Bush-Francis Catatonia Rating Scale Research Articles

Generalized Periodic Discharges Associated With Catatonia and Delirium: A Case Series.

Generalized periodic discharges are a repeated and generalized electroencephalography (EEG) pattern that can be seen in the context of altered mental status. This article describes a series of five individuals with generalized periodic discharges who demonstrated signs and symptoms of catatonia, a treatable neuropsychiatric condition. Inpatients with a clinical diagnosis of catatonia, determined with the Bush-Francis Catatonia Rating Scale (BFCRS), and EEG recordings with generalized periodic discharges were analyzed in a retrospective case series. Five patients with catatonia and generalized periodic discharges on EEG were evaluated from among 106 patients with catatonia and contemporaneous EEG measurements. Four of these patients showed an improvement in catatonia severity when treated with benzodiazepines, with an average reduction of 6.75 points on the BFCRS. Among patients with generalized periodic discharges, catatonia should be considered, in the appropriate clinical context. Patients with generalized periodic discharges and catatonia may benefit from treatment with empiric trials of benzodiazepines.

Diagnostic features of paediatric catatonia: multisite retrospective cohort study.

Catatonia is a neuropsychiatric disorder characterised by psychomotor changes that can affect individuals across the lifespan. Although features of catatonia have been described in adults, the most common clinical symptoms among paediatric patients with catatonia are not well characterised. The goal of this study was to characterise the symptoms of catatonia demonstrated by paediatric patients, and to explore demographic and diagnostic factors associated with greater catatonia severity. We conducted a multicentre retrospective cohort study, from 1 January 2018 to 6 January 2023, of patients aged 18 and younger with a clinical diagnosis of catatonia and symptom assessment using the Bush Francis Catatonia Rating Scale (BFCRS). A total of 143 patients met inclusion criteria. The median age was 15 (interquartile range: 13-16) years and 66 (46.2%) patients were female. Neurodevelopmental disabilities were present in 55 (38.5%) patients. Patients demonstrated a mean of 6.0 ± 2.1 signs of catatonia on the Bush Francis Catatonia Screening Item, with a mean BFCRS score of 15.0 ± 5.9. Among the 23 items of the BFCRS, six were present in >50% of patients (staring, mutism, immobility/stupor, withdrawal, posturing/catalepsy, rigidity), and four were present in <20% of cases (waxy flexibility, mitgehen, gegenhalten, grasp reflex). In an adjusted model, patients with neurodevelopmental disorders demonstrated greater BFCRS severity than those with other diagnoses. Catatonia was diagnosed in a range of mental health conditions. Further research is needed to define optimal diagnostic criteria for catatonia in paediatric patients, and clarify the clinical course of the disorder.

Catatonia in patients with dementia: A descriptive study of clinical profiles and treatment response

BackgroundCatatonia is a highly prevalent syndrome in patients presenting with major neurocognitive disorders (dementia). In this study, we aim to provide a comprehensive description of the clinical and therapeutic aspects of catatonia in patients with dementia. MethodThis descriptive study, conducted between September 2015 and June 2022, collected data from 25 patients diagnosed with dementia, out of 143 patients treated for catatonia in our specialized psychiatry department. We collected sociodemographic, clinical and treatment data for each patient. ResultsDementia patients constituted 17% of the catatonic cases. Predominantly female, the cohort had a mean age of 65. Diagnoses included Alzheimer’s (4 patients, 17%) and Parkinson’s (1 patient, 4%) diseases, Lewy body dementia (5 patients, 21%), vascular dementia (4 patients, 17%) and frontotemporal lobar degeneration (10 patients, 41%). The mean Bush-Francis Catatonia Rating Scale score upon admission was 20/69. Overall, complete remission of catatonia was achieved in 75% of patients (n=18), with only 13% (n=3) responding to lorazepam alone, while others required additional interventions such as electroconvulsive therapy (ECT) and/or amantadine. Vascular dementia was predominantly observed in cases resistant to treatment. ConclusionThe findings indicate a frequent co-occurrence of catatonia and dementia, highlighting treatability yet suggesting a potential for resistance to lorazepam, which varies by dementia diagnosis. Investigating the mechanisms underlying this resistance and the variability in treatment response is crucial for developing more precise therapeutic strategies.

Symptoms of Catatonia Observed in Down Syndrome Regressive Disorder: A Retrospective Analysis.

