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Ariza-Salamanca DF, Corrales-Hernández MG, Pachón-Londoño MJ, Hernández-Duarte I. Molecular and cellular mechanisms leading to catatonia: an integrative approach from clinical and preclinical evidence. Front Mol Neurosci 2022; 15:993671. [PMID: 36245923 PMCID: PMC9558725 DOI: 10.3389/fnmol.2022.993671] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
This review aims to describe the clinical spectrum of catatonia, in order to carefully assess the involvement of astrocytes, neurons, oligodendrocytes, and microglia, and articulate the available preclinical and clinical evidence to achieve a translational understanding of the cellular and molecular mechanisms behind this disorder. Catatonia is highly common in psychiatric and acutely ill patients, with prevalence ranging from 7.6% to 38%. It is usually present in different psychiatric conditions such as mood and psychotic disorders; it is also a consequence of folate deficiency, autoimmunity, paraneoplastic disorders, and even autistic spectrum disorders. Few therapeutic options are available due to its complexity and poorly understood physiopathology. We briefly revisit the traditional treatments used in catatonia, such as antipsychotics, electroconvulsive therapy, and benzodiazepines, before assessing novel therapeutics which aim to modulate molecular pathways through different mechanisms, including NMDA antagonism and its allosteric modulation, and anti-inflammatory drugs to modulate microglia reaction and mitigate oxidative stress, such as lithium, vitamin B12, and NMDAr positive allosteric modulators.
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Affiliation(s)
- Daniel Felipe Ariza-Salamanca
- Medical and Health Sciences Education Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- *Correspondence: Daniel Felipe Ariza-Salamanca
| | - María Gabriela Corrales-Hernández
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - María José Pachón-Londoño
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Isabella Hernández-Duarte
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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Dale ML, Brumbach BH, Boxer AL, Hiller AL. Associations Between Amantadine Usage, Gait, and Cognition in PSP: A post-hoc Analysis of the Davunetide Trial. Front Neurol 2021; 11:606925. [PMID: 33408688 PMCID: PMC7779593 DOI: 10.3389/fneur.2020.606925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: Amantadine anecdotally improves gait in progressive supranuclear palsy (PSP) but definitive data is lacking. We investigated associations between amantadine usage, gait, cognition, and activities of daily living in 310 subjects with PSP using data from the davunetide trial. Method: We compared baseline demographics, PSP Rating Scale (PSPRS), Repeat Battery for the Assessment of Neuropsychological Status (RBANS), and Schwab and England Activities of Daily Living (SEADL) scores between subjects taking vs. not taking amantadine using chi-square tests for categorical variables and independent sample t-tests for continuous variables. Using the general linear model (GLM), we tested whether group status predicted total PSPRS, PSPRS-gait and midline, total RBANS, RBANS-attention, and SEADL before and after the 52-weeks follow-up. Results: Subjects taking vs. not taking amantadine were similar at baseline, except subjects taking amantadine had a higher Clinical Global Impression (CGI) Score (p = 0.01). However, the CGI change score did not differ between groups at week 52 (p = 0.10). Using GLM models (controlling for covariates), we found that subjects taking vs. not taking amantadine did not significantly predict total PSPRS, PSPRS-gait and midline, total RBANS, RBANS-attention, or SEADL at baseline, week 52, or the change score between baseline and week 52. Discussion: This post-hoc analysis of the davunetide trial did not find an association between amantadine and gait or cognitive measures in PSP, but was not powered to find such a difference. Future studies should still examine amantadine for symptomatic benefit in multiple PSP subtypes.
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Affiliation(s)
- Marian L Dale
- Department of Neurology, Oregon Health & Science University, The VA Portland Health Care System, Portland, OR, United States
| | - Barbara H Brumbach
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, United States
| | - Adam L Boxer
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Amie L Hiller
- Department of Neurology, Oregon Health & Science University, The VA Portland Health Care System, Portland, OR, United States
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Hutchison L, Silber Y, Rollhaus E, Gnerre C. Amantadine Augmentation in Pediatric Catatonia: A Case Report and Review of the Literature. PSYCHOSOMATICS 2020; 61:193-199. [PMID: 31543245 DOI: 10.1016/j.psym.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Lisa Hutchison
- Department of Psychiatry, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
| | | | - Esther Rollhaus
- Department of Psychiatry, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Carolyn Gnerre
- Department of Psychiatry, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
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Progressive Encephalomyelitis With Rigidity and Myoclonus Syndrome Presenting as Catatonia. PSYCHOSOMATICS 2018; 60:83-87. [PMID: 30143326 DOI: 10.1016/j.psym.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/30/2022]
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Abstract
OBJECTIVE To investigate the evidence-based treatment of catatonia in adults. The secondary aim is to develop a treatment protocol. MATERIALS AND METHODS A systematic review of published treatment articles (case series, cohort or randomized controlled studies) which examined the effects of particular interventions for catatonia and/or catatonic symptoms in adult populations and used valid outcome measures was performed. The articles for this review were selected by searching the electronic databases of the Cochrane Library, MEDLINE, EMBASE and PSYCHINFO. RESULTS Thirty-one articles met the inclusion criteria. Lorazepam and electroconvulsive therapy (ECT) proved to be the most investigated treatment interventions. The response percentages in Western studies varied between 66% and 100% for studies with lorazepam, while in Asian and Indian studies, they were 0% and 100%. For ECT, the response percentages are 59%-100%. There does not seem to be evidence for the use of antipsychotics in catatonic patients without any underlying psychotic disorder. CONCLUSION Lorazepam and ECT are effective treatments for which clinical evidence is found in the literature. It is not possible to develop a treatment protocol because the evidence for catatonia management on the basis of the articles reviewed is limited. Stringent treatment studies on catatonia are warranted.
