Evaluation, Differential Diagnosis, and Treatment of Catatonia

Evaluation, Differential Diagnosis, and Treatment

Evaluation

Effective treatment starts with a swift and correct diagnosis. In any patient exhibiting marked deterioration in psychomotor function and overall responsiveness, we should consider catatonia. Any patient that is admitted to a psychiatric ward with a severe psychiatric disorder, such as depression, bipolar disorder, a psychotic disorder, or autism spectrum disorder, should be examined routinely. Some signs and symptoms are clear upon observation of the patient during a psychiatric interview. Other specific symptoms, however, such as automatic obedience, ambitendency, negativism should be elicited during a neuropsychiatric examination.

Scales

We can use a rating scale as a screening instrument and aid in the detection and quantification of catatonia. We have found several rating scales reliable, sensitive, and specific:

Rogers Catatonia Scale
Bush-Francis Catatonia Rating Scale
Northoff Catatonia Rating Scale
Braunig Catatonia Rating Scale

Early detection of catatonia is of great importance, since catatonic signs possess significant prognostic and therapeutic value.

Investigations

Unfortunately, no laboratory test specifically defines catatonia. The “diagnostic weight” of several proposed laboratory and imaging tests is limited. Laboratory tests, primarily to assess various underlying conditions, including a complete blood count and metabolic panel, erythrocyte sedimentation rate, blood urea nitrogen, creatinine, serum iron, and creatinine-phosphokinase, antinuclear antibodies, and urinalysis, and magnetic resonance imaging, electroencephalogram, cerebrospinal fluid analysis. Given the frequent association with anti-NMDAR-encephalitis, detection of IgG antibodies to NMDAR in cerebrospinal fluid or serum is advisable. Since we found serum iron to be reduced in NMS compared to catatonia, some authors see low serum iron as a risk factor for developing NMS after using antipsychotics in a catatonic patient. A drug screen to detect common illicit and prescribed substances is necessary.

Fish's Clinical Psychopathology: Signs and Symptoms in Psychiatry

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Sims' Symptoms in the Mind: Textbook of Descriptive Psychopathology

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Oxford Handbook of Psychiatry (Oxford Medical Handbooks)

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Shorter Oxford Textbook of Psychiatry Paperback

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