Psychiatry - December 2008 - (Page 48)

APPENDIX 2, PART 3. KANNER scale examination for catatonic signs Patients with catatonia exhibit some unique responses to interaction with the examiner and the environment. These responses tend not to be associated with clinical severity in chronic populations. Consequently, the presence of these signs from the examination tends to confirm the presence of catatonia, but should not be used for initial assessment or treatment response. These signs may wax and wane over time. A. Confirmatory tests for catatonic signs—speech 1. Parroting (Echolalia): Patient repeats spoken word, in parrot-like fashion. 0 = Absent 1 = Repeats entire phrase, complete echolalia 1 = Repeats end of phrase, terminal echolalia or logoclonia 1 = Repeats beginning of phrase, initial echolalia 2. Gibberish (verbigeration): Patient produces nonsense words or sounds. 0 = Absent 1 = Word salad, sensible words, nonsensical sequence, rapid cadence 1 = Babbling, nonsense words in sensible cadence 1 = Yelling words or phrases at loud volume, but out of context 3. Perseveration: Repeatedly returns to same topic or persists with same movement. 0 = Absent 1 = Repeats same answer to previous question 1 = Repeats same action for a previous request 1 = Returns to same topic or phrase in conversation B. Confirmatory tests for catatonic signs—motor 4. Waxy flexibility: Patient maintains examiner’s imposed postures for greater than one minute. 0 = Absent 1 = Present 5. Catalepsy: Patient maintains examiner imposed postures briefly but gradually returns limb to a position of rest within one minute. 0 = Absent 1 = Present 6. Echopraxia: Mimicking of examiner's movements. 0 = Absent 1 = Present 7. Command-verbal (automatic obedience and ambitendency): Exaggerated cooperation with examiner's request or spontaneous continuation of movement requested or patient becomes “motorically stuck” in indecisive, hesitant movement. 0 = Absent 1 = Present—follows even senseless and illogical commands (automatic obedience) 1 = Present—follows the motoric command instead of the verbal command (automatic obedience) 1 = Present—follows the motoric command partway, then stops (ambitendency) 8. Command-motor (mitgehen): Arm raising in response to light pressure of finger, despite instructions to the contrary (e.g., patient walks hand-in-hand with examiner after being told not to). 0 = Absent 1 = Present—goes with examiner after light touch of hand-in-hand 1 = Present—light touch overcomes the position of the limb 9. Paratonia (gegenhalten): Equal and opposite motoric resistance to passive movement of a limb. 0 = Absent 1 = Present—continuous oppositional force 1 = Present—intermittent oppositional force 10. Grasp reflex: Closes hand on examiner’s digit upon contact with patient’s palm. 0 = Absent 1 = Present—fingers flex slightly with initial pressure 1 = Present—finger and thumbs fold over examiner’s finger 1 = Patient grasps examiner’s finger, loosely or tightly 1 = Patient hooks examiner’s fingers with flexion of fingers 11. Metronome test: Patient persists with movement of limb initiated by examiner. 0 = Absent 1 = Present—arm continues to swing back and forth multiple (4 or more) times before coming to rest at the patient’s side 1 = Present—arm continues to swing back like a metronome 12. Magnetism: Patient moves his limb toward outstretched hand of the examiner. 0 = Absent 1 = Present—patient’s wrist moves toward examiner’s open hand (0.5–2 inches) 1 = Present—patient’s wrist moves to the palm of examiner’s open hand 1 = Present—patient is excessively compliant in examination (e.g., told to sit on examination table but lays back on table) Record total # of confirmatory signs = Range (0–12) APPENDIX 3. KANNER scale examination—confirmatory tests # PROCEDURE SYMPTOMS 1 Examiner observes patient while behind nurses station on unit or in clinic. Activity level, abnormal movements 2 Examiner observes patient while trying to engage in a conversation “My name is Dr. Carroll. Can you say Dr. Carroll?” “Can you name five towns in our state (province)?” “Which towns would you like to visit someday?” Examiner places patient’s arm in the air at a 90-degree angle. If it remains stationary, this is waxy flexibility. If it falls slowly to side, this is catalepsy. Parroting (echolalia), gibberish (verbigeration), perseveration 3 Waxy flexibility 4 Examiner scratches head in exaggerated manner, then puts one open hand on left temple and watches patient, then puts the other open hand on right temple and watches patient. Examiner extends hand stating “Do NOT shake my hand.” Patient may become motorically stuck. Examiner states, “Place your left wrist on your right wrist.” “Good, now place your left wrist on your left wrist.” Examiner asks patient to extend arm. Examiner places one finger beneath patient’s hand and tries to raise it slowly after stating, “Do NOT let me raise your arm.” Echopraxia 5 Command-verbal (automatic obedience and ambitendency) 6 Command-motor (mitgehen) 7 Examiner passively flexes patient’s arm at the elbow. Examiner uses greater and lesser force to determine if the degree of motor resistance changes according to the force applied. Paratonia (gegenhalten) 8 Examiner places index finger flat on palm of patient’s hand. Patient’s fingers and thumb are observed for flexion. Grasp reflex 9 Patient’s arm is at rest at his side. Examiner says, “I will swing your arm back and forth. When I let go you let it come to rest as it will.” Metronome test 10 Patient’s arm is at rest. Examiner reaches slowly with extended hand open as if to grasp patient’s wrist at about three inches from wrist of patient’s resting arm. Magnetism 48 Psychiatry 2008 [ V O L U M E 5, NUMBER 12, DECEMBER]

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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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