Psychiatry - December 2008 - (Page 47)

APPENDIX 2, PART 2. KANNER scale 1. Excitement: Extreme nongoal-directed hyperactivity, constant motor activity. This may include aggressive movements and walking for prolonged periods. 0 = Absent 2 = Excessive motion, intermittent 4 = Constant motion, hyperkinesis without rest periods 6 = Extreme motoric excitement, frenzied motor activity 8 = Extreme motoric excitement with potential or actual harm 2. Immobility: Extreme hypoactivity, immobile. 0 = Absent 2 = Mild hypoactivity or bradykinesia 4 = Bradykinesia, but is able to move on request 6 = Akinesia with few spontaneous movements but may be able to move on command 8 = Akinesia with few spontaneous movements, lasting greater than one day 3. Stupor: Minimally responsive to stimuli. 0 = Absent 2 = Inert, but may interact briefly 4 = No reaction to any external stimuli 6 = No reaction to noxious stimuli 8 = No reaction to deep, painful stimuli 4. Mutism: Verbally unresponsive or minimally responsive. 0 = Absent 2 = Verbal response to questions only (speech-prompt) or occasional spontaneous utterances 4 = Verbally unresponsive to majority of questions 6 = No speech; does not speak when spoken to 8 = No speech for greater than one day 5. Staring: Fixed gaze, avoidant gaze, decreased blinking. 0 = Absent 2 = Poor eye contact, decreased blinking but will look at examiner 4 = Gaze held, occasionally shifts attention to examiner 6 = Fixed gaze; does not look at examiner; may look when requested 8 = Fixed gaze/staring for greater than one day 6. Posturing: Spontaneous maintenance of posture(s). 0 = Absent 2 = Brief episodes of “freezing” in a position for usually less than one minute 4 = Longer episodes of more than one minute for less than one day 6 = Bizarre posture, twisted or contorted body position less than one day 8 = Any posture maintained for more than one day 7. Grimacing: Facial spasms, facial tics, or odd facial expressions. 0 = Absent 2 = Present, with major provocation 4 = Present, with minor provocation 6 = Present, without any provocation, spontaneously 8 = Present, with prolonged grimace or “facial cramp” 8. Stereotypy: Repetitive, nongoal-directed movements. 0 = Absent 2 = Present, without injury 4 = Present, with minor self injury (e.g., removes scab with frequent movements) 6 = Present, with significant self injury (e.g., puts finger into eye and scratches cornea) 8 = Present, with severe self injury (loss of function such as loss of one eye, one hand) 9. Mannerisms: Repetitive, goal-directed but noncontextual movements (e.g., saluting a door or brushing hair without comb or brush in hand). 0 = Absent 2 = Present, without injury 4 = Present with minor self injury (e.g., removes patch of hair from frequent combing movements) 6 = Present with significant self injury (e.g., abrades scalps with frequent combing) 8 = Present with severe self-injury (loss of function, loss of skin integrity from extensive excoriation) 10. Rigidity: Maintenance of a rigid position despite efforts to be moved; may be transient. 0 = Absent 2 = Mild cog-wheeling 4 = Moderate, increased muscle tone; may wax and wane 6 = Severe, lead-pipe rigidity 8 = Extreme, resists all movement; limb cannot be repositioned 11. Flaccidity: Maintenance of a slack muscle tone; may be transient. 0 = Absent 2 = Mild, reduced muscle tone 4 = Moderate, reduced muscle tone; may wax and wane 6 = Severe, reduced muscle tone and movement; for less than one day 8 = Extreme, reduced muscle tone and movement; for greater than one day 12. Negativism: Resistance to instructions or attempts to move or examine the patient. 0 = Absent 2 = Mild resistance (e.g., will not follow some commands) 4 = Moderate resistance (e.g., will not follow any commands, refuses to open mouth on examiner’s request or for nursing staff to administer oral medication) 6 = Severe resistance (e.g., will not open eyelids for examiner or nursing staff) 8 = Opposition (e.g., holds eyelids or mouth shut even after efforts to gently open them) 8 = Active negativism; does the opposite of examiner’s request (e.g,. opens mouth when told to close mouth) 13. Refusal to eat. 0 = Absent 2 = Minimal food intake for less than one day 4 = Reduced food intake or odd food rituals for more than one day 6 = Reduced food intake or odd food rituals for more than one day; eats only when fed by another person, or with frequent prompts 8 = Requires nasogastric tube or supplemental feeding 14. Refusal to drink. 0 = Absent 2 = Minimal fluid intake for less than one day 4 = Reduced fluid intake or odd drinking rituals for more than one day 6 = Reduced fluid intake or odd drinking rituals for more than one day; drinks only with assistance of another person or frequent prompts 8 = Requires IV hydration or supplemental fluids 15. Impulsivity: Sudden changes in behavior without provocation. 0 = Absent 2 = Occasionally acts up or runs away without prior warning 4 = Frequently acts up and runs away at least once per week 6 = Constant impulsive behavior; requires constant supervision 8 = Extreme impulsive behavior, with great potential for harm (e.g. swallows spoons, coins or runs into walls) 16. Nudism: Removes clothes or presents nude in public without provocation. 0 = Absent 2 = Present; missing some articles of clothing 4 = Present; missing most articles of clothing (e.g., appears in underwear) 6 = Present; is undressed or nude in semiprivate area 8 = Present; is nude in public areas without provocation 17. Incontinence (psychogenic): Incontinent even after taken to bathroom, without significant bowel or bladder disease. 0 = Absent 2 = Present; occasional diurnal urinary incontinence 4 = Present; frequent diurnal urinary incontinence 6 = Present, diurnal fecal incontinence 8 = Both fecal and urinary incontinence 18. Combativeness: Hostility and/or striking out at others suddenly in a nongoaldirected manner. 0 = Absent 2 = Occasionally hostile toward others; low potential for injury (e.g., irrational, angry verbal outbursts) 4 = Frequently hostile toward others; occasionally strikes out; moderate potential for injury 6 = Constantly hostile toward others; frequently strikes out; serious danger to others 8 = Combative and/or has struck out at others or objects in past week (e.g., has broken down a door) Record Total Score = Range (0 to 144) [VOLUME 5, NUMBER 12, DECEMBER] Psychiatry 2008 47

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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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