Psychiatry - December 2008 - (Page 45)

components that were characterized as 1) affective, 2) hypoactive, 3) hyperactive, and 4) behavioral. In their editorial, Rosebush and Mazurek7 pointed out that catatonia seemed to disappear from the landscape over the last century because psychiatry sought out verbal, introspective, and ‘interviewable’ patients. They expressed concerns regarding the affective and behavioral sections of the NCS because catatonic patients may be difficult to interview. These two sections may reduce the accuracy of the NCS in patients who are mute and exhibit negativism.7 The Braunig Catatonia Rating Scale (2000). Braunig, Kruger, and Shugar developed Catatonia Rating Scale (CRS)10 for catatonia that has 21 items with possible scores of 0 to 4 (absent, minimal, moderate, marked, severe). These are defined by time intervals of observation during a 45-minute examination ( 20 minutes). The scores range from 21 to 84. The scale is based on the work of several German language authors (Wernicke, Kraepelin, Kleist, Kahlbaum, Blueler, Meyer-Gross, and Leonhard). They group mitgehen and echophenomena under “abnormal suggestibility of will” (i.e., gegengriefen). This scale has been studied under factor analysis, but has not been used to measure treatment response.10,11 Fink and Taylor Criteria (2003). Fink and Taylor made a strong argument for a separate classification for catatonia (katatonia) in DSM-V.6 They proposed a set of criteria for the detection and diagnosis of catatonia that is based on the earlier work of Taylor.24 They did recommend the use of the BFCRS for research and clinical use. Consequently, the Fink and Taylor criteria (and the earlier version) have been used in screening for catatonia in at least two case series studies.25,26 45 TABLE 1. Comparison of BFCRS versus KANNER Dimension BFCRS KANNER Screening Items 1–17 “Wired’N Mired” mnemonic in part I Rating Items 1–23 Items 1–18 in part II Multiple signs (2 or more signs per item) Items 2,5,7 None Items for test of catatonia None Items 1–12 in Part III Range of scores 0–3 (Items 1–17 are 1, 2, or 3; Items 18–23 are 0 or 3) 0–8 (Items 1–18 ) Total scores 0–69 0–144 Motor exam Less precise More precise Terminology Classical Standard Use in chronic catatonia May need some revision28 Unknown Standardized Yes No Kahlbaum, Northoff, and use of termination of movement as a test Conceptual underpinning Kahlbaum’s description CONCERNS OVER CATATONIA RATING SCALES In spite of the classical history of catatonic signs, there is much confusion over the reference definitions for the terms used in these rating scales. Definitions tend to vary from one scale to the other.27 These include mannerisms versus stereotypy, catalepsy versus waxy flexibility, and mitgehen versus mitmachen. Most North American psychiatry textbooks fail to adequately define these terms. Each rating scale has [VOLUME 5, the support of its own research group leading to lack of uniformity in catatonia rating scales. In research and clinical institutions, there may be differing views regarding the weight of scale items. Consequently, most of these scales are not routinely used to measure treatment response. The BFCRS is most commonly cited for treatment studies in the North American publications. These scales may also not be sensitive enough to measure treatment response.27 12, DECEMBER] NUMBER Psychiatry 2008 45

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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