Contributor Information. Corresponding author. Abstract 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.
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Contributor Information. Corresponding author. Abstract 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. 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.
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.
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.
Barriers to the Detection of Catatonia 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. Barriers to Recognition of Catatonia 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.
We found low concurrent validity in criteria terminology and suggest that a new approach to detection of catatonia is warranted.
Bush-Francis Catatonia Rating Scale (BFCRS)
Catatonia associated with schizoaffective disorder Catatonia associated with substance-induced psychotic disorder Catatonia associated with bipolar and related disorders Catatonia associated with major depressive disorder Catatonic disorder due to another medical condition If catatonic symptoms are present but they do not form the catatonic syndrome , a medication- or substance-induced aetiology should first be considered. Motor activity is nearly non-existent. Individuals in this state make little or no eye contact with others and may be mute and rigid. One might remain in one position for a long period of time, and then go directly to another position immediately after the first position.
The Detection and Measurement of Catatonia