Down Syndrome Regressive Disorder (DSRD) is a neuropsychiatric condition associated with severe symptomology and a negative impact on quality of life. DSRD frequently presents with catatonic symptoms. However, few studies have reported the specific catatonic symptoms that occur in DSRD. We conducted a retrospective analysis of medical records in a large health system in the southern United States to identify patients with diagnoses of DS with catatonic symptoms who presented for clinical care between 1/1/2018 and 12/1/2023. Patients were included in the study if they had a diagnosis of DSRD or met the criteria for DSRD using consensus guidelines on retrospective chart review, and catatonia as confirmed in clinical documentation and had a full Bush Francis Catatonia Rating Scale (BFCRS) documented at the time of initial catatonia diagnosis. A total of nine patients who met the criteria for DSRD and catatonia using the BFCRS were identified. The average age of patients at the time of DSRD diagnosis was 21.1years (SD = 13.87). The mean BFCRS score on initial evaluation was 17.3 (SD = 7.0) and the mean number of positive catatonia signs was 11.1 (SD = 1.5). Staring was present in all cases (n = 9, 100%), followed by mutism, grimacing, and rigidity (n = 7, 77.9%). In a sample of nine patients with DSRD, all patients were diagnosed with catatonia. Catatonia is severe if undiagnosed and untreated. Future research is needed to assess specific symptoms of catatonia in DSRD, and longitudinal outcomes to assess optimal means of treatment.

Effectiveness and Safety of Flumazenil Augmentation During Electroconvulsive Therapy.

Benzodiazepines are considered to negatively affect seizure quality and duration during electroconvulsive therapy (ECT). Several researchers have advocated the use of flumazenil, a competitive benzodiazepine receptor antagonist, for patients treated with benzodiazepines during ECT. However, clinical evidence regarding flumazenil use in ECT remains sparse. The aim of this study is to investigate the effects of flumazenil on seizure duration and adverse effects. All patients with depressive disorders, treated with flumazenil during a course of ECT in 2019 in a tertiary hospital, were identified through a retrospective chart review. Seizure duration was recorded before and after flumazenil administration. Effectiveness of ECT was assessed using the Inventory of Depressive Symptomatology and the Bush-Francis Catatonia Rating Scale. Postictal agitation was ascertained by identifying patients who received additional sedatives immediately after ECT or who needed physical restraint. Twenty-six patients were included, receiving a total of 363 treatments, of which 263 were augmented with flumazenil. Flumazenil administration increased electroencephalogram seizure duration on average with 10.5 seconds comparing ECT with or without flumazenil (P = 0.003). In 21.8% of the cases, no increase in seizure duration was observed. Postictal agitation occurred at least once in 34.6% of the patients receiving flumazenil during their course of ECT. Our results show that flumazenil increases seizure duration, albeit with limited clinical implications. Noteworthy, the prevalence of postictal agitation is high. When confronted with short seizures, clinicians should therefore deploy other available techniques to lower seizure threshold before considering flumazenil.

Use of ECT for Children With and Without Catatonia: A Single-Site Retrospective Analysis.

The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation. For all patients, Clinical Global Impressions-Improvement scale scores indicated that it was very likely for a subject to experience at least "much improvement" with the estimated probability of receiving a Clinical Global Impressions-Improvement scale score better than 3 of 0.852 (t.s. = 16.3; P < 0.001; 95% confidence interval, 0.711-0.931). All patients with catatonia demonstrated a positive clinical response and experienced a statistically significant reduction in total Bush-Francis Catatonia Rating Scale scores observed (t = 11.9; df = 20; SD = 6.3; P < 0.001; 95% confidence interval, 12.6-17.9). No significant adverse events were reported for any patient in the cohort. However, 14 (38.9%) patients experienced prolonged seizures, all of which were terminated with propofol (mean, 49.7 mg). This study provides further data supporting the safe and effective use of pediatric ECT in the treatment of various psychiatric conditions. However, more research is needed to determine the risk factors associated with prolonged seizures and the optimal seizure parameters in young people.

Electroconvulsive therapy for catatonia in anti-NMDA receptor encephalitis: A case series

BackgroundAnti-NMDAR encephalitis is the most common cause of immune-mediated catatonia. Case seriesThree females presented with neuropsychiatric symptoms and were empirically treated with first-line immunotherapy and ovarian teratoma resection for suspected autoimmune encephalitis, preceding diagnostic confirmation via NMDAR antibody positivity. They required escalating large doses of benzodiazepines for refractory malignant catatonia resulting in ICU level care. ECT treatments were initiated, and patients were gradually noted to have clinical improvement as was measured by the Bush-Francis Catatonia Rating Scale. ConclusionsClinicians should recognize catatonia among patients with suspected anti-NMDAR encephalitis and consider the early implementation of ECT into treatment algorithms.

