Table 1 Overlapping clinical criteria for catatonia and pediatric acute-onset neuropsychiatric syndrome (PANS).

From: Youth with severe mental illness and complex non-somatic motor abnormalities: conflicting conceptualizations and unequal treatment

    

PANS

    

(Swedo et al.)*

(Pfeiffer et al.)**

 

DSM-5

BFCRS

PCRS

Criteria

Item

Criteria

Item

Catalepsy (i.e., passive induction of a posture held against gravity)

X

X

X

X

II.6. Sensory or motor abnormalities

X

2.6. Sensory or motor abnormalities

Waxy flexibility (i.e., slight and even resistance to positioning by examiner)

X

X

X

X

II.6. Sensory or motor abnormalities

X

2.6. Sensory or motor abnormalities

Agitation (i.e., not influenced by external stimuli)

X

  

X

II.3. Irritability, aggression, and/or severely oppositional behaviors

X

2.3. Irritability, aggression, and/or severely oppositional behaviors

Negativism (i.e., opposing or not responding to instructions or external stimuli)

X

X

X

X

II.3. Irritability, aggression, and/or severely oppositional behaviors

X

2.3. Irritability, aggression, and/or severely oppositional behaviors

Posturing (i.e., spontaneous and active maintenance of a posture against gravity)

X

X

X

X

II.6. Sensory or motor abnormalities

X

2.6. Sensory or motor abnormalities

Mannerisms (i.e., odd caricature of normal actions)

X

X

X

X

II.6. Sensory or motor abnormalities

X

2.6. Sensory or motor abnormalities

Stereotypes (i.e., repetitive, abnormally frequent, non-goal directed movements)

X

X

X

X

II.6. Sensory or motor abnormalities

X

2.6. Sensory or motor abnormalities

Echopraxia (i.e., mimicking another’s movements)

X

X

X

X

II.6. Sensory or motor abnormalities

X

2.6. Sensory or motor abnormalities

Excitement (i.e., extreme hyperactivity, constant motor unrest which is apparently non-purposeful. Not to be attributed to akathisia or goal-directed agitation)

 

X

X

X

II.6. Sensory or motor abnormalities

X

2.6. Sensory or motor abnormalities

Rigidity (i.e., maintenance of a rigid position despite efforts to be moved, exclude if cogwheeling or tremor present)

 

X

X

X

II.6. Sensory or motor abnormalities

X

2.6. Sensory or motor abnormalities

Withdrawal (i.e., refusal to eat, drink and/or make eye contact)

 

X

X

X

I. Abrupt, dramatic onset of obsessive-compulsive disorder or severely restricted food intake

X

1. Abrupt, dramatic onset (culmination within 72 h) of … severely restricted food intake.

Impulsivity (i.e., patient suddenly engages in inappropriate behavior without provocation. Afterwards can give no, or only facile explanation)

 

X

 

X

II.3. Irritability, aggression, and/or severely oppositional behaviors

X

3. Irritability, aggression, and/or severely oppositional behaviors

Mitgehen (i.e., “anglepoise lamp”, arm raising in response to light pressure or finger, despite instruction to the contrary)

 

X

 

X

II.6. Sensory or motor abnormalities

X

6. Sensory or motor abnormalities

Ambitendency (i.e., patient appears motorically “stuck” in indecisive hesitant movement)

 

X

 

X

II.6. Sensory or motor abnormalities

X

6. Sensory or motor abnormalities

Gegenhalten (i.e., resistance to passive movement which is proportional to strength of the stimulus, appears automatic rather than willful)

 

X

 

X

II.6. Sensory or motor abnormalities

X

6. Sensory or motor abnormalities

Grasp reflex (i.e., per neurological exam)

 

X

 

X

II.6. Sensory or motor abnormalities

X

6. Sensory or motor abnormalities

Combativeness (i.e., usually in an undirected manner, with no, or only a facile explanation afterwards)

 

X

 

X

II.3. Irritability, aggression, and/or severely oppositional behaviors

X

3. Irritability, aggression, and/or severely oppositional behaviors

Incontinence (i.e., nocturnal enuresis, daytime urinary incontinence, or fecal incontinence)

  

X

X

II.7. Somatic signs and symptoms, including sleep disturbances, enuresis, or increased urinary frequency.

X

7. Somatic signs and symptoms, including sleep disturbances, enuresis, or increased urinary frequency.

Automatic compulsive movements (i.e., involuntary muscle activity exhibited in posture, attitudes, mimic, or gesture due to inhibition or forced motor action)

  

X

X

II.6. Sensory or motor abnormalities

X

6. Sensory or motor abnormalities

Schizophasia (i.e., scrambled speech)

  

X

X

II.4. Behavioral (developmental) regression

X

4. Behavioral (developmental) regression

  1. The first four columns of this table have been previously published by Benarous et al.14. Proposed consensus guidelines and clinical criteria for PANS were compared for potential overlap with catatonic symptoms. For visualization purposes, only clinical criteria for catatonia deemed to significantly overlap with PANS were shown. Table 1 demonstrates that unspecific PANS-items due to their non-specificity can be attributed to multiple catatonic symptoms. For example, “Sensory or motor abnormalities” - proposed as criteria for PANS - could theoretically also fulfill catatonic items pertaining to catalepsy, waxy flexibility, posturing, mannerisms, stereotypes, echopraxia, excitement, rigidity, mitgehen, ambitendency, gegenhalten, grasp reflex and automatic compulsive movements. Moreover, enuresis is also included in the PCRS and deemed significant for pediatric catatonia14. In addition, PANS item “irritability, aggression and/or severely oppositional behaviours” closely mimic catatonic symptoms of agitation, negativism, and combativeness. “Reduced intake of food or fluid”, by Pfeiffer et al. proposed as a definition of severe PANS-symptoms, is also included in DSM-V, BFCRS and PCRS under withdrawal (i.e., refusal to eat, drink and/or make eye contact). Indeed, although not formally included as a diagnostic item, pediatric catatonia has been depicted as a treatable cause of developmental regression58, while also included as a PANS item (i.e., “Behavioural (developmental) regression”).
  2. *Proposed clinical criteria of Pediatric Acute onset Neuropsychiatric Syndrome (PANS) by Swedo et al.4.
  3. **Proposed clinical criteria of Pediatric Acute onset Neuropsychiatric Syndrome (PANS) by Pfeiffer et al.5.
  4. PANS Pediatric Acute onset Neuropsychiatric Syndrome, DSM-5 Diagnostic and Statistical Manual of mental disorders version V, BFCRS Bush-Francis Catatonia Rating Scale, PCRS Pediatric Catatonia Rating Scale.
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