Bush-Francis Catatonia Screening Instrument Research Articles

The Course of Schizophrenia Spectrum Disorders With Episodes of Catatonic Depressions

Introduction Mood symptoms, especially depressive ones, occur in the majority of patients with schizophrenia spectrum disorders (SSD). Therefore, depression is often identified as one of the symptomatological dimensions of schizophrenia. Catatonia is also considered by some researchers as one of the dimensions of schizophrenia, or as an independent transnosological formation. Catatonia in SSD may be associated with affective dysregulation and is often accompanied by depression. Although the clinical course of SSD has been well studied previously, its relationship with psychopathological structure of episodes of SSD remains not entirely clear.ObjectivesTo determine the impact of episodes of catatonic depression on the course and prognosis of SSD.MethodsA sample of 60 patients with episodic course of SSD who met the criteria for catatonia according to the Bush-Francis Catatonia Screening Instrument (BFCSI) and for depression according to the Calgary depression schizophrenia scale (CDSS) was analyzed. An analysis of the clinical course of SSD was carried out on the basis of the medical history of all patients in the study sample and follow-up observation of 42 patients for 5 years. Global Assessment of Functioning Scale (GAF) was used to assess the prognosis of SSD.ResultsPatients were divided into two groups depending on the period of manifestation of catatonia in the clinical course of SSD: during the first episode or during subsequent episodes. The sample of patients with the first episode (n=43, 71.7 %) was divided into three subgroups. A relatively favorable course of SSD was observed only in 13 patients (30.2 %; 21.7 % of SSD sample). The course of disorder was characterized by similar episodes with a high proportion of affective symptoms, long-term remissions and minimally expressed negative symptoms (GAF score=75.2±5.82). A relatively unfavorable course of SSD was observed in 15 patients (34.9 %; 25.0 % of SSD sample). It was characterized by moderate negative and chronic subdepressive symptoms with low frequency of catatonic and psychotic relapses (GAF score=62.3). An unfavorable course of SSD was also observed in 15 patients (34.9 %; 25.0 % of SSD sample). It was characterized by a high frequency of relapses with a tendency to form a chronic conditions with residual catatonic signs and psychotic symptoms (GAF score=50.1). In the sample of patients with manifestation of catatonia in the second or subsequent episodes (n=17; 28.3 %), the clinical course of SSD was unfavorable. It was characterized by a rapid augmenting of negative symptoms with the formation of psychomotor poverty syndrome with residual catatonic symptoms (GAF score=52.7).ConclusionsOur study shows that the occurrence of catatonic depressive episodes in the clinical course of SSD in most cases is an unfavorable prognostic factor.Disclosure of InterestNone Declared

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.

Catatonia in the peripartum: A cohort study using electronic health records

BackgroundDue to limited existing literature available on the presentation and treatment of catatonia in the peripartum, this retrospective descriptive cohort study aimed to examine demographic data, catatonic features, diagnoses pre- and post-catatonic episodes, treatment and the presence of obstetric complications. MethodsIndividuals with catatonia were identified in a previous study using anonymised electronic healthcare records from a large mental health trust in South-East London. The presence of features from the Bush-Francis Catatonia Screening Instrument was coded by the investigators and longitudinal data were extracted from structured fields and free text. Results21 individuals were identified from the larger cohort, each of whom experienced one episode of catatonia in the postpartum period, and all had had an inpatient psychiatric admission. 13 patients (62 %) presented after their first pregnancy and 12 (57 %) experienced obstetric complications. 11 (53 %) attempted breastfeeding and 10 (48 %) received a diagnosis of a depressive disorder following the episode of catatonia. The majority presented with immobility or stupor, mutism, staring and withdrawal. All were treated with antipsychotics and 19 (90 %) received benzodiazepines. ConclusionsThis study suggests that signs and symptoms of catatonia during the peripartum are similar to other catatonic presentations. However, the postpartum may be a period of high risk for catatonia and obstetric factors, such as birth complications, may be relevant.

