Read pages 101- 138 in the DSM-5-TR
Read Boland, R., & Verduin, M. (2022). Kaplan Chapter 5: Schizophrenia Spectrum and Other Psychotic Disorders
Zuckerman, E. (2019). Clinician’s Thesaurus: The Guide to Conducting Interviews and Writing Psychological Reports. (8th ed.). The Guilford Press. o Review Part 1: Chapters 1-3, pg. 35-50 Mental Status Exam Special emphasis on: • Chapters 3: 3.9, 3.11, 3.16, 3.17, 3.20, 3.20, 3.24 • Chapter 12: 12.8, 12.10, 12.15, 12.18, 12.22, 12.30
Read Morrison and Flegel: Chapter 12Prepare a comprehensive posting on how one would assess and diagnose a catatonia. Be sure to consider the existing research literature on the topic to determine if any standardized assessment instruments can aid in this task.
Reply to discussion post using APA 7 format
Catatonia is a neuropsychiatric condition characterized by significant disturbances in psychomotor function and is often associated with schizophrenia and other mental health disorders (Von Känel et al., 2022). The syndrome encompasses a variety of symptoms including disruptions in motor behavior, voluntary control, and autonomic function. Assessing catatonia usually involves the use of clinical rating scales and necessitates clinicians with expertise in evaluating such conditions (Von Känel et al., 2022).
The DSM and ICD criteria, along with the Bush-Francis Catatonia Rating Scale (BFCRS) and the Northoff Catatonia Rating Scale (NCRS), are commonly used and recommended as reliable tools for assessing symptoms of catatonia (Hirjak et al., 2024).
The total score for the Bush-Francis Catatonia Rating Scale (BFCRS) can vary from 0 to 69. The initial 14 items of this scale make up the Bush-Francis Catatonia Screening Instrument (BFCSI), which is utilized to determine whether catatonia is present or not. A diagnosis of catatonia is made if at least two items on the BFCSI are identified, regardless of their severity (Von Känel et al., 2024).
The Northoff Catatonia Scale (NCS) comprises 40 items evaluating symptoms related to catatonia across motor (13 items), affective (12 items), and behavioral (15 items) domains. A diagnosis of catatonia is confirmed if the total score on the NCS exceeds 7, and at least one symptom per domain (motor, affective, behavioral), regardless of severity, is present (Von Känel et al., 2024).
According to Hirjak et al. (2024) the choice of diagnostic tool determines which specific symptoms of catatonia are assessed, each with its total scores, diagnostic criteria, and cutoff scores. Moreover, the symptom patterns of catatonia can vary over time, sometimes presenting as periods of excitement and at other times as withdrawal within the same individual. Additionally, fluctuations in catatonia symptoms can be influenced by the underlying mental disorder and may also be triggered or exacerbated by antipsychotic medications (Hirjak et al., 2024). Given that assessments like those based on DSM-5 criteria or clinical rating scales generally focus on symptoms at a single point in time, they may not adequately capture these fluctuations.
The critical first step in diagnosing catatonia involves identifying its distinctive clinical features. Symptoms such as immobility and mutism are especially prevalent, and their occurrence, when no other condition explains them, should prompt a suspicion of catatonia. This then leads to the assessment of additional catatonic symptoms to confirm the diagnosis (Rasmussen, 2016).
Rasmussen (2016) noted all patients suspected of catatonia should undergo EEG testing to screen for potential neurological conditions. In cases of nonconvulsive status epilepticus, epileptiform activity is typically observed, while encephalopathy may manifest as slowing. Generally, EEG results in catatonia are normal unless an underlying condition is present. Standard laboratory investigations should encompass a complete blood count, blood urea nitrogen, creatinine, blood glucose, liver enzymes, electrolytes, thyroid function tests, and urinalysis to assess for comorbid conditions or complications (Rasmussen, 2016). Dehydration is often prevalent in catatonic patients and should be addressed promptly. Regular monitoring of vital signs is essential, as hypertension and fever, along with elevated creatine phosphokinase, decreased serum iron, and leukocytosis, may indicate the onset of malignant catatonia or neuroleptic malignant syndrome, particularly in patients exposed to antipsychotic agents. Additionally, a thorough review of the patient’s recent medication history, particularly regarding antipsychotic agents or benzodiazepines, is crucial (Rasmussen, 2016).
Catatonia can manifest either as an acute episode or in chronic forms. Effective treatments include lorazepam and electroconvulsive therapy (ECT). However, treating chronic catatonia is more challenging due to ongoing symptoms of unclear origin and a reduced responsiveness to benzodiazepines. Individuals who have experienced catatonia for an extended period or have been diagnosed with schizophrenia might exhibit a diminished likelihood of response (Rasmussen, 2016).
Despite available treatments, catatonia continues to be linked with a higher mortality rate, particularly when it is not accurately diagnosed. Thus, prompt diagnosis of catatonia is essential to reduce the risks of morbidity and mortality. (Hirjak et al., 2024).
In summary, assessing and diagnosing catatonia requires a comprehensive evaluation, including the use of standardized assessment instruments like the BFCRS & NCRS. Timely recognition and intervention are crucial for optimizing patient outcomes and preventing potential complications associated with catatonia.
References
Hirjak, D., Brandt, G. A., Fritze, S., Kubera, K. M., Northoff, G., & Wolf, R. C. (2024). Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types. Schizophrenia Research, 263, 93–98. https://doi.org/10.1016/j.schres.2022.12.019Links to an external site.
Rasmussen, S. A., Mazurek, M. F., & Rosebush, P. I. (2016). Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology. World Journal of Psychiatry, 6(4), 391–398. https://doi.org/10.5498/wjp.v6.i4.391Links to an external site.
Von Känel, S., Nadesalingam, N., Alexaki, D., Baumann Gama, D., Kyrou, A., Lefebvre, S., & Walther, S. (2022). Measuring catatonia motor behavior with objective instrumentation. Frontiers in Psychiatry, 13, 880747. https://doi.org/10.3389/fpsyt.2022.880747Links to an external site.