Factor analysis and validation of the Bush Francis catatonia rating scale-Spain version

Background and objectivesThe aim of this study was to assess the reliability and validity of the Bush Francis Catatonia Screening Instrument and Bush Francis Catatonia Rating Scale Spain Version (BFCSI-SV and BFCRS-SV) using the ICD-11 and DSM-5 diagnostic criteria as well as other catatonia scales. MethodsOne hundred patients were admitted to the inpatient psychiatry unit at Hospital Universitari Germans Trias I Pujol and two psychiatrists administered the BFCRS-SV to the first 10 patients to assess inter-rater reliability. The BFCRS-SV, BFCSI-SV, Modified Rogers Scale (MRS), Abnormal Involuntary Movement Scales, Barnes Akathisia Rating Scale, and Modified Simpson-Angus Scale were then employed. ResultsThe results showed that 27% of patients had catatonia using the DSM-5 diagnostic criteria. Additionally, 51% of patients had 2 or more BFCRSI-SV items (Sensitivity: 100%; Specificity: 67.12%). The alpha coefficient values were 0.80 and 0.84 for the BFCSI-SV and BFCRS-SV, respectively, and the intraclass correlation coefficient values were 0.902 and 0.903. The area under the ROC curve was 0.971 and 0.96, and the instruments had a strong positive correlation with the DSM-5 score, ICD-11 score, and MRS. The study identified a three-factor model comprising the inhibition, excitement, and parakinetic dimensions. ConclusionsOverall, the results suggest that the BFCSI-SV and BFCRS-SV are valid and reliable tools for the diagnosis of catatonia, especially when using a cut-off score of 5 or higher for the BFCSI-SV and 7 or higher for the BFCRS-SV.

In-hospital catatonia, delirium, and coma and mortality: Results from the delirium and catatonia prospective cohort investigation

BackgroundCatatonia, a form of acute brain dysfunction typically linked with severe affective and psychotic disorders, occurs in critical illness with delirium and coma. Delirium and coma are associated with mortality, though catatonia's relationship with mortality is unclear. We aim to describe whether catatonia, delirium, and coma are associated with mortality. MethodsWe enrolled a convenience cohort of critically ill adults (N = 378) at an academic medical center. We assessed catatonia, delirium, and coma using the Bush-Francis Catatonia Rating Scale, the Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation-Sedation Scale, respectively. We tested the associations between previous day brain dysfunction state occurrence with in-hospital and one-year mortality using multivariable time-dependent risk models. Additionally, we tested the association between brain dysfunction duration and one-year mortality. ResultsCatatonia was not associated with death on the day after diagnosis during hospitalization, and neither previous catatonia occurrence nor duration was associated with one-year mortality. Delirium was not associated with death on any day following diagnosis during hospitalization, and neither previous delirium occurrence nor duration was associated with one-year mortality. The occurrence of coma was associated with death on any day after diagnosis during hospitalization (HR 2.30,CI 1.19–4.44,p = 0.014), as well as through one year following hospital discharge (HR 1.68,CI 1.09–2.59,p = 0.02). ConclusionsComa, but neither catatonia nor delirium, was associated with future day in-hospital and one-year mortality. More research is needed to understand catatonia's clinical impact. Delirium results differ from existing literature likely due to cohort demographics and size. Coma results highlight the prognostic significance of suppressed arousal while critically ill.

Immunotherapy responsiveness and risk of relapse in Down syndrome regression disorder

Down syndrome regression disorder (DSRD) is a clinical symptom cluster consisting of neuropsychiatric regression without an identifiable cause. This study evaluated the clinical effectiveness of IVIg and evaluated clinical characteristics associated with relapse after therapy discontinuation. A prospective, multi-center, non-randomized, observational study was performed. Patients met criteria for DSRD and were treated with IVIg. All patients underwent a standardized wean-off therapy after 9–12 months of treatment. Baseline, on-therapy, and relapse scores of the Neuropsychiatric Inventory Total Score (NPITS), Clinical Global Impression-Severity (CGI-S), and the Bush–Francis Catatonia Rating Scale (BFCRS) were used to track clinical symptoms. Eighty-two individuals were enrolled in this study. Patients had lower BFCRS (MD: −6.68; 95% CI: −8.23, −5.14), CGI-S (MD: −1.27; 95% CI: −1.73, −0.81), and NPITS scores (MD: −6.50; 95% CI: −7.53, −5.47) while they were on therapy compared to baseline. Approximately 46% of the patients (n = 38) experienced neurologic relapse with wean of IVIg. Patients with neurologic relapse were more likely to have any abnormal neurodiagnostic study (χ2 = 11.82, P = 0.001), abnormal MRI (χ2 = 7.78, P = 0.005), and abnormal LP (χ2 = 5.45, P = 0.02), and a personal history of autoimmunity (OR: 6.11, P < 0.001) compared to patients without relapse. IVIg was highly effective in the treatment of DSRD. Individuals with a history of personal autoimmunity or neurodiagnostic abnormalities were more likely to relapse following weaning of immunotherapy, indicating the potential for, a chronic autoimmune etiology in some cases of DSRD.

Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis.

Pediatric catatonia is a highly co-morbid condition with treatment options often limited to electroconvulsive therapy (ECT) or lorazepam. However, lorazepam may not be readily available, and access to ECT is limited by restrictive legislation and stigma. This study aims to provide alternative treatment options for pediatric catatonia. The study involved a single-site retrospective analysis of a private university hospital in the southern United States. The study included patients under eighteen with catatonia who received psychopharmacologic treatment with an agent other than lorazepam. The patients were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), and Kanner Catatonia Examination (KCE) at the time of initial evaluation and upon stabilization. A retrospective clinical global impressions-improvement (CGI-I) score was assigned by four authors. 102 pediatric patients diagnosed with catatonia were identified, and 31 met criteria for the study. 20 (65%) were white, 6 (19%) were Black, 4 (13%) were Hispanic, and 1 (3%) were Indian. Most patients (N = 18; 58%) were insured by Medicaid. The mean age at the time of catatonia diagnosis was 13.5 years. All patients were stabilized on either clonazepam or diazepam, with 21 (68%) requiring treatment with an additional medication of either an anti-epileptic, N-methyl-D-aspartate (NMDA) receptor antagonist, and aripiprazole or clozapine. Statistically significant reductions in the BFCRS [t = 11.2, df = 30, std = 6.3, p < 0.001, 95% CI = (7.8, 15.1)], KCS [t = 4.6, df = 38, p < 0.001, 95% CI = (12.0, 31.0)], and KCE [t = 7.8, df = 30, std = 1.8, p < 0.001, 95% CI = (1.9, 3.2)] were observed. For CGI-I the results showed that the estimated probability of observing a score better than no change (>4) is 0.976 [t.s. = 43.2, p < 0.001, 95% CI = (0.931,0.992)], indicating the average subject is expected to experience some improvement. In conclusion, all patients responded to these treatments with improvement in their catatonic symptoms. Alternative pharmacologic interventions for catatonia, including benzodiazepines other than lorazepam, valproic acid, NMDA receptor antagonists, and atypical antipsychotics were safe and effective in treating catatonia in this population.

Analysis of the Serie of Cases of Neuroleptic Malignant Syndrome (Cross-Sectional Observational Study)

Background: neuroleptic malignant syndrome (NMS) is the most dangerous complication of therapy with neuroleptics with high mortality. The publications on MNS are the reviews articles or case reports.The aim of study: an identification of the frequency of occurrence of NMS harm in patients of the city psychiatric hospital over a 4-year period, a clarification of the clinical manifestations of this complication, an analysis of the effectiveness of the treatment and rate of deaths.Patients and methods: 19 cases with a confirmed diagnosis of NMS who were treated for 4 years in one of the clinical psychiatric hospitals in Moscow with 1158 beds. All patients met the criteria for the diagnosis of NMS according to DSM-5 (333.92). The severity of extrapyramidal disorders was assessed on the Simpson–Angus Rating Scale (SAS). The Bush–Francis Catatonia Rating Scale (BFCRS) was used to assess the features and severity of catatonic symptoms. All patients underwent a study of the general clinical analysis and biochemical analysis of blood with the determination of the number of leukocytes and the activity of the enzyme creatine phosphokinase (CPK).Results: the incidence of NMS was 0.035% of all treated patients, mortality— 10.5%. Most often, NMS develops during treatment with haloperidol and much less frequently with the appointment of atypical antipsychotics risperidone and clozapine in patients with schizophrenia, acute polymorphic mental disorder, organic mental disorders, including dementia. The influence of such factors as gender, age, type of disease on the development of NMS has not been established. The age of patients with a fatal outcome was higher than the average for the group. The clinical picture of NMS was characterized by a combination of catatonic, extrapyramidal and somato-vegetative disorders with hyperthermia, leukocytosis and increased activity of CPK.Conclusion: today NMS remains a relatively rare, but extremely dangerous complication of antipsychotic therapy, with a high risk of death and can develop both in the treatment with first and second generation antipsychotics in patients with schizophrenia and acute polymorphic mental disorder and in organic mental disorders, including dementia.