Catatonia in adult anti-NMDAR encephalitis: an observational cohort study

BackgroundAnti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most prevalent autoimmune encephalitis and is closely related to catatonia. This study aimed to investigate the clinical features and disease outcomes of adult catatonic anti-NMDAR encephalitis patients.MethodsAdult patients diagnosed with anti-NMDAR encephalitis between January 2013 and October 2021 were retrospectively enrolled in this study. According to the Bush Francis Catatonia screening instrument (BFCSI), patients were divided into two groups: those with catatonia and those without catatonia. The modified Rankin scale (mRS), Clinical Assessment Scale for Autoimmune Encephalitis (CASE), Neuropsychiatric Inventory (NPI), Patient Health Questionnaire-9 (PHQ-9) and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) scores were assessed at follow-up. The Mann–Whitney U test (nonparametric), Student’s t test (parametric), and chi-squared test were used to analyse the differences between the two groups.ResultsEighty-four patients were recruited, including twenty-five catatonic patients and fifty-nine noncatatonic patients. Among them, 28 had positive antibody only in cerebrospinal fluid (CSF), 4 had positive antibody only in serum and 52 had positive antibody both in CSF and serum. Catatonic patients experienced more disturbance of consciousness (p = 0.01), aggression (p = 0.046) and affective disorders (p = 0.043) than noncatatonic patients. The mRS scores of the catatonia group assessed at admission (p = 0.045) were worse than those of the non-catatonia group. Catatonic patients were more inclined to develop deep vein thrombosis (p = 0.003), decubitus (p = 0.046), pneumonia (p = 0.025), and to be admitted to the intensive care unit (ICU) (p = 0.011) than noncatatonic patients. All patients in the catatonia group received first-line immunotherapy. At the 24-month follow-up, 2 patients in the catatonia group did not achieve good outcomes. At the last follow-up, the catatonia group had more relapses (p = 0.014) and more neuropsychiatric problems (p = 0.035).ConclusionsAdult anti-NMDAR encephalitis patients with catatonia present distinct clinical features in disease course and are prone to experience more relapses and long-term neuropsychiatric problems than those without catatonia.

Factor Structure of Catatonia in Catatonic Depression

IntroductionDepression with catatonic features is a relatively common condition that can pose difficulties in nosological assessment and lead to life-threatening complications.ObjectivesTo determine the structure of catatonia associated with depression, and its subtypes.MethodsThe exploratory factor analysis with maximum likelihood (MLE) data extraction and varimax rotation was used in a sample of 96 patients with depressive, bipolar or schizophrenia spectrum disorders, who were depressed and who met the criteria for catatonia according to the Bush-Francis Catatonia Screening Instrument (BFCSI).ResultsThe factor analysis revealed four factors of catatonia in depression, accounting for 57.3% of the variance. “Agitated” factor (eigenvalue 5.65, 18.2% of the variance) includes agitation, impulsivity, emotional lability, verbigeration, sudden muscular tone alterations, ambitendency, perseveration and stereotypy. “Hypokinetic” factor (eigenvalue 5.05, 16.3% of the variance) includes mutism, withdrawal, stupor, staring, negativism, rigidity, posturing and gegenhalten. “Proskinetic” factor (eigenvalue 3.65, 11.8% of variance) includes automatic obedience, mitgehen, echophenomena, catalepsy and waxy flexibility. “Parakinetic” factor (eigenvalue 3.41, 11.0% of variance) includes grimacing, flat affect, compulsive emotions, mannerisms and compulsive behavior. “Agitated catatonia” is a more specific subtype and is usually associated with bipolar disorder. “Hypokinetic catatonia” is the most common but less specific subtype. “Proskinetic catatonia” in depression does not occur apart from other subtypes of catatonia. “Parakinetic catatonia” is most commonly associated with schizophrenia spectrum disorders.ConclusionsOur study shows the heterogeneity of catatonic features in depression and facilitates the nosological diagnosis of catatonic depression.DisclosureNo significant relationships.

Catatonia Psychopathology and Phenomenology in a Large Dataset.

