Abstract
BackgroundClinical assessment of catatonia includes the use of diagnostic systems, such as the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) and the International Classification of Disease, Tenth Revision (ICD-10), or screening tools such as the Bush Francis Catatonia Screening Instrument (BFCSI)/Bush Francis Catatonia Rating Scale (BFCRS) and the Braunig Catatonia Rating Scale. In this study, we describe the inter-rater reliability (IRR), utilizing the BFCSI, BFCRS, and DSM-5 to screen for catatonia.MethodsData from 10 participants recruited as part of a larger prevalence study (of 135 participants) were used to determine the IRR by five assessors after they were trained in the application of the 14-item BFCSI, 23-item BFCRS, and DSM-5 to assess catatonia in new admissions. Krippendorff’s α was used to compute the IRR, and Spearman’s correlation was used to determine the concordance between screening tools. The study site was a 35-bed acute mental health unit in Dora Nginza Hospital, Nelson Mandela Bay Metro. Participants were mostly involuntary admissions under the Mental Health Care Act of 2002 and between the ages of 13 and 65 years.ResultsOf the 135 participants, 16 (11.9%) had catatonia. The majority (92 [68.1%]) were between 16 and 35 years old, with 126 (93.3%) of them being Black and 89 (66.4%) being male. The BFCRS (complete 23-item scale) had the greatest level of inter-rater agreement with α = 0.798, while the DSM-5 had the lowest level of inter-rater agreement with α = 0.565. The highest correlation coefficients were observed between the BFCRS and the BFCSI.ConclusionThe prevalence rate of catatonia was 11.9%, with the BFCSI and BFCRS showing the highest pick-up rate and a high IRR with high correlation coefficients, while the DSM-5 had deficiencies in screening for catatonia with low IRR and the lowest correlation with the other two tools.
Highlights
Clinical assessment of catatonia includes the use of diagnostic systems, such as the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) and the International Classification of Disease, Tenth Revision (ICD-10), or screening tools such as the Bush Francis Catatonia Screening Instrument (BFCSI)/Bush Francis Catatonia Rating Scale (BFCRS) and the Braunig Catatonia Rating Scale
Data from 135 participants were collected from September 2020 to February 2021 to screen for catatonia, with the first 10 participants suspected of having catatonia each screened by five assessors to determine the inter-rater reliability (IRR) and concordance rates of the assessment tools
Implications of findings for mental health systems This study demonstrates that professional nurses working in mental health can be upskilled with one session to apply available and free screening tools such as the BFCSI/BFCRS, to assess patients with catatonia
Summary
Clinical assessment of catatonia includes the use of diagnostic systems, such as the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) and the International Classification of Disease, Tenth Revision (ICD-10), or screening tools such as the Bush Francis Catatonia Screening Instrument (BFCSI)/Bush Francis Catatonia Rating Scale (BFCRS) and the Braunig Catatonia Rating Scale. Catatonia shows a wide range of prevalence in different populations, from less than 10% to just above 60% [1,2,3] This may be influenced by factors that include the assessment tools used to screen for catatonia and the Zingela et al International Journal of Mental Health Systems (2021) 15:82 the dearth of studies on catatonia in South Africa, our study could potentially have a wide-ranging application for future research on prevalence studies for catatonia and could be a source of comparison for future studies and findings. It may provide useful guidance for clinicians in the assessment of catatonia. Several studies have indicated that the BFCSI is a reliable and valid screening tool for catatonia [1,2,3,4, 7,8,9]
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