Objective: To develop a rating instrument to identify catatonia by virtual viewing of motor assessments

Background: Catatonia is a motor comorbidity complicating mental and physical disorders and untreated due to lack of recognition [1-3]. Remote identification of catatonia on motor assessments is hindered by the inability to implement the face-to-face procedures to diagnose catatonia. We demonstrated the feasibility to utilize published measures to identify catatonia in children to characterize catatonia through remote viewing of recorded motor assessments [4].

Method: First, we utilized the most widely used clinical criteria [5, 6] and rating scales [7,8] identified in a systematic review [9] and a rating scale for catatonia in children [10] to construct tabulation of the key criteria to identify catatonia [Table 1]. Second, we expanded the number of possible items to include all items in all of the rating procedures [5-8, 10]. Third, we limited our possible checklist for movements and utterances that can be identified through visual observation of motor assessments. Fourth, we organized items in categories that could readily be scored by experienced raters viewing virtual motor assessments. Fifth, we expressed items succinctly in a checklist without foreign, idiosyncratic, and ambiguous terms [Table 2].

Results: We have distilled 23 key items from a vast spectrum of characteristics of catatonia in widely used rating procedures to be expressed in a simple checklist to be rated present or absent. To facilitate the utilization of our concise procedure to identify catatonia by remote viewing of motor assessments, we are pleased to share our protocol with our colleagues around the world [11].

Conclusion: Our protocol provides a tool for experienced raters to identify catatonia through the remote viewing of motor assessments. This will be the foundation to identify biomarkers for catatonia and related conditions and to facilitate the diagnosis and treatment of catatonia through the video observation of motor assessments. This contribution will facilitate the development of quantitative measurements to assess catatonia in clinical trials, behavioral, and pharmacotherapeutic treatment endeavors. Future investigations will include the assessment of reliability and validity. Artificial intelligence will be applied to provide course, prognosis, and treatment algorithms based on the signature of the initial rating.

Table 2

Table 1

References: 1. Wortzel J, Maeng D, Francis A, Oldham M. Prevalent gaps in understanding the features of catatonia among psychiatrists, psychiatry trainees, and medical students. J Clin Psychiatry 2021; 82(5): 21m14025.
2. Lloyd JR, Silverman ER, Kugler JL, Cooper JJ. Electroconvulsive therapy for patients with catatonia: current perspectives. Neuropsychiatr Dis Treat 2020; 16: 2191-2208. doi: 10.2147/NDT.S231573.
3. Smith AC, Holmes EG. Catatonia: a narrative review for hospitalists. Am J Med Open 2023; 10: 100059. doi: 10.1016/j.ajmo.2023.100059.
4. Kadubandi N, Elshourbagy A, Brašić J. Feasibility of reliable, remote assessment of a 13-year-old boy who stopped talking [abstract]. Mov Disord. 2024; 39 (suppl 1): S735-S736. Available online: https://www.mdsabstracts.org/abstract/feasibility-of-reliable-remote-assessment-of-a-13-year-old-boy-who-stopped-talking/
5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5)®, Arlington, Virginia, USA, American Psychiatric Association, 2013, pp 119-121.
6. ICD-11 for Mortality and Morbidity Statistics. Catatonia. 2024. Available at: https://icd.who.int/browse/2024-01/mms/en#486722075 Accessed on 18 June 2024
7. Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand 1996; 93:129-136.
8. Northoff G, Koch A, Wenke J, Eckert J, Bǒker H, Pflug B, Bogerts B. Catatonia as a psychomotor syndrome: a rating scale and extrapyramidal motor symptoms. Mov Disord 1999; 14 (3): 404-416.
9. Hirjak D, Brandt GA, Fritze S, Kubera KM, Northoff G, Wolf RC. Distribution and frequency of clinical criteria and rating scales for diagnosis and assessment of catatonia in different study types. Schizophr Res 2024; 263: 93-98.
10. Benarous X, Consoli A, Raffin M, et al. Validation of the Pediatric Catatonia Rating Scale (PCRS). Schizophr Res 2016; 176:378-386.
11. Kadubandi N, Elshourbagy A, Smith L, Balousha A, Tacik P, Barnett J, Brasic J. Feasibility of reliable, remote assessment of a 13-year-old boy who stopped talking. Zenodo, V6, 2025. https://doi.org/10.5281/zenodo.15015103

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MDS Abstracts - https://www.mdsabstracts.org/abstract/development-of-a-rating-instrument-to-identify-catatonia-by-virtual-viewing-of-motor-assessments/