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Liu XF, Zhao SW, Kratochvil Z, Jiang JC, Cui D, Wang L, Fan JW, Gu YW, Yin H, Cui JJ, Chang X, Cui LB. Affected cortico-striatal-cerebellar network in schizophrenia with catatonia revealed by magnetic resonance imaging: indications for electroconvulsive therapy and repetitive transcranial magnetic stimulation. PSYCHORADIOLOGY 2023; 3:kkad019. [PMID: 38666113 PMCID: PMC10917379 DOI: 10.1093/psyrad/kkad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 04/28/2024]
Abstract
Catatonia is a psychomotor syndrome that can occur in a broad spectrum of brain disorders, including schizophrenia. Current findings suggest that the neurobiological process underlying catatonia symptoms in schizophrenia is poorly understood. However, emerging neuroimaging studies in catatonia patients have indicated that a disruption in anatomical connectivity of the cortico-striatal-cerebellar system is part of the neurobiology of catatonia, which could serve as a target of neurostimulation such as electroconvulsive therapy and repetitive transcranial magnetic stimulation.
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Affiliation(s)
- Xiao-Fan Liu
- Department of Radiology, Xi'an Gaoxin Hospital, Xi'an 710075, China
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Shu-Wan Zhao
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | | | - Jia-Cheng Jiang
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Di Cui
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Lu Wang
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Jing-Wen Fan
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Yue-Wen Gu
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
| | - Hong Yin
- Department of Radiology, Xi'an People's Hospital, Xi'an 710004, China
| | - Jin-Jin Cui
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiao Chang
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai 200433, China
| | - Long-Biao Cui
- Schizophrenia Imaging Lab, Fourth Military Medical University, Xi'an 710032, China
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Shaanxi Provincial Key Laboratory of Clinic Genetics, Fourth Military Medical University, Xi'an 710032, China
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi'an 710061, China
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Badura Brzoza K, Główczyński P, Błachut M. Paralyzed by Fear?-A Case Report in the Context of Narrative Review on Catatonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10161. [PMID: 36011796 PMCID: PMC9407999 DOI: 10.3390/ijerph191610161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/06/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
In ICD-11, catatonia is a complex syndrome that includes psychomotor disorders (negativity, catalepsy, wax flexibility, mutism, automatism, mannerisms, or echolalia) and volitional processes affect modulation and action planning, which leads to hypofunctional, hyperfunctional, or parafunctional motor action. This is a very important clue that this state can be associated with both mental and somatic diseases. In order to create a narrative review, authors analyzed the diagnostic criteria of ICD-10 and ICD-11 and searched the PubMed medical base for articles on the diagnosis and different approaches to the treatment of catatonia. The treatment of catatonia is not standardized. It is based on the use of benzodiazepines, GABAa receptor antagonists, NMDA receptor antagonists, D2 receptor antagonist, and electroconvulsive therapy (ECT). The authors also would like to present the case of a patient in whom the diagnosis of catatonia was not so clear according to the diagnostic criteria, emphasizing the importance of the key diagnosis for the patient's recovery. The authors would also like to point out that the topic of catatonia should be of interest not only to psychiatrists, but also to doctors of other specialties, who may encounter cases of catatonia complicating somatic states in hospital wards.
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Di Iorio R, Rossi S, Rossini PM. One century of healing currents into the brain from the scalp: From electroconvulsive therapy to repetitive transcranial magnetic stimulation for neuropsychiatric disorders. Clin Neurophysiol 2021; 133:145-151. [PMID: 34864511 DOI: 10.1016/j.clinph.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/01/2021] [Accepted: 10/30/2021] [Indexed: 11/27/2022]
Abstract
Electroconvulsive therapy (ECT) was applied for the first time in humans in 1938: after 80 years, it remains conceptually similar today except for modifications of the original protocol aimed to reduce adverse effects (as persistent memory deficits) without losing clinical efficacy. We illustrate the stages of development as well as ups and downs of ECT use in the last eighty years, and the impact that it still maintains for treatment of certain psychiatric conditions. Targeted, individualized and safe noninvasive neuromodulatory interventions are now possible for many neuropsychiatric disorders thanks to repetitive transcranial magnetic stimulation (rTMS) that injects currents in the brain through electromagnetic induction, powerful enough to depolarize cortical neurons and related networks. Although ECT and rTMS differ in basic concepts, mechanisms, tolerability, side effects and acceptability, and beyond their conceptual remoteness (ECT) or proximity (rTMS) to "precision medicine" approaches, the two brain stimulation techniques may be considered as complementary rather than competing in the current treatment of certain neuropsychiatric disorders.
