Catatonia as a psychomotor syndrome: A rating scale and extrapyramidal motor symptoms

BACKGROUND: Catatonia was first described by Kahlbaum as a psychomotor dise ase with motor, behavioral, and affective symptoms. Tn keeping with this co ncept, we developed a rating scale for catatonia (Northoff Catatonia Scale [NCS]) with three different categories of symptoms (i.e., motor, behavioral , affective). Furthermore, the question of the relationship among catatonic symptoms, extrapyramidal motor symptoms, and neuroleptics was addressed in the present study. METHOD: 34 acute catatonic patients and 68 age-, sex-, diagnosis-, and medi cation-matched psychiatric control subjects were investigated on days 0, 1, 3, 7, and 21 with the NCS, with other already validated catatonia rating s cales by Rosebush, Bush (BFCRS), and Rogers (MRS), as well as with scales f or hypokinetic (SEPS) and dyskinetic (AIMS) extrapyramidal motor features. Validity and reliability of the new scale, factor analysis, correlational a nalysis, and differences between catatonic patients and psychiatric control subjects were statistically calculated. RESULTS: NCS showed high validity (i.e., significant positive correlations [p < 0.0001] with the other scales, significant differences between cataton ic and control subjects), high intra- and interrater reliabilities (r = 0.8 0-0.96), and high affective subscores. Factor analysis revealed four factor s best characterized as affective, hypoactive, hyperactive, and behavioral. Catatonic scores in NCS correlated significantly with AIMS on day 0 and SE PS on days 7 and 21. There were no significant differences in catatonic (i. e., NCS, MRS, BFCRS) and extra-pyramidal (i.e., AIMS, SEPS) scores between neuroleptically treated and untreated catatonic subjects. CONCLUSIONS: The following conclusions were drawn: (1) the NCS has to be co nsidered as a valid and reliable rating instrument for catatonia; (2) catat onia can be characterized by psychomotor symptoms encompassing motor, affec tive, and behavioral alterations; and (3) extrapyramidal hyperkinesias like dyskinesias are apparently closely related to catatonic symptoms which, in general, seem to be relatively independent of previous neuroleptic medicat ion.