by AZ Antosik-Wójcińska · 2019 — for catatonic signs and symptoms. Catatonic signs/symptoms were scored according to both the DSM-5 diagnostic criteria and the Bush–Francis Catatonia
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Psychiatr. Pol. 2019; 53(6): 1251Œ1260 PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE) www.psychiatriapolska.pl DOI: https://doi.org/10.12740/PP/ 102657The frequency of catatonic syndrome in an acute psychiatric wardRozália Takács 1,2, Márton Asztalos 2,3, Gabor S. Ungvari 4, 5, Gábor Gazdag 6,71 Tóth Ilona Medical Service, Psychiatric Outpatient Service, Csikó sétány 9., 1213 Budapest, Hungary2 School of Doctoral Studies, Semmelweis University, Budapest, Hungary 3 Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark 4 University of Notre Dame Australia/Graylands Hospital, Perth, Australia 5 6 1st Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc Hospital, Budapest, Hungary7 Department of Psychiatry and Psychotherapy, Semmelweis University Medical School, Budapest, HungarySummaryAim. The aim of this prospective study was to determine the prevalence of the catatonic syndrome in a cohort of patients admitted to acute psychiatric units in Hungary. Method. Patients admitted to the acute inpatient unit of the Center of Psychiatry and Ad -diction Medicine, Szent István and Szent László Hospitals in a 4-month period were screened for catatonic signs and symptoms. Catatonic signs/symptoms were scored according to both the DSM-5 diagnostic criteria and the BushŒFrancis Catatonia Rating Scale (BFCRS). Clini-cal diagnoses were established using the Structured Clinical Interview for DSM-IV Disorders (SCID), while cognitive performance was estimated with the Clock Drawing Test and the Mini-Mental State Examination (MMSE).Results. During the study period, 342 patients were admitted to the above-mentioned acute according to the BFCRS and the DSM-5, respectively. Conclusions. The prevalence of catatonic syndrome in an acute inpatient setting is within assessment (BFCRS) and routine clinical judgment (DSM-5) is noteworthy and suggests
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Rozália Takács et al. 1252 life-threatening complications, recognition of catatonic symptoms is vitally important.Key words: catatonia, prevalence, DSM-5, BushŒFrancis Catatonia Rating ScaleIntroduction The concept, clinical features, and nosological status of catatonia, which can be and psychomotor abnormalities [1], has undergone a number of changes since it was of his 26 cases clearly shows that he described a syndrome [3]. The ubiquitous nature of catatonic signs and symptoms, or the catatonic syndrome, had already been widely accepted before the turn of the twentieth century [4, 5].Persistent catatonic syndromes with poor prognosis arising in the context of of catatonic schizophrenia, mainstream psychiatry erroneously equated catatonia with schizophrenia in the subsequent decades [7, 8]. Starting from the 1970s, catatonia as disorders [9], and a host of neurological, medical [10], and drug/substance abuse-related conditions [11]. The association of catatonia with medical and psychiatric DSM-5 [14] takes these conceptual changes into account by broadening the syndromes associated with any psychiatric disorders including neurodevelopmental, psychotic, bipolar, and depressive disorders. In addition, a semi-independent category, was retained from DSM-IV. Despite the recent upsurge in the interest in catatonia, it is still under-recognized Data on the prevalence of catatonia vary widely depending on the characteristics of the study design, measurement tools and patient population [17]. However, there is a consensus that the prevalence of catatonia in acute psychiatric patients is between
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1253The frequency of catatonic syndrome in an acute psychiatric ward patients referred to a psychiatric intensive care unit [20]. Stuivega and Morrens [21] -erature. A possible explanation for this extremely high rate is that patients in the most acute phase of their illness in a psychiatric intensive care unit were included and as -sessed immediately after admission.With notable exceptions [22, 23], most experts opine that catatonia most frequently -agnostic criteria [1, 24, 25]. The reliable detection of catatonia poses a challenge to researchers and clinicians alike because the diagnostic criteria and assessment tools are still not universally agreed upon [26]. The BushŒFrancis Catatonia Rating Scale (BFCRS) is used most frequently in research [18]. DSM-5 lists 12 catatonic symptoms, 3 or more of which must be present to diagnose catatonia [14]. Stuivenga and Morrens [21] diagnosed the same 130 acutely ill psychiatric patients according to the BFCRS, DSM-IV and DSM-5 immediately after admission, and reported prevalence rates of There are two aspects of catatonic syndrome that have received scant attention in the literature. Neither the subjective experiences of catatonic patients, nor their cogni -tive performance have been studied in a systematic manner. Despite of the relatively high frequency of catatonic symptoms and signs, there is a paucity of publications on catatonia in the Eastern European literature. For in -stance, apart from the papers by the authors of the current study, only 3 articles have been published by Hungarian authors in the last 15 years (a description of 3 cases of catatonia treated with aripiprazole [27], a review on the overlap of catatonia and neuroleptic malignant syndrome [28], and on movement disorders in psychiatric disorders [29]).The aim of this prospective study was to determine the prevalence and symp- referred to the acute psychiatric ward of a general hospital in Budapest, Hungary. The cognitive performance of a geriatric subset of the current sample has been re-ported elsewhere [30].Material and methodCatatonic signs and symptoms were scored according to both the DSM-5 diagnostic criteria and the BushŒFrancis Catatonia Rating Scale (BFCRS). Clinical diagnoses were established using the Structured Clinical Interview for DSM-IV Disorders (SCID), the Clock Drawing Test and the Mini-Mental State Examination (MMSE).