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Affiliation(s)
- Riccardo Di Iorio
- Neurology Unit, Policlinic A. Gemelli Foundation IRCCS, Rome, Italy.
| | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Section of Neurology and Clinical Neurophysiology, Policlinico Le Scotte, University of Siena, Italy
| | - Paolo M Rossini
- Department of Neuroscience & Neurorehabilitation, IRCCS San Raffaele-Pisana, Rome, Italy
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Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges. Neurol Int 2021; 13:570-586. [PMID: 34842777 PMCID: PMC8628989 DOI: 10.3390/neurolint13040057] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/29/2022] Open
Abstract
Catatonia is a syndrome that has been associated with several mental illness disorders but that has also presented as a result of other medical conditions. Schizophrenia and other psychiatric disorders such as mania and depression are known to be associated with catatonia; however, several case reports have been published of certain medical conditions inducing catatonia, including hyponatremia, cerebral venous sinus thrombosis, and liver transplantation. Neuroleptic Malignant Syndrome and anti-NMDA receptor encephalitis are also prominent causes of catatonia. Patients taking benzodiazepines or clozapine are also at risk of developing catatonia following the withdrawal of these medications—it is speculated that the prolonged use of these medications increases gamma-aminobutyric acid (GABA) activity and that discontinuation may increase excitatory neurotransmission, leading to catatonia. The treatment of catatonia often involves the use of benzodiazepines, such as lorazepam, that can be used in combination therapy with antipsychotics. Definitive treatment may be found with electroconvulsive therapy (ECT). Aberrant neuronal activity in different motor pathways, defective neurotransmitter regulation, and impaired oligodendrocyte function have all been proposed as the pathophysiology behind catatonia. There are many clinical challenges that come with catatonia and, as early treatment is associated with better outcomes, it becomes imperative to understand these challenges. The purpose of this manuscript is to provide an overview of these challenges and to look at clinical studies regarding the pathophysiology, diagnosis, and treatment of as well as the complications and risk factors associated with catatonia.
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Hansbauer M, Wagner E, Strube W, Röh A, Padberg F, Keeser D, Falkai P, Hasan A. rTMS and tDCS for the treatment of catatonia: A systematic review. Schizophr Res 2020; 222:73-78. [PMID: 32600779 DOI: 10.1016/j.schres.2020.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Catatonia is a potentially life threatening syndrome in various psychiatric disorders. As first line treatment, benzodiazepines and electroconvulsive therapy (ECT) are recommended. In some cases, benzodiazepines are ineffective and ECT is not available or contraindicated. Therefore, the search for new and alternative treatment strategies is of great importance. OBJECTIVE To review the evidence for alternative neurostimulation treatment strategies (rTMS and tDCS) for catatonia according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. METHOD We performed a systematic literature search in several electronic databases. We also searched the WHO International Clinical Trials Registry Platform (ICTRP) and the ClinicalTrials.gov database to detect registered studies. RESULTS We identified nine publications on rTMS treatment and four publications on tDCS in catatonia. Most of the publications reported clinically relevant improvement of catatonic symptoms. Only two publications reported insufficient improvement. The available Bush-Francis Catatonia Rating Scale scores showed statistical significant improvement following rTMS and tDCS. We could not identify any finished clinical studies or case series, dedicated to this topic. We also could not identify any publications that compared first line treatment options with rTMS or tDCS. CONCLUSIONS Based on the case report literature, rTMS and tDCS might be promising alternative treatment strategies for patients who do not respond to benzodiazepines or in case ECT is not available or contraindicated. There are even hints that rTMS or tDCS might be an option in patients who respond to ECT but need long-term treatment to control catatonic symptoms. Further clinical trials are needed to allow for an evidence-based evaluation of potential risks and benefits of rTMS and tDCS for catatonia.
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Affiliation(s)
- Maximilian Hansbauer
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany.
