Catatonia as a psychomotor syndrome: A rating scale and extrapyramidal motor symptoms

Abstract

BACKGROUND Catatonia was first described by Kahlbaum as a psychomotor disease with motor, behavioral, and affective symptoms. In keeping with this concept, we developed a rating scale for catatonia (Northoff Catatonia Scale [NCS]) with three different categories of symptoms (i.e., motor, behavioral, affective). Furthermore, the question of the relationship among catatonic symptoms, extrapyramidal motor symptoms, and neuroleptics was addressed in the present study. METHOD 34 acute catatonic patients and 68 age‐, sex‐, diagnosis‐, and medication‐matched psychiatric control subjects were investigated on days 0, 1, 3, 7, and 21 with the NCS, with other already validated catatonia rating scales by Rosebush, Bush (BFCRS), and Rogers (MRS), as well as with scales for hypokinetic (SEPS) and dyskinetic (AIMS) extrapyramidal motor features. Validity and reliability of the new scale, factor analysis, correlational analysis, and differences between catatonic patients and psychiatric control subjects were statistically calculated. RESULTS NCS showed high validity (i.e., significant positive correlations [p <0.0001] with the other scales, significant differences between catatonic and control subjects), high intra‐ and interrater reliabilities (r = 0.80–0.96), and high affective subscores. Factor analysis revealed four factors best characterized as affective, hypoactive, hyperactive, and behavioral. Catatonic scores in NCS correlated significantly with AIMS on day 0 and SEPS on days 7 and 21. There were no significant differences in catatonic (i.e., NCS, MRS, BFCRS) and extrapyramidal (i.e., AIMS, SEPS) scores between neuroleptically treated and untreated catatonic subjects. CONCLUSIONS The following conclusions were drawn: (1) the NCS has to be considered as a valid and reliable rating instrument for catatonia; (2) catatonia can be characterized by psychomotor symptoms encompassing motor, affective, and behavioral alterations; and (3) extrapyramidal hyperkinesias like dyskinesias are apparently closely related to catatonic symptoms which, in general, seem to be relatively independent of previous neuroleptic medication.

Catatonia: Diagnosis, Classification, and Treatment

“…This scale has been confirmed as highly reliable and sensitive to clinical change [16,17]. Other catatonia rating scales have been published and generally correlate well [18,19]. Although the BFCRS has proven useful and practical for clinical and research purposes, the comparative clinical use of these scales is not well-established.…”

Catatonia: A Review

“…The availability of several rating scales for catatonia might help to better define the syndrome and its epidemiology. Some of them have shown validity and good inter-rater reliability (25,37). DSM-IV-TR requires two prominent signs to be present in order to meet the criteria.…”

Cataleptic postures in thalamic hemorrhage: case report

“…The authors suggest that catatonic patients have dysfunction in the inhibitory control of the motor cortical function with increased gaba-ergic sensitivity. They mentioned that disturbances in the cortico-limbic and thalamo-cortical circuits may be responsible for the catatonic postures 12 . They also found a significant decreased blood flow in the right prefrontal and parietal cortex in patients with catatonia 13 .…”