Extension, translation and preliminary validation of the Northoff Scale for Subjective Experience in Catatonia (NSSC)

BackgroundIn the last two decades, much neuroscientific research has been done on the pathomechanisms of catatonia. However, catatonic symptoms have mainly been assessed with clinical rating scales based on observer ratings. Although catatonia is often associated with strong affective reactions, the subjective domain of catatonia has simply been neglected in scientific research. MethodsThe main objective of this study was to modify, extend and translate the original German version of the Northoff Scale for Subjective Experience in Catatonia (NSSC) and to examine its preliminary validity and reliability. Data were collected from 28 patients diagnosed with catatonia associated with another mental disorder (6A40) according to ICD-11. Descriptive statistics, correlation coefficients, internal consistency and principal component analysis were employed to address preliminary validity and reliability of the NSSC. ResultsNSSC showed high internal consistency (Cronbach's alpha = 0.92). NSSC total scores were significantly associated with Northoff Catatonia Rating Scale (r = 0.50, p < .01) and Bush Francis Catatonia Rating Scale (r = 0.41, p < .05) thus supporting its concurrent validity. There was no significant association between NSSC total score and Positive and Negative Symptoms Scale total (r = 0.26, p = .09), Brief Psychiatric Rating Scale (r = 0.29, p = .07) and GAF (r = 0.03, p = .43) scores. ConclusionThe extended version of the NSSC consists of 26 items and was developed to assess the subjective experience of catatonia patients. Preliminary validation of the NSSC revealed good psychometric properties. NSSC is a useful tool for everyday clinical work to assess the subjective experience of catatonia patients.

Missing Piece of Puzzle: Electro-Convulsive Therapy (ECT) in Patients with anti-NMDA Receptor Encephalitis (P5-5.012)

<h3>Objective:</h3> To emphasize the importance of early clinical recognition of catatonia and implementation of ECT as adjuvant therapy in patients with anti-NMDAR encephalitis. <h3>Background:</h3> Catatonia is a symptom of anti-NMDAR encephalitis which can evolve rapidly into malignant catatonia with autonomic instability and increased morbidity. Although early immunomodulatory therapy is important to treat the underlying autoimmune disorder, resistant catatonia may require adjuvant management with ECT. <h3>Design/Methods:</h3> Not applicable. <h3>Results:</h3> We describe the cases of three females aged 23.7 ± 2.5, who were diagnosed with anti-NMDAR encephalitis. They presented with neuropsychiatric symptoms and were promptly and empirically treated with IV solumedrol with oral prednisone taper, IVIG, +/− plasma exchange (case 3), preceding diagnostic confirmation via CSF NMDA antibody positivity. Ovarian teratomas were detected in all cases and resected shortly after hospitalization. Additionally, cases 1 and 2 received Rituximab while hospitalized, and cases 2 and 3 received anti-seizure medications for temporal onset seizures. In spite of this, all required escalating large doses of benzodiazepines, in conjunction with amantadine and bromocriptine, for refractory malignant catatonia with dysautonomia. ECT treatments were thus initiated (once to twice daily for first week, followed by three times weekly) with bilateral electrode placement. All cases tolerated ECT treatments well and were gradually noted to have marked clinical improvement as was measured by the Bush-Francis Catatonia Rating Scale (BFCRS) (initial assessment: 27.6 ± 8.3; last assessment 1.3 ± 1.5). <h3>Conclusions:</h3> This case series supports the growing body of evidence emphasizing the importance of clinical recognition of catatonia among patients with suspected or confirmed anti-NMDAR encephalitis, and the early implementation of ECT into treatment algorithms. The use of standardized assessment tools such as the BFCRS and cognitive impairment screening scales should be considered for monitoring of symptom response and tolerability. <b>Disclosure:</b> Dr. Wadi has nothing to disclose. Dr. Mandge has nothing to disclose.

Immunotherapy Responsiveness and Risk of Relapse in Down Syndrome Regression Disorder (S34.003)

