Table 2 Conservative assessment of putative catatonic items in published PANS case-reports (Frankovich et al. [2015])—Case 1.
Catatonic criteria | DSM-5 | PCRS | BFCRS | Reference (PANS) | Rationale for putative presence of catatonic items |
|---|---|---|---|---|---|
Criteria fulfilled/total score | 3 | 11 | 13 | ||
Mutism (i.e., no, or very little, verbal response, not applicable if there is established aphasia) | X | 2 | 2 | (a) “Nearly absent communication (both talking and writing) except to discuss her braces.” (b) “Her illness stayed at this intensity with continued behavioral regression, cognitive deterioration, anxiety, perseverations, repetitive self-soothing, delayed or absent verbal responses, persistent insomnia, poor hygiene, poor oral intake with ongoing weight loss, and jaw tremor.” | General: No indication of aphasia. DSM-5: Assessment – “no, or very little, verbal response”. PCRS: Assessment – “Speaks less than 20 words/5 min” BFCRS: Assessment – “Speaks less than 20 words/5 min” |
Stereotypes (i.e., repetitive, abnormally frequent, non-goal directed movements) | X | 3 | 3 | (a) “She also had severe insomnia (not sleeping for 4 consecutive days), nearly absent communication (both talking and writing) except to discuss her braces, constant wiping of her face with her right hand, and inconsolable crying and screaming, and she was unable to engage in daily life activities including bathing and other personal hygiene activities.” (b) “Her illness stayed at this intensity with continued behavioral regression, cognitive deterioration, anxiety, perseverations, repetitive self-soothing, delayed or absent verbal responses, persistent insomnia, poor hygiene, poor oral intake with ongoing weight loss, and jaw tremor.” | General: No indication of invasive thoughts or ideas. Frequency constant. Intensity unclear. DSM-5: Equivalent to “repetitive, abnormally frequent non-goal directed movements”. PCRS: a) Description – “Repetitive, abnormally frequent, non-goal directed movements” b) Assessment – “Constant” BFCRS: a) Description – “Repetitive, non-goal directed motor activity (e.g., finger-play; repeatedly touching, patting or rubbing self); abnormality not inherent in act but in frequency.” b) Assessment – “Constant” |
Impulsivity (i.e., patient suddenly engages in inappropriate behavior without provocation. Afterwards can give no, or only facile explanation) | - | - | 3 | “Her behavioral issues became unmanageable because of her constant and obsessive hitting of her parents, crying and screaming, running into the streets, hiding, and trying to jump out of moving cars.” | General: Item not included in DSM-5 or PCRS. No indication of capacity to subsequently motivate/explain behavior. BFCRS: a) Description – “Patient suddenly engages in inappropriate behavior (e.g., runs down hallway, starts screaming or takes off clothes) without provocation. Afterwards can give no, or only a facile explanation”. b) Assessment – “Constant or not redirectable (impulsivity)” |
Withdrawal (i.e., refusal to eat, drink and/or make eye contact)a | X | 3 | 3 | (a) “She could not feed herself, swallow, or chew, and food would fall out of her mouth if her mother fed her.” (b) “Her illness stayed at this intensity with continued behavioral regression, cognitive deterioration, anxiety, perseverations, repetitive self-soothing, delayed or absent verbal responses, persistent insomnia, poor hygiene, poor oral intake with ongoing weight loss, and jaw tremor.” | DSM-5: Equivalent to “refusal to eat, drink and/or make eye contact”. PCRS: a) Item – “20. Refusal to eat, drink” b) Description – “Severe decrease of daily food or drink intake” c) Assessment – “No per os intake for one day or more” BFCRS: a) Description – “refusal to eat, drink and/or make eye contect” b) Assessment – “No PO intake/interaction for 1 day or more” |
Combativeness (i.e., usually in an undirected manner, with no, or only a facile explanation afterwards) | - | - | 2 | “Her behavioral issues became unmanageable because of her constant and obsessive hitting of her parents, crying and screaming, running into the streets, hiding, and trying to jump out of moving cars.” | General: Item not present on the DSM-5 or PCRS BFCRS: a) Description – “Usually in an undirected manner, with no, or only a facile explanation afterwards” b) Assessment – “Frequently strikes out, moderate potential for injury” |
Incontinence (i.e., nocturnal enuresis, daytime urinary incontinence, or fecal incontinence)b | - | 3 | - | “Three weeks into the course of this illness she developed urinary incontinence, and extreme persistent urinary frequency of unknown cause, ultimately requiring her to wear diapers.” | General: Item not present on the DSM-5 or BFCRS PCRS: a) Description – “Nocturnal enuresis, daytime urinary incontinence, or fecal incontinence” b) Assessment – “Constant” |
