Fluctuation of Catatonic Signs in a Naturalistic Clinical Sample

Abstract

Background

We are unaware of investigations into whether catatonic signs fluctuate over short periods, so we quantified changes in catatonic signs over 24-hours in a naturalistic clinical sample.

Methods

Psychiatric inpatients with catatonia were evaluated using the Bush Francis Catatonia Rating Scale (BFCRS) during morning rounds (t₁), at approximately 5-6 p.m. (t₂), and the following day’s rounds (t₃). Descriptive statistics were calculated regarding changes in sign presence/absence, severity, and laterality, as well as catatonic caseness.

Results

Twenty-six patients were included, and 19.2% (5/26) were not treated for catatonia using GABA (gamma-aminobutyric acid)-ergic agents, NMDA (N-methyl-D-aspartate)-receptor antagonists, or electroconvulsive therapy from t₁ to t₃. All patients experienced at least one of the following for at least one catatonic sign from t₁ to t₃: disappearance, emergence, laterality change, or severity change. Among untreated patients from t₁ to t₃, BFCRS scores were higher at t₁ and t₃ than t₂, suggesting catatonia may be more severe in the morning. Where BFCRS scores were available for all timepoints, 8.3% (2/24) of patients lost caseness at t₂ and regained it at t₃, including 20.0% (1/5) of untreated patients.

Conclusion

These data suggest catatonic signs fluctuate over short periods, and catatonic caseness may be lost and regained over 24 h.