Catatonia or EPS: Differentiating suble catatonic features from EPS 2/2 neuroleptics

[Madden007]

Catatonia is the most underdiagnosed medical/psychiatric syndrome, especially when the signs or subtle. Once diagnosed, catatonia is often responsive to medication. One thing that still bothers me, and I wonder how some of the more seasoned folks deal with it here, is differenting catatonia from EPS since rigidity, psychomotor ******ation, blunted affect, and etc are often seen in both condition. Thoughts?

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[clausewitz2]

Catatonia is the most underdiagnosed medical/psychiatric syndrome, especially when the signs or subtle. Once diagnosed, catatonia is often responsive to medication. One thing that still bothers me, and I wonder how some of the more seasoned folks deal with it here, is differenting catatonia from EPS since rigidity, psychomotor ******ation, blunted affect, and etc are often seen in both condition. Thoughts?

Rigidity is not at all typical in catatonia, that is not what flexibilitas cerea means.

 

[thepoopologist]

Catatonia is the most underdiagnosed medical/psychiatric syndrome, especially when the signs or subtle. Once diagnosed, catatonia is often responsive to medication. One thing that still bothers me, and I wonder how some of the more seasoned folks deal with it here, is differenting catatonia from EPS since rigidity, psychomotor ******ation, blunted affect, and etc are often seen in both condition. Thoughts?

2/2 neuroleptics. Ok, so that narrows it down

There's no clear defining line from what I know (thus far).

There are differences i.e. rigidity vs waxy flexibility as mentioned.
There is a matter of degree i.e. psychomotor slowing and blunted affect vs slowing down so much that responsiveness is a big problem and aspiration pneumonia is a concern.
There is a judgement call i.e. increased temperature because it's malignant catatonia vs NMS. Then the argument that NMS is a subset of malignant catatonia.
There's the variations i.e. catatonia that results in agitation vs slowing, what looks like EPS from a lot of neuroleptics vs sudden withdrawal of neuroleptics, spike in temperature because of catatonia or NMS or some other reason.

Clinically, I hedge my bets if it's unclear. For example add a course of Ativan for a week to see if they improve, assuming they're hemodynamically and medically stable. If not the latter, then that's up to CL and medicine to hash out. Medicine likes to add dopamine agonists, which is again is a judgement call in someone with for example schizophrenia, but it depends on how far gone the patient is.

 

[jbomba]

Rigidity is not at all typical in catatonia, that is not what flexibilitas cerea means.

Why is rigidity part of the Bush-Francis then?

 

[clausewitz2]

Why is rigidity part of the Bush-Francis then?

When they say rigidity they are talking about resisting being moved out of particular poses, which is not very much like neuroleptic rigidity.it's also not definitional of catatonia, as you can tell from the fact the B-F contains items that are also almost the opposite of rigidity (mitgehen etc). The B-F is one instrument of several that is used to try and screen for and quantify catatonia, it does not define it (and isn't trying to), and is not entirely in accord with other rating scales or definitions.busch francis is used mainly because it is simple and quick.

More specifically, DSM-V removed rigidity as a criterion for catatonia. This paper ( The diagnostic criteria and structure of catatonia ) found in a sample of 232 catatonic patients that rigidity was not present in the majority and eliminating it affected caseness for fewer than 2% of patients. Thus, it is a poor diagnostic criterion.

Also, what kind of rigidity is very important, even for B-F. They explicitly exclude rigidity if cogwheeling or tremor of any kind is present, often overlooked.

 

[jbomba]

When they say rigidity they are talking about resisting being moved out of particular poses, which is not very much like neuroleptic rigidity.it's also not definitional of catatonia, as you can tell from the fact the B-F contains items that are also almost the opposite of rigidity (mitgehen etc). The B-F is one instrument of several that is used to try and screen for and quantify catatonia, it does not define it (and isn't trying to), and is not entirely in accord with other rating scales or definitions.busch francis is used mainly because it is simple and quick.

More specifically, DSM-V removed rigidity as a criterion for catatonia. This paper found in a sample of 232 catatonic patients that rigidity was not present in the majority and eliminating it affected caseness for fewer than 2% of patients. Thus, it is a poor diagnostic criterion.

Also, what kind of rigidity is very important, even for B-F. They explicitly exclude rigidity if cogwheeling or tremor of any kind is present, often overlooked.

I appreciate that thorough explanation, thanks.

 

[Madden007]

When they say rigidity they are talking about resisting being moved out of particular poses, which is not very much like neuroleptic rigidity.it's also not definitional of catatonia, as you can tell from the fact the B-F contains items that are also almost the opposite of rigidity (mitgehen etc). The B-F is one instrument of several that is used to try and screen for and quantify catatonia, it does not define it (and isn't trying to), and is not entirely in accord with other rating scales or definitions.busch francis is used mainly because it is simple and quick.

More specifically, DSM-V removed rigidity as a criterion for catatonia. This paper found in a sample of 232 catatonic patients that rigidity was not present in the majority and eliminating it affected caseness for fewer than 2% of patients. Thus, it is a poor diagnostic criterion.

Also, what kind of rigidity is very important, even for B-F. They explicitly exclude rigidity if cogwheeling or tremor of any kind is present, often overlooked.

thank you all for the thoughtful responses

 

[Alemo]

Rigidity means UNIFORM resistance throughout the range of motion of a muscle group. Waxy flexibility is INITIAL resistance that gives way while moving the group. Posturing is the assumption by the patient of a posture, while catalepsy is the ability to be posed by the examiner.
It helps if you think of the motor symptoms of catatonia as similar to some basal ganglia problems (unable to start and stop movements, unable to control impulses, negativism, muteness, vocal tics, etc etc).