Clinical assessment of catatonia includes the use of diagnostic systems, like the Diagnostic and Statistical Manual 5 (DSM-5) and International Classification of Disease Manual 10 (ICD-10), or screening tools such as the Bush Francis Screening Instrument (BFCSI)/Bush Francis Catatonia Rating Scale (BFCRS) and Braunig’s Catatonia Rating Scale. In this study, we describe the inter-rater reliability (IRR), utilizing the BFCSI, BFCRS and DSM-5 to screen for catatonia.
Data from 10 participants recruited as part of a larger prevalence study were used to determine IRR by five assessors after they were trained in the application of the 14-item BFCSI, 23-item BFCRS and DSM-5 to assess catatonia in new admissions. Krippendorff α was used to compute the IRR, and Spearman’s correlation was used to determine concordance between screening tools. The study was performed at a 35-bed acute mental health unit in Dora Nginza Hospital, Nelson Mandela Bay Metro. Participants were mostly involuntary admissions under the Mental Health Care Act of 2002 and between the ages of 13 and 65 years and older.
The majority (8, 80%) were 35 years or less and males (8, 80%). At least six (60%) of the ten participants were found to have catatonia based on the BFCSI/BFCRS and DSM-5 criteria. The BFCRS (complete 23-item scale) had the greatest level of inter-rater agreement with an α=0.798, while the DSM-5 had the lowest level of inter-rater agreement with an α=0.565. The highest correlation coefficients were observed between the BFCRS and BFCSI.
The BFCSI and BFCRS were found to be sensitive tools for screening for catatonia with high IRR and high correlation coefficients, while the DSM 5 showed some deficiencies in screening for catatonia with low IRR and lowest correlation with the other two tools.