BackgroundThe external clinical manifestations (psychopathology) and internal subjective experience (phenomenology) of catatonia are of clinical importance but have received little attention. This study aimed to use a large dataset to describe the clinical signs of catatonia; to assess whether these signs are associated with underlying diagnosis and prognosis; and to describe the phenomenology of catatonia, particularly with reference to fear.MethodsA retrospective descriptive cross-sectional study was conducted using the electronic healthcare records of a large secondary mental health trust in London, United Kingdom. Patients with catatonia were identified in a previous study by screening records using natural language processing followed by manual validation. The presence of items of the Bush-Francis Catatonia Screening Instrument was coded by the investigators. The presence of psychomotor alternation was assessed by examining the frequency of stupor and excitement in the same episode. A cluster analysis and principal component analysis were conducted on catatonic signs. Principal components were tested for their associations with demographic and clinical variables. Where text was available on the phenomenology of catatonia, this was coded by two authors in an iterative process to develop a classification of the subjective experience of catatonia.ResultsSearching healthcare records provided 1,456 validated diagnoses of catatonia across a wide range of demographic groups, diagnoses and treatment settings. The median number of catatonic signs was 3 (IQR 2–5) and the most commonly reported signs were mutism, immobility/stupor and withdrawal. Stupor was present in 925 patients, of whom 105 (11.4%) also exhibited excitement. Out of 196 patients with excitement, 105 (53.6%) also had immobility/stupor. Cluster analysis produced two clusters consisting of negative and positive clinical features. From principal component analysis, three components were derived, which may be termed parakinetic, hypokinetic and withdrawal. The parakinetic component was associated with women, neurodevelopmental disorders and longer admission duration; the hypokinetic component was associated with catatonia relapse; the withdrawal component was associated with men and mood disorders. 68 patients had phenomenological data, including 49 contemporaneous and 24 retrospective accounts. 35% of these expressed fear, but a majority (72%) gave a meaningful narrative explanation for the catatonia, which consisted of hallucinations, delusions of several different types and apparently non-psychotic rationales.ConclusionThe clinical signs of catatonia can be considered as parakinetic, hypokinetic and withdrawal components. These components are associated with diagnostic and prognostic variables. Fear appears in a large minority of patients with catatonia, but narrative explanations are varied and possibly more common.

Catatonia Spectrum: Validation of a Questionnaire Investigating Catatonia Spectrum

AimA growing body of literature has demonstrated the utility of a dimensional perspective on mental disorders. The current study aims to determine the psychometric properties of the Catatonia Spectrum (CS), a new questionnaire specifically tailored to assess the spectrum of catatonia, from full blown forms to subthreshold ones.Methods86 adults with at least three symptom criteria for catatonia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 81 adults affected by borderline personality disorder (BPD), 104 adults with a diagnosis of major depressive disorder (MDD), and 105 subjects without mental disorders (CTL), were recruited from six Italian University Departments of Psychiatry and administered the: Bush-Francis Catatonia Rating Scale (BFCRS), Bush-Francis Catatonia Screening Instrument (BFCSI), and CS.ResultsCS scale demonstrated a high level of internal consistency and excellent test-retest reliability for total and domain scores. CS domain scores were positively and significantly correlated with each other (p < 0.001) with Pearson’s coefficients ranging from 0.337 to 0.663. All the CS domain scores were highly correlated with the CS total score. The correlation coefficients between CS and alternative measures of catatonia appeared all significant and positive. Significant differences among diagnostic groups on both CS domains and total scores were found. CS total scores increased significantly and progressively from the CTL, to the MDD and the BDP group, up to the catatonia group, which reported the highest value.ConclusionThe CS showed excellent internal consistency and test-retest reliability and strong convergent validity with alternative dimensional measures of catatonia. The questionnaire performed differently across the four diagnostic groups, with an increasing score gradient from healthy controls to patients with MDD, BPD and up to the catatonia group.

Management and outcomes of catatonia: A prospective study in urban South Africa.