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Daniel Keeser
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Nußbaumstraße 7, 80336 München, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Medical Faculty, Augsburg, Germany
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Cui H, Jiang L, Wei Y, Li W, Li H, Zhu J, Pang J, Wang J, Li C. Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis. Gen Psychiatr 2019; 32:e100051. [PMID: 31673675 PMCID: PMC6802976 DOI: 10.1136/gpsych-2019-100051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/31/2019] [Accepted: 07/29/2019] [Indexed: 01/10/2023] Open
Abstract
Background Pharmacological and conventional non-pharmacological treatments are only moderately effective in treating generalised anxiety disorder (GAD). Recently, repetitive transcranial magnetic stimulation (rTMS) has attracted interest because of its potential therapeutic value. Aim To investigate the efficacy and safety of rTMS treatment for GAD. Methods Literature studies published in English or Chinese were screened in 10 electronic databases up to 5 December 2018. The included studies' bias risk was assessed using Cochrane risk of bias assessment tool. Meta-analysis was performed to compute the standardised mean difference (SMD) and risk ratio (RR) along with its 95% CIs through using RevMan V.5.3. Heterogeneity was inspected by I2 and the χ2 test. We performed subgroup analysis and meta-regression to investigate heterogeneity. We used funnel plot to assess publication bias. We used the GRADE approach to assess the whole quality of evidence. Results Twenty-one studies, with a total sample size of 1481, were analysed. The risk of bias in most studies included is moderate, the majority of which are lacking of blinding methods of treatment allocation. The treatment had beneficial effects in the rTMS group compared with the control group in mean anxiety score (SMD=-0.68; 95% CI -0.89 to -0.46). None of the 21 studies included here reported severe adverse events. As for dropout rates, there are no statistically significant differences between the two groups (RR 1.14, 95% CI 0.72 to 1.82) or adverse events (RR 0.95, 95% CI 0.77 to 1.18). No particular influence on the heterogeneity of any variable was observed. The risk of publication bias was low. According to the GRADE approach, the evidence levels of primary outcome (treatment effects) and secondary outcomes (acceptability and safety) were rated as 'medium'. Conclusion The use of rTMS combined with medication treatment may have a significant positive anti-anxiety effect on patients with GAD. However, we should interpret the results cautiously due to the relatively high heterogeneity of the meta-analysis. Future high-quality clinical trials are needed to confirm our results.
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Affiliation(s)
- Huiru Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijuan Jiang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanyan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjuan Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoyan Pang
- School of government, Shanghai University of Political Science and Law, Shanghai, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.,Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.,Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
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Warriach ZI, Shamim SA, Saeed A, Kashif S, Malik BH. Association of the Thrombo-embolic Phenomenon with Electroconvulsive Therapy Treatment in Schizophrenia with Catatonia Patient. Cureus 2019; 11:e5656. [PMID: 31700757 PMCID: PMC6822908 DOI: 10.7759/cureus.5656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/14/2019] [Indexed: 01/25/2023] Open
Abstract
Catatonia is a condition in which patients manifest with a complex of symptoms of behavioral and motor abnormalities. This condition can present with schizophrenia, bipolar, depression, and certain neurological illnesses. In this article, we analyze the coincidence of deep venous thrombosis (DVT) in schizophrenia with catatonia patients managed with electroconvulsive therapy (ECT) and the possible outcome of complications as an adverse event. The conclusion drawn from this traditional review reveals the importance of early diagnosis and treatment intervention of catatonia patients with ECT. No bleeding-related complications occurred with the use of anticoagulants by catatonic patients managed with ECT and having underlying thrombosis. Literature also indicates that ECT can be safely administered for patients with distal deep venous thrombosis (DVT) treated with anticoagulants, while those with proximal DVT, ECT should be halted and anticoagulation treatment should be continued until the resolution of DVT to safely resume the ECT sessions. A possible alternative to ECT therapy for the patients with refractory schizophrenia with catatonia (who have safety concerns) is recombinant transcranial magnetic stimulation (rTMS). Nonetheless, more studies are needed to support our assertion.
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Affiliation(s)
- Zain I Warriach
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sohaib A Shamim
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Aisha Saeed
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Saima Kashif
- Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Sharma A, Choudhury S, Anand N, Grover S, Singh SM. The use of rTMS in an adolescent presenting with acute catatonia: A case report. Asian J Psychiatr 2018; 37:1-2. [PMID: 30086466 DOI: 10.1016/j.ajp.2018.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/29/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Akhilesh Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Shinjini Choudhury
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Naveen Anand
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Shubh Mohan Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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