Journal Article Annotations
2016, 3rd Quarter
Annotations by Lex Denysenko, MD, FAPM
Also of interest:
The finding: Prevalence of catatonia in the C-L setting in patients over the age of 65 was 6 in 108 patients (5.5%). Rigidity and immobility were the most common symptoms. Most had delirium as well as catatonia. The authors conclude that it was unclear if use of the Bush Francis Catatonia Screening instrument was successful in capturing any additional cases of catatonia that would not have been identified by standard routine psychiatric interview and examination.
Strength: Prospective study across 6 hospitals in a 6 month period.
Weaknesses: Subjects were consented, and 45 were unable to be consented, which may have affected results of the study. It is unclear who performed the catatonia screenings, how they were trained, and how cases of catatonia were confirmed. It is unclear if the subjects filled DSM-5 criteria for catatonia, or if their symptoms could be better explained by another disorder (example: Parkinson’s Plus syndrome, stroke).
Relevance: Catatonia in the elderly population has been estimated to be higher in prevalence than in all age adults in at least one prior study, and this prospective study supports this. Delirium and catatonia were both present in 50% of the subjects. A better/easier screening instrument for detecting catatonia in the general medical setting is needed.
The finding: This study shows the Bush Francis Catatonia Rating Scale loses reliability when severity of catatonia was low. It proved difficult to reduce the symptoms to three factors and still maintain reliability, with 63% of the variance unexplained.
Strengths: Largest sample size yet for such a study. Study included subjects from variety of settings (inpatient, outpatient, and C-L settings). Included a large subset of patients with validated catatonia by treatment response. First study to use item response theory to estimate each element of catatonia scale in terms of utility and reliability.
Weaknesses: Sample size may still be too small to generate conclusive or generalizable results.
Relevance: This study supports a conclusion that further work on creating a more improved rating or screening instrument for catatonia in all settings is necessary. Further exploration of the core components of catatonia has yet to be fully discovered.