Objectives:Rapid intervention for catatonia with benzodiazepines and electroconvulsive therapy can prevent fatal complications. We describe the management and treatment response of 44 patients with catatonia in a psychiatric unit in urban South Africa. The objective was to screen admissions for catatonia and investigate management, treatment response, and treatment outcomes.Method:We used a prospective, descriptive, observational study design and collected data using a data collection sheet, the Bush Francis Catatonia Screening Instrument, the Bush Francis Catatonia Rating Scale, and the Diagnostic Statistical Manual-5 to assess catatonia in new admissions from September 2020 to August 2021.Results:Of the 241 participants screened on admission, 44 (18.3% of 241) screened positive for catatonia on the Bush Francis Catatonia Screening Instrument, while 197 (81.7% of 241) did not. Thirty-eight (86.4% of 44) received lorazepam, seven (15.9%) received clonazepam, and two (4.6%) received diazepam, implying that three (6.8%) of the 44 participants with catatonia received more than one benzodiazepine sequentially. Ten (22.7% of 44) patients received electroconvulsive therapy. Seven of those treated with electroconvulsive therapy (15.9% of 44 and 70% of 10) responded well and were discharged, whereas 22 (50% of 44 and 64.7% of 34) of those given lorazepam were discharged. Patients treated with electroconvulsive therapy had a higher initial Bush Francis Catatonia Rating Scale score. One patient (2.3%) relapsed within 4 weeks of discharge. Twenty (45.5%) of the 44 patients with catatonia had low average iron levels, 14 (31.8%) had low vitamin B12, and 24 (54.6%) had high creatinine kinase.Conclusion:Both lorazepam and electroconvulsive therapy were found to be effective treatments for catatonia with good response and outcomes. The length of hospital stay of patients with catatonia was similar to that of patients without catatonia. Treatment guidelines for catatonia need to include the role and timing of electroconvulsive therapy to augment current treatment protocols for the use of lorazepam.

Assessment of catatonia and inter-rater reliability of three instruments: a descriptive study

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.

Protocol for a prospective descriptive prevalence study of catatonia in an acute mental health unit in urban South Africa

IntroductionCatatonia arises from serious mental, medical, neurological or toxic conditions. The prevalence range depends on the setting and the range is anything from 7% to 63% in other countries. South...

Diagnosing catatonia and its dimensions: Cluster analysis and factor solution using the Bush Francis Catatonia Rating Scale (BFCRS).

Advances in research into catatonia in the preceding two decades has offered increasing clarity and an improved understanding of various aspects of this complex syndrome. Despite the above, there are several aspects that hinder a broader interpretation of these findings, the most common being a lack of consensus on the criteria required for diagnosing catatonia. Whilst being the most frequently used tool for diagnosis, the number of signs from Bush-Francis Catatonia Rating Scale (BFCRS) needed to diagnose catatonia remain unclear. This study aimed to determine the number of signs required to accurately diagnose catatonia using BFCRS and delineate its dimensions in an acute inpatient unit in the Indian setting. A random sample of 300 patients were evaluated for catatonia within 24 h of admission. Cluster Analysis followed by discriminant analysis and receiver operating curve analysis (ROC) provided cut-off values for diagnosing catatonia syndrome. Principle Component Analysis (PCA) with varimax rotation was used to identify factors in those with catatonia. Findings revealed that a cut off of two signs from both Bush-Francis Catatonia Screening Instrument or BFCSI (sensitivity of 100 %, specificity of 96.2 % as well as a positive predictive value [PPV] of 79.6 % and negative predictive value [NPV] 100 % with ROC AUC value of 0.98) and complete BFCRS (sensitivity of 100 % and specificity of 90.7 %, PPV of 80.7 and NPV of 100 % with ROC AUC for at least two items cut-off being 0.95) accurately detected catatonia. However, the prevalence of catatonia in the same population increased by 4% from 16.3% to 20.3% using the BFCRS rather than the BFCSI. The BFCRS generated a 3-factor model accounting for 65.48 % variance offering the best fit, indicating three discrete dimensions to catatonia, namely retarded, excited and what we named as "aberrant volitional". Interestingly, the aberrant volitional dimension comprises of signs that need to be elicited rather than passively observed and excluding one, none of them are part of the BFCSI. Findings of this study suggest that the BFCRS more accurately detects catatonia rather than the BFCSI. Additionally, three dimensions of catatonia more coherently explain the catatonic syndrome given that 55.7 % of the sample had signs from more than one factor concurrently. We propose that the BFCRS rather than BFCSI be routinely administered for evaluating all suspected cases of catatonia to ensure more accurate detection as well as identifying the aberrant volitional dimensional signs more consistently. The three-dimensional model also offers great opportunities to further unravel the pathophysiological basis of catatonic signs more systematically.

