Subjective experience, psychosocial functioning and different psychomotor clusters in catatonia: How are they connected?

Catatonia involves decreased, increased, and abnormal psychomotor activity, but most previous studies mainly focused on motor signs, neglecting the patients' subjective experiences. This study aimed to characterize psychomotor activity levels as introduced in the ICD-11 and their relation to subjectivity and overall psychosocial functioning in catatonia. We examined 54 patients with catatonia and 90 patients with schizophrenia spectrum- or mood disorders according to ICD-11 using an extensive battery of psychomotor-related clinical rating scales and Northoff Scale for subjective experience in catatonia (NSSC). For catatonia patients partial correlation coefficients between ICD-11 psychomotor clusters and their surrogate parameters were calculated. Group differences were analyzed using MANCOVA and post-hoc ANOVA. Finally, linear discriminant analysis (LDA) was used to examine the classification value of the respective rating scales and different surrogate parameters of ICD-11-related psychomotor activity. In catatonia patients decreased psychomotor activity was associated with psychomotor retardation (p<.05)), while increased activity was positively correlated with impulsivity and negatively correlated with psychomotor retardation (both p-values<.01). Abnormal psychomotor activity was positively associated with stereotypies as well as mannerisms, affectation and posturing. Significant group differences were observed in subjective experience, social performance, trait anxiety, psychomotor slowing, processing speed, and cognitive functioning. LDA revealed that the respective psychomotor-related rating scales are capable of distinguishing between diagnostic groups, albeit with varying degrees of classification accuracy (61.8 %-87.5 %). We identified a relationship between varying levels of psychomotor activity, subjective experiences, and psychosocial functioning in catatonia as defined by the ICD-11. Future large-scale studies are needed to validate these findings and refine assessment tools, such as the NSSC, by integrating subjective experiences with objective rating scales. This approach could pave the way for more tailored treatment options that consider the unique subjective experiences of catatonia patients.