Psychiatry - December 2008 - (Page 44)

of patients with catatonic symptomatology. These criteria advanced the study of catatonia and highlighted important concepts that underlie catatonia. The clinician, however, may be challenged with some patients with katatonia who fail to meet this set of criteria but not others. Unfortunately, no rating scale was developed from these criteria. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (1994). The development of DSMIV brought about a new set of criteria for catatonia as a subtype of schizophrenia as well as a specifier for bipolar disorder and major depression. DSM-IV also included catatonia due to a general medical condition. DSM-IV catatonia criteria required 2 out of examined this proposed rating scale and found it to have high correlation with other catatonia rating scales.9 The Rosebush criteria do not take into account catatonic excitement and positivism (e.g., automatic obedience, mitgehen, ambitendency). This set of criteria is helpful but may exclude a number of patients with catatonic signs. Rogers Scale (1991). The Modified Rogers Scale rates both extrapyramidal signs (EPS) and catatonic signs.5 It contains several conceptual approaches to catatonia and catatonic signs. It is founded upon the concept that catatonic features are a form of EPS. Consequently the phenomenology is rated independent of presumed etiology and medications (e.g., antipsychotics). Rogers lists 36 motor signs and describes a The authors propose that the term katatonia (with a “k”) be used to describe this crosssectional clinical syndrome to avoid continuation of the more recent nosological confusion. 5 signs, except for catatonia due to a general medical condition, where only 1 out of 5 was needed. We have previously pointed out the deficiencies of the DSM-IV and DSM-IV-TR (Text Revision) criteria.18 There is currently no rating scale for DSM-IV or DSM-IVTR catatonia criteria. Stompe et al19 found that the sensitivity was greater for diagnoses with a higher number of items in katatonia criteria. Rosebush et al (1990). Rosebush et al20 described the Kahlbaum criteria with more than two cardinal features with more than one secondary feature. They used this criteria to identify catatonic features and measure treatment response. The Rosebush rating scale was proposed but it has never been published. Northoff 44 Psychiatry 2008 [ V O L U M E 5, NUMBER neuropsychiatric motor examination. Each item is rated on a scale of 0 to 2 with scores ranging from 0 to 72. The Rogers scale has not been widely used in treatment. The Modified Rogers Scale provides definitions for gegenhalten, mitgehen, stereotypy, mannerism, echopraxia, bizarre gait, aprosodic speech, excitement, and negativism. It also describes overcompliance, iteration (the repetition of movements), and hypermetamorphosis. This scale has been used in institutional populations, including patients with mental retardation. It was also used by Starkstein et al21 in a treatment study of catatonic features in patients with Parkinson’s disease and depression. The Bush-Francis Catatonia Rating Scale (1996). The Bush12, DECEMBER] Francis Catatonia Rating Scale (BFCRS) was the first instrument constructed for the systematic, standardized, and quantifiable examination of catatonia using operationally defined signs and symptoms.22 The BFCRS consists of 23 items accompanied by specific instructions to standardize the examination. Seventeen items are scored on a 0 to 3 scale while the remaining six are rated as either absent (“0”) or present (“3”). Selection of the items was based on a review of the classical and contemporary literature. The interrater reliability of BFCRS was established on 28 acutely ill patients presenting with catatonic syndrome that arose in the context of various psychiatric disorders. Catatonia ratings with the BFCRS predicted a high probability of treatment responsiveness to lorazepam.23 Since its development, the BFCRS has been the most commonly used scale in research in catatonia. It is readily available for clinical use and has been translated into several languages. Our research team has used the BFCRS and considers it the gold standard compared to other scales. The Northoff Catatonia Scale (1999). The Northoff Catatonia Scale (NCS) was based upon Kahlbaum’s descriptions of catatonia including 1) hypokinesias, 2) hyperkinesias, 3) affective symptoms, and 4) behavioral alterations. The NCS contains 40 items, rated from 0 to 2, with the scores ranging from 0 to 80. Northoff et al9 performed extensive evaluation of the NCS and compared it to several rating scales. They found the NCS to be valid and reliable for rating catatonia. Also, hypokinesias and hyperkinesias were independent of antipsychotic medication. There was no significant difference between the NCS and the modified Rogers scale in the detection of catatonic patients. A score of >7 on the NCS separated catatonic from noncatatonic psychiatric patients. A factor analysis yielded four

Table of Contents Feed for the Digital Edition of Psychiatry - December 2008

Psychiatry - December 2008 Editor’s Message Contents Editorial Advisory Board Antidepressant Prescribing by Specialty and Treatment of Premenstrual Dysmorphic Disorder Pain, Pain, Go Away: Antidepressants and Pain Management Why Psychotherapy Helps the Patient in Chronic Pain General Medical Drugs Associated with Depression Katatonia: A New Conceptual Understanding of Catatonia and a New Rating Scale Thermoregulation and the Role of Calcium Signalling in Neurotransmission Cognition and Schizophrenia: Is There a Role for Cognitive Assessments in Diagnosis and Treatment? Journal Watch Information for Authors

Psychiatry - December 2008

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