<h3>Objective:</h3> This study evaluated the clinical effectiveness of IVIg and evaluated clinical characteristics associated with relapse after therapy discontinuation in persons with Down Syndrome Regression Disorder (DSRD). <h3>Background:</h3> Down syndrome regression disorder (DSRD) is a clinical symptom cluster consisting of neuropsychiatric regression without an identifiable cause. Although presumably polyfactorial, a minority of individuals with this condition have been found to have inflammatory biomarkers and are immunotherapy responsive. This study evaluated the clinical effectiveness of IVIg and evaluated clinical characteristics associated with relapse after therapy discontinuation. <h3>Design/Methods:</h3> A prospective, multi-center, non-randomized, observational study was performed. Patients met criteria for DSRD and were treated with IVIg. All patients underwent a standardized wean off therapy after 9–12 months of treatment. Baseline, on therapy, and relapse scores of the Neuropsychiatric Inventory Total Score (NPITS), Clinical Global Impression-Severity (CGI-S), and the Bush-Francis Catatonia Rating Scale (BFCRS) were used to track clinical symptoms. <h3>Results:</h3> Eighty-two individuals were enrolled in this study. Patients had lower BFCRS (MD: −6.68; 95% CI: −8.23, −5.14), CGI-S (MD: −1.27; 95% CI: −1.73, −0.81), and NPITS scores (MD: −6.50; 95% CI: −7.53, −5.47) while they were on therapy compared to baseline. Approximately 46% of the patients (n = 38) experienced neurologic relapse with wean of IVIg. Patients with neurologic relapse were more likely to have any abnormal neurodiagnostic study (χ2 = 11.82, p = 0.001), abnormal MRI (χ2 = 7.78, p = 0.005), and abnormal LP (χ2 = 5.45, p = 0.02), and a personal history of autoimmunity (OR: 6.11, p&lt;0.001) compared to patients without relapse. <h3>Conclusions:</h3> IVIg was highly effective in the treatment of DSRD. Individuals with a history of personal autoimmunity or neurodiagnostic abnormalities were more likely to relapse following weaning of immunotherapy, indicating the potential for, a chronic autoimmune etiology in some cases of DSRD. <b>Disclosure:</b> Dr. Santoro has received personal compensation for serving as an employee of UCB. Dr. Santoro has received personal compensation for serving as an employee of Cycle Pharma. Dr. Spinazzi has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Zalkin Law Firm. The institution of Dr. Spinazzi has received research support from Konica Minolta. The institution of an immediate family member of Dr. Filipink has received research support from NIH . Dr. Filipink has received personal compensation in the range of $0-$499 for serving as a Author with Medlink. Dr. Hayati Rezvan has nothing to disclose. The institution of Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. The institution of Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Kammeyer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Ogborn-Mihm Trial Lawyers. The institution of Dr. Kammeyer has received research support from Rocky Mountain Multiple Sclerosis Center. Dr. Patel has nothing to disclose. The institution of Dr. Sannar has received research support from Colorado Department of Public Health and Environment. The institution of Dr. Sannar has received research support from National Institute of Health. Dr. Dwyer has nothing to disclose. Dr. Banerjee has nothing to disclose. Dr. Khoshnood has nothing to disclose. Dr. Jafarpour has nothing to disclose. Ms. Boyd has nothing to disclose. Dr. Partridge has nothing to disclose. The institution of Dr. Gombolay has received research support from CDC. The institution of Dr. Gombolay has received research support from NIH. Dr. Christy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SAGE Publishing. Dr. Christy has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for The Becker Law Firm . The institution of Dr. Christy has received research support from Biohaven. Dr. ORTEGA BERNARDO has nothing to disclose. Dr. Manning has nothing to disclose. Dr. Van Mater has nothing to disclose. Dr. Worley has nothing to disclose. Dr. Franklin has nothing to disclose. The institution of Dr. Stanley has received research support from NIH. The institution of Dr. Stanley has received research support from NIH. Dr. Brown has nothing to disclose. The institution of George Capone has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ACImmune. The institution of George Capone has received research support from LuMind. Dr. Quinn has nothing to disclose. Dr. Rafii has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AC Immune. Dr. Rafii has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Keystone Bio. Dr. Rafii has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alzheon.

Psychiatric features in NMDAR and LGI1 antibody-associated autoimmune encephalitis.

Patients with autoimmune encephalitis (AE) often developed psychiatric features during the disease course. Many studies focused on the psychiatric characteristic in anti-NMDAR encephalitis (NMDAR-E), but anti-LGI1 encephalitis (LGI1-E) had received less attention regarding the analysis of psychiatric features, and no study compared psychiatric characteristic between these two groups. The clinical data of AE patients (62 NMDAR-E and 20 LGI1-E) who developed psychiatric symptoms were analyzed in this study. In NMDAR-E, the most common higher-level feature was "behavior changes" (60/62, 96.8%) and the lower-level feature "incoherent speech" was observed in 33 patients (33/62, 53.2%), followed by "agitation" (29/62, 46.8%) and "incongruent laughter/crying" (20/62, 32.3%). Similar to NMDAR-E, "behavior changes" was most common in LGI1-E (17/20, 85.0%), but the features of suicidality, eating, and obsessive-compulsive were not reported. The top three lower-level features were visual hallucinations (9/20, 45.0%), incoherent speech (8/20, 40.0%), and mood instability (7/20, 35.0%). The comparative study found that "incongruent laughter/crying", in lower-level features, was more frequently observed in NMDAR-E (32.3% vs. 0%, p = 0.002). Moreover, the Bush Francis Catatonia Rating Scale (BFCRS) assessing the catatonic symptoms in NMDAR-E were higher than LGI1-E, but the 18 item-Brief Psychiatric Rating Scale (BPRS-18) showed no difference in the two groups. In summary, both NMDAR-E and LGI1-E often developed psychiatric symptoms. In contrast with LGI1-E, the psychiatric feature "incongruent laughter/crying" was more frequently associated with NMDAR-E, and catatonic symptoms were more severe in NMDAR-E.