Delirium and Catatonia in Critically Ill Patients: The Delirium and Catatonia Prospective Cohort Investigation.

Catatonia, a condition characterized by motor, behavioral, and emotional changes, can occur during critical illness and appear as clinically similar to delirium, yet its management differs from delirium. Traditional criteria for medical catatonia preclude its diagnosis in delirium. Our objective in this investigation was to understand the overlap and relationship between delirium and catatonia in ICU patients and determine diagnostic thresholds for catatonia. Convenience cohort, nested within two ongoing randomized trials. Single academic medical center in Nashville, TN. We enrolled 136 critically ill patients on mechanical ventilation and/or vasopressors, randomized to two usual care sedation regimens. Patients were assessed for delirium and catatonia by independent and masked personnel using Confusion Assessment Method for the ICU and the Bush Francis Catatonia Rating Scale mapped to Diagnostic Statistical Manual 5 criterion A for catatonia. Of 136 patients, 58 patients (43%) had only delirium, four (3%) had only catatonia, 42 (31%) had both, and 32 (24%) had neither. In a logistic regression model, more catatonia signs were associated with greater odds of having delirium. For example, patient assessments with greater than or equal to three Diagnostic Statistical Manual 5 symptoms (75th percentile) had, on average, 27.8 times the odds (interquartile range, 12.7-60.6) of having delirium compared with patient assessments with zero Diagnostic Statistical Manual 5 criteria (25th percentile) present (p < 0.001). A cut-off of greater than or equal to 4 Bush Francis Catatonia Screening Instrument items was both sensitive (91%; 95% CI, 82.9-95.3) and specific (91%; 95% CI, 87.6-92.9) for Diagnostic Statistical Manual 5 catatonia. Given that about one in three patients had both catatonia and delirium, these data prompt reconsideration of Diagnostic Statistical Manual 5 criteria for "Catatonic Disorder Due to Another Medical Condition" that preclude diagnosing catatonia in the presence of delirium.

Catatonia in an inpatient gerontopsychiatric population

There are limited data on the prevalence of catatonia in the elderly. The aim of this study was to determine the prevalence of catatonia in elderly patients (=/> 65 years) acutely admitted to the psychiatric unit of a general hospital. All patients aged 65 years and above admitted to a general hospital psychiatric unit over a 4-month period were screened for catatonia with the 14-item Bush-Francis Catatonia Screening Instrument (BFCSI). Patients with a minimum of 2 symptoms on the BFCSI were rated with the 23-item Bush-Francis Catatonia Rating Scale (BFCRS). Catatonia was simultaneously evaluated according to DSM-5 criteria. Clinical diagnoses were established using the validated Hungarian versions of the Structured Clinical Interview for DSM-IV Disorders, the Mini Mental State Examination and the Clock Drawing Test. Ninety-eight (28.1%) of the 342 patients admitted to the psychiatric unit during the study period were above 65 years of age; 11 (11.22%) and 6 (6.12%) patients were classified as having catatonia according to the BFCRS and DSM-5 criteria, respectively. The majority of the patients had catatonia due to a medical condition. A significant minority of gerontopsychiatric inpatients present with catatonia. Dementia was not a risk factor for catatonia.

Development and validation of the Bush-Francis Catatonia Rating Scale - Brazilian version.

This article aims to describe the adaptation and translation process of the Bush-Francis Catatonia Rating Scale (BFCRS) and its reduced version, the Bush-Francis Catatonia Screening Instrument (BFCSI) for Brazilian Portuguese, as well as its validation. Semantic equivalence processes included four steps: translation, back translation, evaluation of semantic equivalence and a pilot-study. Validation consisted of simultaneous applications of the instrument in Portuguese by two examiners in 30 catatonic and 30 non-catatonic patients. Total scores averaged 20.07 for the complete scale and 7.80 for its reduced version among catatonic patients, compared with 0.47 and 0.20 among non-catatonic patients, respectively. Overall values of inter-rater reliability of the instruments were 0.97 for the BFCSI and 0.96 for the BFCRS. The scale's version in Portuguese proved to be valid and was able to distinguish between catatonic and non-catatonic patients. It was also reliable, with inter-evaluator reliability indexes as high as those of the original instrument.

