Diagnosing subtypes of neuroleptic malignant syndrome: an introduction to the Lee-Carroll Scale.

BACKGROUND: Neuroleptic malignant syndrome (NMS) shares common features with catatonia and serotonin syndrome (SS). For instance, catatonia is a risk factor for the development of NMS. METHODS: We performed a pilot study to examine if the Lee-Carroll Scale is able to differentiate the proposed NMS subtypes and explore possible relationship between NMS and SS. A consecutive series of cases reported to the Neuroleptic Malignant Syndrome Information Service (NMSIS) were reviewed with 29 cases of "definite NMS." The Hynes-Vickar Scale (an NMS scale), Hegerl Scale (a SS scale), and Lee-Carroll Scale (an NMS subtype scale) were applied to these case report forms. CONCLUSIONS: Although the groups were too small for statistical analysis, the 2 catatonic NMS subtypes appear to have higher NMS scores on the Hynes-Vickar Scale, and lower SS scores on the Hegerl Scale than the non-catatonic NMS subtype. The scores on the Lee-Carroll Scale were highest for non-catatonic NMS subtype. This pilot study suggests that the Lee-Carroll scale may help differentiate the subtypes of NMS, and provides some support that non-catatonic NMS may be a form of SS. NMS subtypes may be important in the early detection and treatment of NMS.

Katatonia: a new conceptual understanding of catatonia and a new rating scale.

MODERN PSYCHIATRIC NOSOLOGIES SEPARATE CATATONIA ALONG THE LINES OF PRESUMED ETIOLOGY: bipolar, major depression, schizophrenia, and/or due to a general medical condition. Catatonic signs have always possessed significant diagnostic, therapeutic, and prognostic value. Kahlbaum's description of this syndrome in his monograph "Katatonia" included careful documentation of phenomenology. Kahlbaum selected the term katatonia to describe "tension insanity." He felt that the neuromotor signs were more important than the content of delusions (e.g. megalomania). While he felt that he was describing a unitary illness, he did identify mood disturbance, psychosis, and medical factors in this new illness.(1) In modern times, the term catatonia has become limited to describe a specifier of neuropsychiatric illnesses.The authors of this article feel that the term katatonia should be used to describe a group of neuropsychiatric illnesses presenting with catatonic signs. This may prevent the misconception that "catatonia is schizophrenia" and improve the detection of katatonia in patients. Specifically, katatonia is also observed in mood disorders, general medical conditions, and pervasive developmental disorders. The literature also supports the view of Dr. Leo Kanner and his description for neuromotor and neuropsychiatric signs in autistic disorder. This scale is named in honor of Dr. Kanner. It was developed by the authors and includes some of Dr. Kanner's core concepts. This paper will identify the clinical features of katatonia and introduce the KANNER scale (see Appendix 1) to improve conceptualization, detection, and measurement of this important clinical syndrome.

The detection and measurement of catatonia.

Catatonia is a complex neuropsychiatric syndrome that occurs with primary psychiatric disorders or secondary to general medical conditions. Catatonia is often neglected when screening and examining psychiatric patients. Undiagnosed catatonia can increase morbidity and mortality, illustrating the need to effectively screen patients for presence of catatonia as well as their response to treatment. There are many barriers to the diagnosis of catatonia that may explain the low rates of diagnosis in modern psychiatry. This article will review the many barriers that exist in the detection, recognition, and diagnosis of catatonia. Various criteria and rating scales have been applied to catatonia. The lack of precise definitions and validity of catatonia has hindered the detection of catatonia, thus delaying diagnosis and appropriate treatment. This review article will illustrate the need for a new rating scale to screen and detect catatonia as it occurs in a variety of healthcare settings. This article will also review the characteristics such a scale should possess to produce a quality instrument to aid in the appropriate care of the catatonic patient.