Fluctuation of Catatonic Signs in a Naturalistic Clinical Sample

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 (t 1 ), at approximately 5-6 p.m. (t 2 ), and the following day’s rounds (t 3 ). 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 t 1 to t 3 . All patients experienced at least one of the following for at least one catatonic sign from t 1 to t 3 : disappearance, emergence, laterality change, or severity change. Among untreated patients from t 1 to t 3 , BFCRS scores were higher at t 1 and t 3 than t 2 , 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 t 2 and regained it at t 3 , 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.