Catatonia in acute psychiatric patients

Introduction Over the past years, catatonia received increasing attention. The concept of catatonia has been decoupled from schizophrenia and broadened. Aim The aim of our prospective study was to determine the prevalence of catatonia in patients admitted to an acute psychiatric ward. Material and methods We examined all patients acutely admitted to the Centre for Psychiatry and Addiction Medicine (CPAM) of Szent Istvan and Szent Laszlo Hospitals, from 01/04/2015 to 31/07/2015. We used Bush Francis Catatonia Screening Instrument (BFCSI) for the assessment of catatonic signs. In case of presence of 2 or more symptoms on BFCSI, the severity of catatonia was rated with Bush Francis Catatonia Rating Scale (BFCRS). After detailed clinical examination, we used Structured Clinical Interview for DSM-IV, Mini Mental State Examination and Clock Drawing Test in setting up a diagnose. Results In the study period, altogether 338 patients were admitted to CPAM. Catatonia could be diagnosed in 8.55% of them, according to BFCRS and in case of 5.02% the diagnosis of catatonia could be set up according to DSM-5 diagnostic criteria. Female patients were present in 58.62%. The mean age was 57.62 years. Schizophrenia spectrum disorder was diagnose in 41.3%, dementia in 27.5%, affective disorder in 6.89%, alcohol, drug withdrawal syndrome, Down syndrome and mental retardation in 3.44% each, other organic disease in 10.34% of all catatonia cases. Conclusion Catatonia can be present in a variety of psychiatric conditions. Its specific therapy gives a special importance to the recognition of this syndrome.

Catatonia in Children Following Systemic Illness.

Background:The term catatonia was first introduced in 1874 and several etiologies, both organic and psychiatric have been attributed to the clinical phenotype of catatonia. The interesting feature is their response to lorazepam irrespective of their etiology.Patients and Methods:Four patients admitted with verbal and motor unresponsiveness following febrile illness were evaluated for infective and metabolic causes. Those who qualified for catatonia as per Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition criteria and Bush-Francis Catatonia Screening Instrument screening tool and rating scale were evaluated in detail and reported. Observations: Catatonia occurs in clusters, females are more affected than males. Electroencephalogram can be abnormal based on the precipitating symptom. Minor changes in serum total iron and transferrin saturation and nonspecific elevation of viral antibody titers are seen in some patients. Lorazepam challenge always gives the diagnosis.Result:All patients where females and had preceeding systemic or CNS infection. Three out of the Four patients where independent at the end of one month.Conclusion:Catatonia should be considered as a differential diagnosis in all children with verbal and motor unresponsiveness, which have no other explanation. Early initiation of treatment is very rewarding at least during short term follow-up.

Prevalence and symptomatology of catatonia in elderly patients referred to a consultation-liaison psychiatry service.

To determine the prevalence and clinical correlations of catatonia in patients aged over 65 years who are referred to a consultation-liaison service within a regional area of Australia. Additionally, to examine if the use of standardised screening tools is likely to change the rate of diagnosis of catatonia within the consultation-liaison service. One hundred and eight referrals from general hospital wards were assessed using the Bush-Francis Catatonia Screening Instrument (BFCSI) and associated examination; each consented patient was screened for catatonic symptoms. If two or more signs were present on the BFCSI, then severity was rated using the Bush-Francis Catatonia Rating Scale. These clinical characteristics were compared with their socio-demographic and medical data. Prevalence of catatonia was 5.5%. The most common symptoms appeared to be rigidity, posturing and immobility (67% of cases), and were elicited through routine psychiatric examination. Routine psychiatric history and examination are likely sufficient to elicit catatonic signs in a consultation-liaison setting. Standardised screening examination may be more suited for conducting research or for use when examining for catatonia in psychiatric inpatient settings.

Response to Treatment in Patients with Catatonia Referred to a Liaison Psychiatry Service in a General Hospital.

