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Fluctuation of Catatonic Signs in a Naturalistic Clinical Sample

Brian S. Barnett,Andrew Francis

Published 2025 in Annals of Clinical Psychiatry

ABSTRACT

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 (t1), at approximately 5-6 p.m. (t2), and the following day’s rounds (t3). 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 t1 to t3. All patients experienced at least one of the following for at least one catatonic sign from t1 to t3: disappearance, emergence, laterality change, or severity change. Among untreated patients from t1 to t3, BFCRS scores were higher at t1 and t3 than t2, 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 t2 and regained it at t3, 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.

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