The Modified Rogers Scale It rates abnormalities in movement, volition, speech, and overall behaviour and aids in the distinction of catatonic signs from similar extrapyramidal side effects. It has eleven items, out of which three or more constitute a diagnosis of catatonic syndrome. Items The following are the items included in the Modified Rogers Scale. Stupor Mutism Negativism Opposition Posturing Catalepsy Automatic obedience Echophenomena Rigidity Verbigeration Withdrawal. For information on other scales used in catatonia, see Rating Scales for Catatonia . 

The Bush–Francis Catatonia Rating Scale  The Bush–Francis Catatonia Rating Scale, has been widely recommended for its ease of use and reliability and validity. In this scale, the presence of two or more signs is suggestive of catatonia. Is the most widely used instrument for catatonia. The Bush–Francis Catatonia Rating Scale has twenty-three items, and there is also a shorter, 14-item screening version. The reliability and validity of the Bush–Francis Catatonia Rating Scale has been established (Bush et al, 1996). The screening section marks items #1-14 as either “absent” or “present.” The full-scale rates items #1-23 on a scale of 0-3. The ratings are made based on the observed behaviours during the examination, except for completing the items for “withdrawal” and “autonomic abnormality,” which may be based upon either observed b behaviours/or chart documentation. Rate items only if well defined. If uncertain, rate the item as “0”. Using the Bush–Francis Catatonia Rating Scale, 32% of

Catatonia Catatonia involves a significant psychomotor disturbance, which can occur as catalepsy , stupor , excessive purposeless motor activity, extreme negativism (seemingly motiveless resistance to movement), mutism , and echolalia (imitating speech), or echopraxia (imitating movements). Copyright Notice Adapted from Wikipedia. Text is available under the  Creative Commons Attribution-ShareAlike License 3.0 ; additional terms may apply.

Organic Causes of Stupor and Catatonia A plethora of medical conditions can cause catatonia and stupor . (Reviewed by: Serra-Mestres et. al, 2018)    Subarachnoid hemorrhages, Basal ganglia disorders Non‐convulsive status epilepticus  Locked‐in and akinetic mutism states  Endocrine and metabolic disorders, e.g. Wilson’s disease, hypoxia  Down syndrome, Infections, Dementia Drug toxicity and withdrawal states, even clozapine.

Because of its N-methyl-d-aspartic acid antagonist properties, amantadine (100–500   mg three times a day), and its derivative memantine (5–20   mg/day), have been tried in catatonia. Carroll and coworkers identified 25 cases of amantadine and memantine use in the treatment of catatonia. All cases improved, mostly after 1–7   days. It should be noted, however, that six were unpublished, and that seven other were cases experiencing a “catatonia-parkinsonian syndrome” while under treatment with the high-potency neuroleptic drugs haloperidol or fluphenazine. The symptoms diminished when neuroleptics were tapered, and they added amantadine. Since then, they have published eleven additional cases describing the successful use of amantadine or memantine in catatonia. In one case, in an adolescent girl, catatonia that was resistant to ECT improved after the addition of amantadine. Only in a review of Hawkins and coworkers, they report a case in which the use of amantadine remained without eff

Zolpidem, a positive allosteric modulator of gamma-aminobutyric acid receptors, seems to be a safe and effective treatment alternative. 

Benzodiazepines for the Treatment of Catatonia Benzodiazepines are the first-choice treatment for catatonia, regardless of the underlying condition. Benzodiazepines are positive allosteric modulators of GABA-A receptors and will correct deficient GABA-ergic function in the orbitofrontal cortex. Following a positive Lorazepam Challenge Test , repeated doses of benzodiazepines can a treatment. Their use is safe, easy, and effective, with remission rates reported to be as high as 70–80%. About 65% Rates in a Naturalistic Study In a naturalistic study of 66 children and adolescents with catatonia, they found that benzodiazepines improved catatonia in 65% of cases , that there was no relation between dose and level of improvement, that the dose was higher sometimes (up to 15 mg of lorazepam) than the dose recommended in pediatric patients, and that side effects were few. Two-thirds Improved in a Trial of 107 adults In a recent trial in 107 adult inpatients ( 49% with a psychotic disorde

  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 Catatoni

An overview of Catatonia Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. Catatonia can accompany many psychiatric illnesses and somatic diseases. A minority of catatonic patients suffer from schizophrenia, while a majority has a bipolar disorder. They have also linked catatonia to other psychiatric disorders, such as obsessive-compulsive disorder, post-traumatic stress disorder, or withdrawal from alcohol or benzodiazepines. In up to 25% of cases, they relate catatonia with general medical or neurologic conditions. Recent studies show repeatedly that catatonic symptoms are observable in most patients diagnosed with anti-N-methyl-d-aspartate receptor encephalitis. In adolescents and young adults with autism, we find catatonia in 12–17%. Pediatric catatonia also emerges in patients with tic disorders, and a variety of other (developmental) disorders. The same principles of evaluation and treatment seem to apply to pediatric pat