Introduction Catatonia is a neuropsychiatric syndrome described in a variety of general medical, neurological and psychiatric conditions. Response to treatment has not been sufficiently studied in patients in this clinical setting. Objectives To determine the response to treatment of catatonia in patients referred to a liaison psychiatry service. Aim Prospective, descriptive study. Method All patients referred to liaison psychiatry were screened for catatonic phenomena with the Bush–Francis Catatonia Screening Instrument (BFCSI) between January and May 2012. Their response to treatment was recorded. Results 236 patients were referred. Thirteen (5,5%) met research diagnostic criteria for catatonia and 10 (4,2%) DSM – IV criteria. Nine of the 13 patients received treatment with oral lorazepam. Five underwent total remission with doses between 1.5-3 mg/day within 5-13 days of treatment initiation. Two cases received up to 3 mg/day for more than 5 days resulting in a very mild improvement, one of them did not improve following eight sessions of ECT. One patient who received up to 10mg/day, died of the complications of the background health problem and complications. One patient died after the first day of treatment with lorazepam 1 mg/day. Another patient died the day after the diagnosis of catatonia and prior to starting treatment. Three patients with associated delirium improved completely with treatment for the underlying cause. Conclusions Catatonia can be effectively treated. 62% of our patients treated with lorazepam achieved complete resolution of symptoms. 100% of de catatonic patients with delirium also completely improved after treatment of the underlying condition.

Catatonia in a Liaison Psychiatry Service of a General Hospital: Prevalence and Clinical Features

Introduction Catatonia is a neuropsychiatric syndrome described in a variety of medical and psychiatric conditions. The prevalence and clinical features of this syndrome have not been studied sufficiently in patients in this clinical setting. Objectives To determine the prevalence and clinical features of catatonia in patients referred to a liaison psychiatry service at a general hospital. Aim Prospective, descriptive study. Method All patients referred to a liaison psychiatry service were screened for catatonic phenomena using the Bush–Francis Catatonia Screening Instrument (BFCSI), between January and May 2012. The prevalence and clinical features of catatonia were recorded. Results 236 patients were referred. Thirteen (5,5%) met research diagnostic criteria for catatonia and 10 (4,2%) DSM – IV criteria. Three of these patients suffered simultaneously with delirium. All patients presented with the inhibited variant of catatonia and 5 to 12 catatonic signs. 100% presented with immobility/stupor and staring gaze, 84,6% with mutism, 76,9% with rigidity, and 69% with negativism and withdrawal. Sixty-one percent presented with posturing/catalepsy, 53,8% with echophenomena and automatic obedience and 46,1% with stereotypies and grasp reflex, whilst 38,4% presented with grimacing and waxy flexibility. Mitgehen, Gegenhalten and autonomic abnormalities were found in 23% of cases. In 15,3% there were verbigeration, impulsivity, perseveration and combativeness. Excitement, mannerisms and ambitendency were not observed in any case. Conclusion Catatonia is not infrequent in patients referred to a liaison psychiatry service at a general hospital, and it presented with its inhibited variant in all cases. In 23% of patients catatonia occurred simultaneously with delirium.

Complications of Catatonia in Patients in a General Hospital Referred to a Liaison Psychiatry Service.

Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioral and autonomic abnormalities that occurs in the context of general medical, neurological and psychiatric conditions. The complications of this syndrome have not been sufficiently studied in patients in this clinical setting. To determine the rate and type of complications of catatonia in patients referred to a liaison psychiatry service. Prospective descriptive study. All patients referred to liaison psychiatry were screened for catatonic phenomena with the Bush–Francis Catatonia Screening Instrument (BFCSI) between January and May 2012. Any complications of catatonia were recorded. 236 patients were referred. Thirteen (5,5%) met research diagnostic criteria for catatonia and 10 (4,2%) DSM – IV criteria. Of these, six patients (46%) suffered from complications secondary to the catatonic syndrome. These patients were also those with the longer duration of catatonia (more than10 days). The complications observed were malnutrition, dehydration, hyponatremia, hypoglycaemia, and problems related to immobility such as pressure ulcers (the more frequent complication, present in all six patients), acute coronary syndrome, aspiration pneumonia, urinary retention and urinary infection. Three patients died as a result of these complications and their underlying conditions. Medical complications of catatonia were frequent (46%) and were more common in those patients with longer duration of catatonia. Death was also frequent (23%).