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Rozália Takács et al. 1254As part of the comprehensive psychiatric assessment on admission, all patients admitted to the Center of Psychiatry and Addiction Medicine (CPAM), Szent István and Szent László Hospitals from 1 April 2015 to 31 July 2015 were screened for catatonic symptoms. The CPAM has 293 beds, including 64 acute adult psychiatric beds, 88 for addiction medicine and 141 for psychiatric rehabilitation. The CPAM covers a catchment area of approximately 330,000 people. The BushŒFrancis Cata-tonia Screening Instrument (BFCSI) was used to assess catatonic symptoms. If two or more catatonic symptoms were scored on the BFCSI, the severity of catatonia was rated with the BFCRS. and is used as a screening instrument. Catatonic symptoms observed over the 24-hour period preceding the examination are rated from 0 to 3. The sum score on the BFCRS ranges from 2 to 60 (some catatonic features do not co-occur and exclude each other).Catatonia was independently and simultaneously scored according to both the DSM-5 diagnostic criteria (RT) and the BFCRS (MA) by two raters. Inter-rater reli – 30 patients, yielding an excellent kappa value of 0.9 for inter-rater reliability. The principal author made the clinical diagnoses using the validated Hungarian versions of the Structured Clinical Interview for DSM-IV Disorders (SCID I-II) [31, 32]. Basic cognitive functions were assessed using the Clock Drawing Test [33] and the Mini Mental State Examination (MMSE) [34].The study protocol was approved by the Research Ethics Committee of the Szent István and Szent László Hospitals. All participants gave written informed consent. Statistical methodsDescriptive data were calculated as means and standard deviations or percentages, as appropriate.ResultsDuring the study period, 342 patients were admitted to the CPAM. Four patients were discharged before the evaluation; thus 338 patients were included in the study. BFCRS and DSM-5, respectively. The mean age of the catatonic patients was 57.6 ± 3.2
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1255The frequency of catatonic syndrome in an acute psychiatric ward distribution in the catatonic group is presented in Table 1. Table 1. Diagnostic distribution of patients presenting with catatonic syndrome DiagnosisNumber of patientsSchizophrenia spectrum disorder8 (27.5%)Affective disorder 5 (17.2%)Major neurocognitive disorder combined with a medical condition4 (13.8%)Catatonia due to a medical condition3 (10.3%)Major neurocognitive disorder combined with an affective disorder 3 (10.3%)Psychoactive substance withdrawal syndrome2 (6.8%)Personality disorders2 (6.8%)Major neurocognitive disorder1 (3.4%)Alcohol withdrawal syndrome1 (3.4%)Down syndrome1 (3.4%)The prevalence of catatonic symptoms according to the BFCRS was as follows: – Discussion – the literature [35]. Schizophrenia spectrum disorders were most frequently associated with catatonia.As expected, catatonia was diagnosed less frequently according to the DSM-5 than standardized assessment over routine clinical interview. In addition, DSM-5 covers
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Rozália Takács et al. 12566050403020100Immobility/stuporStaringExcitementMitgehenMutismManierismRigidityNegativismCatalepsyPerseverationVerbigeration Automatic obedienceGrimacingWithdrawn behaviorImpulsivityGrasp reflexWaxy flexibility GegenhaltenAmbitendencyVegetative disturbance Figure 1. The prevalence of catatonic symptoms according to the BFCRS (%) from DSM-5 (including staring, Mitgehen, perseveration, verbigeration, automatic – evidence-based consensus regarding the symptomatology of catatonia. These symptoms staring, automatic obedience, and withdrawal have been reported with high frequency in this and other studies [36, 37], their absence from the DSM-5 diagnostic criteria suggests that a revision of these criteria is warranted.In accordance with most of the literature, the retarded type of catatonia [23] domi – diagnosed less frequently. In clinical practice, the use of standardized catatonia questionnaires is recom – treated [38] and early treatment could prevent potentially life-threatening complications such as thromboembolism, pneumonia and dehydration, early recognition of catatonic symptoms is vital [1]. cases occur in the context of a variety of medical and neurological diseases such as hyperparathyroidism [40], diabetic ketoacidosis [41], hepatic dysfunction [42], and