Another Option for Aggression and Self-Injury, Alternative Benzodiazepines for Catatonia in Profound Autism.

Introduction: Individuals with profound autism often present for inpatient care due to aggression. Diagnostic and treatment options are limited. Agitated catatonia is a treatable comorbidity in autism, which should be considered in cases of aggression. Preliminary data report high clinical response rates of catatonia in autism when treated with electroconvulsive therapy (ECT), with poor response to lorazepam. However, access to ECT is often limited, especially in pediatric populations. Methods: We conducted a retrospective chart review to identify cases of hyperactive catatonia with partial response to lorazepam in profoundly autistic children presenting to the pediatric medical hospital. Five cases were identified, all of whom were followed by the child and adolescent psychiatry consult-liaison service during admission and treated without the use of ECT. Data from the medical record were obtained after institutional review board (IRB) approval including the following: (1) treatment course, (2) Bush-Francis Catatonia Rating Scale (BFCRS) scores, and (3) Kanner Catatonia Rating Scale (KCRS) severity scores. The Clinical Global Impressions-Improvement (CGI-I) Scale was applied retrospectively to each case. Results: All five patients demonstrated clinically significant improvements. The average CGI-I score was 1.2. The average percentage reduction in the BFCRS and KCRS severity scores was 63% and 59%, respectively. Two of five patients were first stabilized with infusions midazolam and dexmedetomidine due to the symptom severity and then transitioned to long-acting oral benzodiazepines. Overall, four of five patients were stabilized with oral clonazepam and one of five with oral diazepam. Notably, four of five patients experienced an acute worsening of aggression, self-injury, and other catatonic symptoms with escalating dosages of antipsychotic treatment, which occurred before inpatient admission. All patients experienced resolution of physical aggression toward self and/or others, experienced improvement in their communicative abilities, and were able to return home or enter residential level of care upon discharge. Conclusions: Given the limited availability of ECT and the unclear utility of lorazepam for hyperactive catatonia in autism, the use of long-acting benzodiazepines and/or midazolam infusion may offer a safe and readily available treatment alternative.

ALTERED BIOCHEMICAL PARAMETERS IN CATATONIA: A SHORT TERM EVALUATION

BACKGROUND Catatonia, a bizarre psychomotor syndrome, which was earlier considered as a manifestation of schizophrenia, is now often seen in patients with mania, depression and many other medical condtions. It has been a matter of debate for several decades, whether catatonia is a separate disease entity or a manifestation of different psychiatric or medical disorder. AIMS AND OBJECTIVES In our study, we tried to evaluate and compare the altered biochemical parameters in different conditions of catatonia. This hospital based cross-sectional observational study was conduc METHODS ted in a tertiary care hospital in Guwahati, Assam for a period of 1year from May2021 to April2022 after obtaining clearance from Institutional Ethical Committee(H) of the institution. Total 50 cases of catatonia fullling the selection criteria were included in the study. Bush Francis Catatonia Rating Scale (BFCRS) was used to quantify different conditions of catatonia. The biochemical parameters that were altered RESULTS in majority of the catatonia patients were CPK (increased in 98%patients), haemoglobin(low in 64%patients) and serum iron(low in 54%patients). Statistically signicant difference with the highest mean CPK (514.86) was found in schizophrenia while the lowest mean CPK value(254.54) was found in organic catatonia patients. CONCLUSION Although, there is no specic test for catatonia, laboratory studies provide insight into the pathogenesis of catatonia and has diagnostic and therapeutic implications.

Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types

BackgroundA comprehensive assessment of catatonic symptoms is decisive for diagnosis, neuronal correlates, and evaluation of treatment response and prognosis of catatonia. Studies conducted so far used different cut-off criteria and clinical rating scales to assess catatonia. Therefore, the main aim of this study was to examine the frequency and distribution of diagnostic criteria and clinical rating scales for assessing catatonia that were used in scientific studies so far. MethodsWe conducted a systematic review using PubMed searching for articles using catatonia rating scales/criteria published from January 1st 1952 (introduction of catatonic schizophrenia to first edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM]) up to December 5th, 2022. Results1928 articles were considered for analysis. 1762 (91,39 %) studies used one and 166 (8,61 %) used ≥2 definitions of catatonia. However, 979 (50,7 %) articles did not report any systematic assessment of catatonia. As for clinical criteria, DSM criteria were used by the majority of studies (n = 290; 14.0 %), followed by International Classification of Diseases (ICD) criteria (n = 61; 2.9 %). The Bush-Francis Catatonia Rating Scale (BFCRS) was found to be by far the most frequently utilized scale (n = 464; 22.4 % in the respective years), followed by Northoff Catatonia Rating Scale (NCRS) (n = 31; 1.5 % in the respective years). ConclusionDSM and ICD criteria as well as BFCRS and NCRS were most frequently utilized and can therefore be recommended as valid instruments for the assessment of catatonia symptomatology.

