Describing the features of catatonia: A comparative phenotypic analysis

Area of Science:

• Psychiatry and Neurology
• Clinical Diagnostics

Background:

• Catatonia is frequently under-diagnosed, with inconsistencies in rating scales and diagnostic criteria contributing to clinical challenges.
• Understanding the evolution of catatonia diagnosis within the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) is essential.

Approach:

• This review analyzes the nature of catatonia diagnosis, its historical development in major diagnostic systems, and various scoring methodologies.
• A descriptive survey of individual catatonia signs across different scales and diagnostic criteria was conducted to identify sources of variance in case identification.

Key Points:

• While DSM-5-TR and ICD-11 criteria for catatonia show alignment in included items and definitions, a significant limitation is the absence of defined item thresholds.
• Discrepancies across scales and criteria contribute to diagnostic disagreement among clinicians.
• The Bush-Francis Catatonia Rating Scale and the Northoff scale are highlighted as adaptable for diagnostic criteria, with Bush-Francis noted for efficiency and Northoff for detailed assessment including emotional and volitional aspects.

Conclusions:

• Despite advancements in understanding the catatonia phenotype, significant limitations persist in current ICD and DSM classifications.
• Variations across scales and criteria impede reliable catatonia detection and diagnosis.
• Establishing clear, consistent definitions for catatonia features is paramount for improving diagnostic accuracy and clinical recognition.