Some of the signs (described below) are not listed in the DSM-V criteria, such as excitement, staring, rigidity, withdrawal, automatic obedience, impulsivity, ambitendency, grasp reflex, verbigeration, mitgehen, autonomic abnormality, combativeness and perseveration. This includes 23 items and up to 30 signs. 18 The Bush-Francis Catatonia Rating Scale (BFCRS) is the most widely used scale. Several rating scales have been developed for the assessment of catatonia. 17 The criteria seem rather arbitrary, and the list of associated features highlights the clinical heterogeneity of this neuropsychiatric disorder. According to DSM-V criteria, to make a diagnosis of catatonia one has to have a minimum of 3 of the following 12 clinical features, either observed or elicited during examination: (1) mutism, (2) stupor, (3) catalepsy, (4) waxy flexiblity, (5) agitation, (6) negativism, (7) posturing, (8) mannerisms, (9) stereotypies, (10) grimacing, (11) echolalia, or (12) echopraxia. 17 While the DSM-IV used different sets of criteria for diagnosis of catatonia in schizophrenia and primary mood disorders versus neurological/medical conditions, the revised DSM-V criteria can be applied across all of the different clinical settings. The revised diagnostic criteria were published in the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in 2013. ![]() The diagnosis of catatonia is based on clinical observations. 13 Although it may become life-threatening, 16 catatonia has an excellent prognosis if recognised and treated early. 15 Catatonic patients are at risk for severe complications such as pneumonia, decubitus ulcers, malnutrition, dehydration, contractures and thrombosis and delays in diagnosis and management are associated with increased morbidity. 13, 14 Catatonia usually presents acutely but may present insidiously, and can be transient or chronic, and last for weeks, months and even years. Owing to the wide range of underlying diagnoses, patients with catatonia may present as a medical or psychiatric emergency 13 or develop symptoms during hospitalisation, such as in the intensive care unit (ICU), which can be challenging from a diagnostic standpoint. 5, 10, 12 In a minority of cases, no cause is found and the current prevalence of idiopathic catatonia is unknown. People with bipolar disorders probably constitute the largest subgroup of catatonic patients. 11 Catatonia may be subtle and overlooked, which may account for reports suggesting a declining incidence. 10 The percentage of catatonia due to a general medical condition is reported to range from 20% to 39%. 4, 8, 9 Other surveys have reported a prevalence ranging between 7.6% and 38% among all psychiatric patients. The frequency of catatonia in acute psychiatric admissions is approximately 10%, but estimates range from 5% to 20% based on diagnostic criteria used in prospective studies conducted during 1–12 months of observation at psychiatric units. 4 It is clear that catatonia is no longer limited to schizophrenia, and that it can be seen in the setting of a variety of other conditions such as psychiatric disorders other than schizophrenia, medical, neurological and surgical conditions, as well as in the setting of certain drugs and toxins. 3 The uncertainty about its definition was partly responsible for the long-standing neglect of catatonia in clinical and scientific literature and for its frequent underdiagnosis. Catatonia was subsequently classified by psychopathologists Kraepelin and Bleuler as ‘dementia praecox' (premature dementia), a condition which was later classified as schizophrenia. 1, 2 He considered catatonia as a distinct clinical entity with progressive symptoms. ![]() This article attempts to summaries the clinical features of catatonia discuss some diagnostic challenges, possible mechanisms and available treatment options in this poorly understood condition.Ĭatatonia was first described by German psychopathologist Karl Kahlbaum in Die Katatonie oder das Spannungsirresein in 1874 as a motor syndrome in patients with behavioural disorders. However, there is a wide spectrum of speech and other neurological abnormalities seen in this condition. ‘Waxy flexibility', ‘posturing' and ‘catalepsy' are among the well-recognised motor abnormalities associated with catatonia. Catatonia is a complex neuropsychiatric syndrome characterised by a broad range of motor, speech and behavioural abnormalities.
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