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Catatonia
Rebecca Dai
Nicole Garces
Joanna Wong
Outline
• History (Joanna)
• Diagnosis (Rebecca)
• Characteristics
• Subtypes
• Comorbidity
• Mechanisms (Nicole)
• Treatments (Joanna)
• How Catatonia is an ASC
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Definition of Catatonia
• Catatonia is a
neuropsychiatric
syndrome with a
unique
combination of
mental, motor,
vegetative and
behavioral signs.
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History
• Karl Ludwig Kahlbaum
– Coined the term ‘Catatonia’
• “Catatonia is a brain disease with a
cyclic, alternating course, in which
the mental symptoms are,
consecutively melancholy, mania,
stupor, confusion, and eventually
dementia.”
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Diagnosis
• Duck Principle – if it looks, walks, and
quacks like a duck, then it’s a duck.
• Behavioral characteristics
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Mutism
Stupor
Negativism
Posturing
Echophenomena (Echolalia, Echopraxia)
Stereotypy (palilalia)
Ambitendency
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Subtypes
• Retarded Catatonia
• Excited Catatonia
• Periodic Catatonia
• Malignant Catatonia
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Comorbidity
• Mood disorders
• Psychosis
• Drug intoxication
• Drug withdrawal
• Epilepsy
• Developmental disorder
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Neurophysiology
• Neurochemical findings
– Dopaminergic system
– NMDA receptors
– Seratonin receptors
– GABA-A receptors
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GABA-A Receptors in
Catatonic Patients
• Decreased binding in…
– Left sensorimotor cortex
– Right lateral orbitofrontal cortex
– Right posterior parietal cortex
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Mechanisms cont’d
• Affective symptoms
– Medial orbitofrontal deactivation
– Lateral orbitofrontal/prefrontal
activation
– OPPOSITE of normals
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Mechanisms cont’d
• Motor symptoms
– Disturbed functional connectivity
between orbitofrontal and
premotor/motor cortex
– “top-down modulation”
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Mechanisms cont’d
• Behavioral symptoms
– Decreased activation in lateral
orbitofrontal cortex
• Lesion study shows repetitive behaviors
like that in catatonia
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Treatments
• Barbiturates
• W.J. Bleckwenn- First to report the
relief of catatonia using barbiturates.
• Benzodiazepines are a
common initial treatment
• i.e. Lorazepam, diazepam
– Lorazepam is more sustained
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Treatments (cont.)
• Electroconvulsive Treatment
(ECT)
• Antipsychotic Drugs
• Taken with care
because can cause
neuroleptic malignant syndrome
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Treatment (cont.)
• Sedatives
• Offered to excited catatonic
patients with delirious mania
» Note: Also can can cause malignant
catatonia with withdrawal
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Altered State of
Consciousness
• Lack of control in many motor and
affective behaviors
• Dysfunction between cortical and
subcortical connection
– Limits awareness
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References
Carroll B: GABAa versus GABAb hypothesis of catatonia [letter]. Mov Disord
14: 702-703, 1999.
Catatonia : from psychopathology to neurobiology / edited by Stanley N. Caroff
… [et al.] Washington, DC : American Psychiatric Pub., c2004, 1st ed.
Fink, Max and Michael Alan Taylor (2003). Catatonia: A Clinician’s Guide to
Diagnosis and Treatment. Cambridge, Cambridge Univeristy Press.
Northoff, Georg, et al. Decreased density of GABA-A receptors in the left
sensorimotor cortex in akinetic catatonia: investigation of in vivo
benzodiazepine receptor binding. J. Neurol. Neurosurg. Psychiatry, 1999; 67;
445-450.
Northoff, Georg, et al. Orbitofrontal Cortical Dysfunction n the Akinetic
Catatonia: A Functional magnetic Resonance Imaging Study During Negative
Emotional Stimulation. Schizophrenia Bulletin, 2004; 30; 2; 405-427.
Northoff G: Catatonia—A Psychomotor Syndrome. Stuttgart, Enke Publisher,
1997.
Northoff G: Brain imaging in catatonia: current findings and a
pathophysiological model. CNS Spectr 5:34-46, 2000.
Northoff G, Eckert J, Fritze J: Glutamatergic dysfunction in catatonia?
Successful treatments of three acute akinetic catatonic patients with the NMDAantagonist amantadine. J Neurol Neurosurg Psychiatry 62:404-406, 1997.
Penland, Heath R, et al. The catatonic dilemma expanded. Annals of General
Psychiatry, 2006; 5; 14; 1-9. Taylor, Michael, et al. Catatonia in Psychiatric
Classification: A Home of Its Own. American Journal of Psychiatry, 2003; 160;
1233-1241.
Stein, Elliot, et al. Selective Effects of the Endogenous Cannabinoid
Arachidonylethanolamide (Anandamide) on Regional Cerebral Blood Flow in
the Rat. Neuropsychopharmacology, 1998; 19; 6, 1-11.
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