University of Rochester Medical Center, 300 Crittenden Blvd. Box PSYCH, Rochester, NY 14642.
Schizophr Res. 2024 Jan;263:82-92. doi: 10.1016/j.schres.2022.08.002. Epub 2022 Aug 20.
Catatonia is widely under-detected, and the many differences across catatonia rating scales and diagnostic criteria could be a key reason why clinicians have a hard time knowing what catatonia looks like and what constitutes each of its features.
This review begins by discussing the nature of catatonia diagnosis, its evolution in ICD and DSM, and different approaches to scoring. The central analysis then provides a descriptive survey of catatonia's individual signs across scales and diagnostic criteria. The goal of this survey is to characterize distinctions across scales and diagnostic criteria that can introduce variance into catatonia caseness.
Diagnostic criteria for catatonia in DSM-5-TR and ICD-11 are broadly aligned in terms of which items are included, item definitions and number of items required for diagnosis; however, the lack of item thresholds is a fundamental limitation. Many distinctions across scales and criteria could contribute to diagnostic discordance.
Clear, consistent definitions for catatonia features are essential for reliable detection. Of available scales, Bush-Francis and Northoff can be converted to diagnostic criteria with limited modification. Bush-Francis is the most efficient, with a screening instrument, videographic resources and standardized clinical assessment. Northoff offers the most detailed assessment and uniquely emphasizes emotional and volitional disturbances in catatonia.
The field's understanding of the catatonia phenotype has advanced considerably over the past few decades. However, this review reveals many important limitations in the ICD and DSM as well as differences across scales and criteria that stand in the way of reliable catatonia detection.
紧张症广泛未被发现，而紧张症评定量表和诊断标准之间的诸多差异可能是临床医生难以了解紧张症的表现形式以及其各个特征的重要原因。
本综述首先讨论了紧张症诊断的性质、其在 ICD 和 DSM 中的演变以及评分的不同方法。然后进行了中心分析，对各量表和诊断标准中的紧张症的个体体征进行了描述性调查。本次调查的目的是描述各量表和诊断标准之间的差异，这些差异可能会导致紧张症病例的变异性。
DSM-5-TR 和 ICD-11 中的紧张症诊断标准在包含的项目、项目定义和诊断所需的项目数量方面大致一致；然而，缺乏项目阈值是一个根本的局限性。各量表和标准之间的许多差异可能导致诊断不一致。
对紧张症特征的明确、一致的定义对于可靠的检测至关重要。在现有的量表中，Bush-Francis 和 Northoff 可以通过有限的修改转化为诊断标准。Bush-Francis 是最有效的，它有一个筛查工具、录像资源和标准化的临床评估。Northoff 提供了最详细的评估，并独特地强调了紧张症中的情感和意志障碍。
在过去几十年中，人们对紧张症表型的理解有了很大的进步。然而，本综述揭示了 ICD 和 DSM 中的许多重要局限性，以及各量表和标准之间的差异，这些都妨碍了可靠的紧张症检测。
