goal is not the quest of knowledge itself but the ability to use their available knowledge and skills to prevent and diminish the suffering and disability of their patients. The terminology used in the diagnostic criteria for catatonic schizophrenia has been a concern and may include 5 to 57 signs. We found low concurrent validity in criteria terminology and suggest that a new approach to detection of catatonia is warranted.
Review of three criteria-based definitions 11 , 15 , Results of clear and unambiguous descriptions of 28 terms used to define or describe catatonia:. First, it lacks uniformity in its reference definitions as noted in Table 1. Third, while the BFCRS can be used to measure treatment response we have found that items 17 through 23 may still be present even after patients have improved clinically.
Some patients would still score 3 to 12 points even when clinical improvement has occurred. The scores of items 1 through 17 may not be weighted sufficiently to detect treatment effects. There are several important signs seen in catatonic patients that are not included. Some of the terms are not comprehensible to North American researchers e. There is a need to replace these terms with more common and easily understandable terms or to provide concise and clear definitions.
Perhaps the European catatonia rating scales could provide improved detection, recognition, and measurement of treatment response and provide options for research into catatonia. This new scale could benefit from the decade of studies using the BFCRS and from the development of other scales.
Catatonia is a movement disorder as well as a neuropsychiatric syndrome; thus, a catatonia rating scale is akin to a movement disorder examination. The catatonia rating scale must detect patients who may exhibit catatonia and identify catatonic signs reliably. We recommend that a new catatonia rating scale be used in a variety of clinical settings to detect, identify, and measure catatonia and its response to treatment among a population of at-risk patients.
Such a scale must include reference definitions and should avoid unfamiliar and confusing historical terms. As demonstrated by Stompe and colleagues, the detection of catatonia can be improved if the clinician relies on a greater number of specific signs with precise reference definitions. The authors would like to thank Harold W. Rob Kirkhart, Dr. Niraj Ahuja, Dr. Joseph WY Lee, Dr.
Jose Ramirez, Dr. Rebecca Talbert, Dr. Kishwer Faiz, Dr. Gabor S. Ungvari, Dr. Christopher Thomas, Dr. Brendan T. Carroll, Dr. National Center for Biotechnology Information , U. Journal List Psychiatry Edgmont v. Psychiatry Edgmont. Carroll , MD. Rob Kirkhart Dr. Niraj Ahuja Dr. Joseph WY Lee Dr. Jose Ramirez Dr. Rebecca Talbert Dr. Kishwer Faiz Dr. Ungvari Dr. Christopher Thomas Dr. Carroll Dr. Find articles by Brendan T.
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Abstract Catatonia is a complex neuropsychiatric syndrome that occurs with primary psychiatric disorders or secondary to general medical conditions. Keywords: catatonia, catatonia rating scale, detection, screening, barriers. Introduction Catatonia has been identified in a variety of psychiatric, medical and neurological disorders, and drug-induced states. Barriers to the Detection of Catatonia We have identified the following barriers to the detection of catatonia.
Barriers to Recognition of Catatonia The recognition of catatonic features by criteria used to define catatonia has been found to be inadequate. Barriers to the Validity of Catatonia The terminology used in the diagnostic criteria for catatonic schizophrenia has been a concern and may include 5 to 57 signs. Table 1 Review of three criteria-based definitions 11 , 15 , Open in a separate window. Conclusion Catatonia is a movement disorder as well as a neuropsychiatric syndrome; thus, a catatonia rating scale is akin to a movement disorder examination.
Acknowledgments The authors would like to thank Harold W. Contributor Information Rob Kirkhart, Dr. References 1. Clinical manifestations, diagnosis, and empirical treatments for catatonia.
Prevalence of the catatonic syndrome in an acute inpatient sample
Enter your email address and we'll send you a link to reset your password. Patients with or without psychiatric history with characteristic symptoms of catatonia e. May be used both for initial diagnosis and to monitor treatment response. The full scale is 23 items, with the first 14 questions comprising the screening instrument Bush-Francis Catatonia Screening Instrument.
The Detection and Measurement of Catatonia
Psychomotor symptomatology in psychiatric illnesses View all 18 Articles. Objective: In this exploratory open label study, we investigated the prevalence of catatonia in an acute psychiatric inpatient population. In addition, differences in symptom presentation of catatonia depending on the underlying psychiatric illness were investigated. A factor analysis was conducted in order to generate six catatonic symptom clusters. Composite scores based on this principal component analysis were calculated. Interestingly, when focusing on the DSM-5 criteria of catatonia, 22 patients Furthermore, different symptom profiles were found, depending on the underlying psychopathology.