Catatonia: Disappeared or Under-Diagnosed?

Abstract

Background: Over the last century, especially during the latter half, the prevalence of the diagnosis of catatonic schizophrenia decreased considerably. Several explanations for this phenomenon have been put forward. Sampling and Methods: The present study investigated the frequency of the diagnosis of catatonic schizophrenia in a large sample of admitted psychiatric patients (n = 19,309). In addition, the presence of catatonic symptoms was studied in a sample of patients with schizophrenia (n = 701) and in a group of consecutively admitted psychotic patients (n = 139). In these two groups the effect of the diagnostic procedures on the recognition of catatonia was examined. Results: The diagnosis of catatonic schizophrenia dropped from 7.8% in 1980–1989 to 1.3% in 1990–2001 (p < 0.001). In addition, a possible under-diagnosis of catatonic schizophrenia was found in an independent sample of patients with schizophrenia. Application of a systematic catatonia rating scale in patients admitted with acute psychosis identified a bimodally distributed catatonic dimension. At least 18% of these patients fulfilled the criteria for catatonia. Interestingly, the catatonic subgroup used atypical antipsychotic compounds more frequently (p < 0.05). Conclusions: The results suggest that changes in diagnostic criteria and the diagnostic procedure itself are responsible for the under-recognition of catatonia.

Development and validation of the Bush-Francis Catatonia Rating Scale – Brazilian version

“…Such an historical definition partially explains the lack of care regarding the catatonic syndrome and its dramatic underdiagnosis 10 . It has become clear, though, that catatonic symptoms can be observed not only in schizophrenia but also in several mental disorders, especially affective disorders 30,31 .…”

“…Nevertheless, this is not referred to in present diagnostic compendiums. Such a poor classification status discourages the diagnosis of catatonia in non-psychotic disorders 10 . The lack of a psychopathological definition and conceptual understanding of catatonia 18 jeopardizes research in the field.…”

“…medication, catatonia may actually be underdiagnosed and little-recognized by untrained examiners 7,8,9,10 . As it is a severe and possibly lethal disorder, early diagnosis and treatment are paramount.…”

A Case of Recurrent Hypersomnia With Autonomic Dysfunction

“…Catatonia is an underdiagnosed neuropsychiatric syndrome, with a reported prevalence ranging from 7% to 17% in acute adult psychiatric inpatients. 5 A wide spectrum of signs and symptoms have been described in catatonia.…”

The enigmatic phenotype: Relevant signs and symptoms in schizophrenia

“…The difficulties in the appreciation of motor symptoms can be inferred from the specific history of catatonia, originally recognised as a separate disease entity by Karl Ludwig Kahlbaum and later considered to be a subtype of schizophrenia or an accessory symptom in various neuropsychiatric disorders (review: Van der Heijden et al 2005).…”