ОСОБЕННОСТИ АУТОАГРЕССИВНОГО ПОВЕДЕНИЯ ПРИ РАССТРОЙСТВАХ АУТИСТИЧЕСКОГО И ШИЗОФРЕНИЧЕСКОГО СПЕКТРОВ В ДЕТСКОМ ВОЗРАСТЕ

Relevance. Auto-aggressive harming behavior (ASB) among children and adolescents who suffer from mental disorders of various nosologies is an urgent problem and requires a special approach from the diagnosis and rehabilitation of such patients. Purpose: To identify clinical, pathopsychological and neurophysiological characteristics of ASP in children and adolescents with different etiopathogenesis depending on the manifestation within the framework of ASD and nosologies of the schizophrenic range with affective disorders. Materials and methods. The study included patients being treated in the Department of Child Psychiatry Study of the Federal State Budgetary Institution National Center for Mental Health. Two samples of patients were formed: the first sample included 30 patients (23 boys and 7 girls), the average age was 6.9 ± 2.5 years, with diagnoses according to ICD-10 ‘Childhood autism’ (DA, F84.02), ‘Atypical autism with mental retardation’ (AA with mental retardation, F84.11), ‘Atypical autism without mental retardation’ (AA without mental retardation, F84.12) with the presence of psychotic symptoms during an attack. The second sample consisted of patients with signs of nonsuicidal ASP (with traces of bodily self-harm) with moderate and severe severity within the nosologies of the schizophrenic circle. 25 female children and adolescents were examined, the average age was 14.15±0.95 years, with diagnoses according to ICD-10 of ‘Schizoaffective disorder, depressive type’ (F25.18), ‘Pseudopsychopathic schizophrenia’ (F21.4), ‘Undifferentiated schizophrenia, observation period less than a yea’ (F20.3). Research methods included clinical-psychopathological, pathopsychological, and neurophysiological studies (EEG with spectral analysis and topographic mapping), survey data with psychometric scales. Results. In patients of the 1st sample with ASD, the leading syndrome in the structure of psychosis was catatonic. Self-harm varied in clinical presentation and severity. In 16 (53%) people, self-harm was represented by palm strikes to the head and face, 11 (37%) – hitting the head against various surfaces, 6 (20%) – hitting parts of the body with the palms, and 6 (20%) – biting fingers and hands. The severity of clinical manifestations of ASP in children with ASD corresponded to the data of a psychometric examination: the severity of autism on the CARS scale was 54.3 ± 3.1, according to the general catatonia scale (BFCRS, Bush-Francis Catatonia Rating Scale, 1996) was 32.7 ± 2.5, which corresponds to a ‘severe’ degree of catatonic disorders. A pathopsychological examination of children with ASP within the framework of ASD revealed a delay in psycho-speech development with signs of the formation of a cognitive defect against the background of distorted dysontogenesis with dissociation of cognitive activity, autism, stereotypic behavior, heteroaggression and ASP, emotional flatness and pronounce dnegativism. These children howed diffuse changes in the form of an increase in the level of slow-wave θ activity, which can be considered as an EEG correlate of immaturity, acuity, and regression of mentalfunctions. Behavioral disorders in the second group of patients with nonsuicidal ASP manifest themselves within the nosologies of the schizophrenic circle (F25.18, F21.4, F20.3), occurring with hallucinatory-delusional, psychopathic-like, and negative symptoms of varying severity, against the background of moderate or severe episode with antivital manifestations, without suicidal actions. Often (in 64% of the patients), the course of the underlying disease was accompanied by cognitive deficits with impaired thinking and memory. The total score on the PANSS scale was 102.5 points, on the CGI scale 6-7 points, which corresponds to a pronounced and severe degree of psychopathological symptoms. Pathopsychological analysis in these patients revealed a dissociated type of mental development, a diversity of thinking, disturbances in the form of slips, associations with secondary symptoms, deficits of will and emotions, and disturbances in social functioning. The decrease and disorganization of the α-rhythm and the increased β-rhythm revealed on the EEG were considered assigns of suppression of the activity of the functions of the cerebral cortex and the severity of psychopathological disorders; the dominance of slow θ- and δ-rhythm sindicates the dysontogenesis of mental development with dissociation of cognitive activity and the formation of cognitive deficit.