ReviewMeasuring catatonia: A systematic review of rating scales
Introduction
Catatonia was first described by Kahlbaum as a syndrome of mood and motor abnormalities, including mutism, negativism, stereotypies, catalepsy and verbigeration. Whereas Kahlbaum considered catatonia to represent a distinct clinical entity with typical clinical features and a characteristic course, it was later considered to be a schizophrenia subform (Pfuhlmann and Stober, 2001). The idea that catatonia is tied to schizophrenia was codified in all DSM and ICD editions (Taylor and Fink, 2003), and is still advocated by a few (Pfuhlmann and Stober, 2001). This historical decision partly explains the neglect of the catatonic syndrome, and its dramatic underdiagnosis (van der Heijden et al., 2005). It has become clear, however, that catatonic symptoms are observable not only in schizophrenic psychosis, but, practically in any kind of psychiatric disorder and most frequently in affective disorders (Daniels, 2009, Fink et al., 2010). The neuroleptic malignant syndrome (NMS) is now considered by many as a medication-induced variant of (malignant) catatonia (Carroll and Taylor, 1997, Fink and Taylor, 2006). Recently, it was shown that the majority of patients with anti-NMDA-receptor-encephalitis present catatonic symptoms (Dalmau et al., 2008), and that in adolescents with autism the prevalence of catatonia is between 12 and 17% (Billstedt et al., 2005, Wing and Shah, 2000). As a consequence, many researchers today consider catatonia as a nosologically unspecific syndrome. Recently, others plead for the classification of catatonia as an independent, distinct syndrome, because it is easily recognizable and distinguishable from other conditions, has a characteristic course and an effective treatment response (Dhossche et al., 2010, Fink and Taylor, 2003, Taylor and Fink, 2003). This is not, however, reflected in current diagnostic manuals. The poor classification status, discouraging the diagnosis of catatonia in non-psychotic disorders (van der Heijden et al., 2005), the lack of a clear psychopathological definition and conceptual understanding of catatonia (Carroll et al., 2008), hamper catatonia research. There is an urgent need for a clear definition of the concept and reliable rating instruments to guide both researcher and clinician in diagnosing catatonia and evaluating treatment outcome. Improving the detection of catatonia is of great importance, since the presence of catatonic signs possesses significant prognostic and therapeutic value. In the past two decades, several rating scales have been proposed. In this paper, we briefly review the published catatonia rating scales, comparing their utility in routine clinical practice, and their predictive value in the response to ECT.
Section snippets
Methods
We performed a Medline search, using the search terms “catatonia AND rating scale”, “catatonia criteria”, and “catatonia diagnostic assessment”. Medline was last assessed in December 15, 2010. Abstracts of retrieved papers and – when needed – full text versions were read. The search was supplemented by manual searches of textbooks (Caroff et al., 2004, Fink and Taylor, 2003) and reference lists of selected papers. The use of a catatonia rating scale was looked at. When specific catatonia rating
Results
Medline searches with “catatonia AND rating scale” yielded 47 papers, “catatonia criteria” 102 papers and “catatonia diagnostic assessment” 28 papers. With this search strategy, 6 catatonia rating scales were found: the Rogers Catatonia Scale (Starkstein et al., 1996), the Bush–Francis Catatonia Rating Scale (Bush et al., 1996a), the Northoff Catatonia Rating Scale (Northoff et al., 1999), the Braunig Catatonia Rating Scale (Braunig et al., 2000), the Bush–Francis Catatonia Rating Scale Revised
Psychometric properties
Up to date, 6 different catatonia rating scales are available. Inter-rater reliability (MRS, RCS, BFCRS, BFCSI, NCRS, and BCRS) and internal reliability (RCS, NCRS, and BCRS) of the catatonia rating scales are high. Concurrent validity with other catatonia rating scales has only been studied in one report (Northoff et al., 1999). Significant correlations were found between the NCRS, BFCRS, MRS and RCS. In view of the fluctuating course of catatonia, test–retest reliability seems less important.
Conclusion
Catatonia is a severe neuropsychiatric syndrome with an excellent prognosis if recognized and treated without delay. A quick and correct detection of this syndrome is hampered by the lack of a precise definition (Kirkhart et al., 2007). Observation and psychiatric interview will not suffice to detect the catatonic syndrome, since the most striking symptoms such as posturing, are present only in a minority of the cases. It is of importance to elicit specific catatonic signs during a
Role of funding source
This study was performed without external funding source.
Conflict of interest
No conflict declared.
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