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Rozália Takács et al. 12586. Psychiatrie: Ein Lehrbuch, 6th ed. Leipzig: Barth; 1899.7. The catatonia conundrum: Evidence of psychomotor phe -nomena as a symptom dimension in psychotic disorders Doi: 10.1093/schbul/sbp105.8. Gazdag G, Takacs R, Ungvari GS. Catatonia as a putative nosological entity: A historical sketch . 9. Abrams R, Taylor MA. Catatonia. A prospective clinical study . Arch. Gen. Psychiatry 1976; 10. Gelenberg AJ. The catatonic syndrome 11. Catatonia associated with glutethimide withdrawal . J. Clin. 12. World Health Organization. . Geneva, Switzerland: World Health Organization; 1992. 13. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th ed. Washington, DC: American Psychiatric Association; 1994. 14. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed. Arlington, VA: American Psychiatric Publishing; 2013. 15. Recurrent idiopathic catatonia: Implications beyond the Diagnostic and Statistical Manual of Mental Disorders 5th Edition . 16. Catatonia: Disappeared or under-diagnosed? 17. Rasmussen SA, Mazurek MF, Rosebush PI. Catatonia: Our current understanding of its diag -nosis, treatment and pathophysiology wjp.v6.i4.391.18. Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia. I. Rating scale and standardized examination 19. Peralta V, Cuesta MJ. Motor features in psychotic disorders. II. Development of diagnostic criteria for catatonia 20. Lee JW, Swartz DL, Hallmayer J. Catatonia in a psychiatric intensive care facility: Incidence and response to benzodiazepines 21. Stuivenga M, Morrens M. Prevalence of the catatonic syndrome in an acute inpatient sample . Front. Psychiatry 2014; 5: 174.22. Benzodiazepines in the treatment of catatonic syn -drome 23. Grover S, Chakrabarti S, Ghormode D, Agarwal M, Sharma A, Avasthi A. Catatonia in inpatients with psychiatric disorders: A comparison of schizophrenia and mood disorders . Psychiatry Res.
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1259The frequency of catatonic syndrome in an acute psychiatric ward24. Fink M, Shorter E, Taylor MA. Catatonia is not schizophrenia: Kraepelin™s error and the need to recognize catatonia as an independent syndrome in medical nomenclature . Schizophr. Bull. 25. Takács R, Rihmer Z. 26. Sienaert P, Rooseleer J, De Fruyt J. Measuring catatonia: A systematic review of rating scales . 27. Vörös V, Tényi T. Use of aripiprazole in the treatment of catatonia . Neuropsychopharmacol. 28. Asztalos Z, Egervári L, Andrássy G, Faludi G, Frecska E. Catatonia and neuroleptic malignant syndrome in view of a psychopathological and pathophysiological overlap: A brief review . 29. Hidasi Z, Salacz P, Csibri E. Movement disorders is psychiatric diseases . Neuropsychopharmacol. 30. Takács R, Asztalos M, Ungvari GS, Gazdag G. Catatonia in an inpatient gerontopsychiatric population31. Szádóczky E, Unoka Zs, Rózsa S. SCID-II Strukturált klinikai interjú a DSM-IV II-es tengelyén található személyiségzavarok felmérésére (Structured Clinical Interview for DSM-IV Axis II Disorders) 32. Szádóczky E, Rózsa S, Unoka Zs. SCID-I Strukturált klinikai interjú a DSM-IV I-es tenge -lyén található zavarok diagnosztizálására (Structured Clinical Interview for DSM-IV Axis I) . 33. The challenge of time: Clock-drawing and cognitive function in the elderly 34. Folstein M, Folstein SE, McHugh PR. fiMini-Mental Statefl a practical method for grading the cognitive state of patients for the clinician 35. Francis A, Fink M, Appiani F, Bertelsen A, Bolwig TG, Bräunig P et al. Catatonia in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition 10.1097/YCT.0b013e3181fe28bd. 36. Jaimes-Albornoz W, Serra-Mestres J. Catatonia in the emergency department . Emerg. Med. J. 37. Prevalence and symptomatology of catatonia in elderly patients referred to a consultation-liaison psychiatry service . Australasian Psychiatry 38. Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G. A clinical review of the treat -ment of catatonia. Front. Psychiatry. 2014; 5: 181. Doi: 10.3389/fpsyt.2014.00181. 39. Caroll BT, Goforth HW. Medical catatonia GL, editors. Catatonia: From psychopathology to neurobiology . Washington, DC: American 40. Gatewood J, Organ C, Mead B. Mental changes associated with hyperparathyroidism . Am. J.
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Rozália Takács et al. 126041. Catatonic syndrome associated with diabetes, mellitus . Arch. Neurol. Psychiatry 1934; 42. Catatonia and hepatic dysfunction 43. Catatonia: An unusual manifestation of Wil -son™s disease neuropsych.13120362.Address: Gábor Gazdag1st Department of Psychiatry and Psychiatric RehabilitationJahn Ferenc Hospital e-mail: [email protected]
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