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Affiliation(s)
- Anne CM Pelzer
- Department of Psychiatry, Reinier van Arkel, ‘s-Hertogenbosch
| | | | - Erik den Boer
- Department of Psychiatry, GGzE, Eindhoven, the Netherlands
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Beach SR, Gomez-Bernal F, Huffman JC, Fricchione GL. Alternative treatment strategies for catatonia: A systematic review. Gen Hosp Psychiatry 2017; 48:1-19. [PMID: 28917389 DOI: 10.1016/j.genhosppsych.2017.06.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Catatonia is a commonly encountered syndrome, affecting 10-20% of various psychiatric populations and carrying significant medical co-morbidities. However, there are few established alternative treatment strategies when benzodiazepines are ineffective and electroconvulsive therapy is unavailable. OBJECTIVE The authors systematically review evidence for alternative treatment strategies for catatonia using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. METHOD The authors conducted a search of PubMed database from 1983 to August 2016 to identify articles. Eligible reports presented cases involving treatment of catatonia using modalities other than benzodiazepines or electroconvulsive therapy. RESULTS The authors identified 72 articles, comprising 98 individual cases. N-methyl-d-aspartate-receptor antagonists, anti-epileptic drugs, and atypical antipsychotic agents appeared to have the largest number of reports supporting their effectiveness and safety in treating catatonia patients. CONCLUSIONS Based on the case report literature, the authors propose an updated algorithm for catatonia treatment in cases where benzodiazepines fail and electroconvulsive therapy is not available.
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Affiliation(s)
- Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | | | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Gregory L Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Czepielewski LS, Sodré L, Souza ACL, Bücker J, Burke KP, Ceresér KM, Gama CS. Changes in verbal learning of patients with schizophrenia: Results from a randomized, double-blind, placebo-controlled trial of amantadine adjunctive to antipsychotics. Schizophr Res 2015; 168:571-2. [PMID: 26104472 DOI: 10.1016/j.schres.2015.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Letícia S Czepielewski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Ramiro Barcelos, 2350, Porto Alegre CEP 90035-903, Brazil.
| | - Leonardo Sodré
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Ramiro Barcelos, 2350, Porto Alegre CEP 90035-903, Brazil
| | - Ana Cláudia L Souza
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Ramiro Barcelos, 2350, Porto Alegre CEP 90035-903, Brazil
| | - Joana Bücker
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Ramiro Barcelos, 2350, Porto Alegre CEP 90035-903, Brazil
| | - Kelen P Burke
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Ramiro Barcelos, 2350, Porto Alegre CEP 90035-903, Brazil
| | - Keila M Ceresér
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Ramiro Barcelos, 2350, Porto Alegre CEP 90035-903, Brazil
| | - Clarissa S Gama
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Post Graduate Program in Medicine, Department of Psychiatry, Ramiro Barcelos, 2350, Porto Alegre CEP 90035-903, Brazil
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Wijemanne S, Jankovic J. Movement disorders in catatonia. J Neurol Neurosurg Psychiatry 2015; 86:825-32. [PMID: 25411548 DOI: 10.1136/jnnp-2014-309098] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/28/2014] [Indexed: 12/13/2022]
Abstract
Catatonia is a complex neuropsychiatric syndrome characterised by a broad range of motor, speech and behavioural abnormalities. 'Waxy flexibility', 'posturing' and 'catalepsy' are among the well-recognised motor abnormalities seen in catatonia. However, there are many other motor abnormalities associated with catatonia. Recognition of the full spectrum of the phenomenology is critical for an accurate diagnosis. Although controlled trials are lacking benzodiazepines are considered first-line therapy and N-Methyl-d-aspartate receptor antagonists also appears to be effective. Electroconvulsive therapy is used in those patients who are resistant to medical therapy. An underlying cause of the catatonia should be identified and treated to ensure early and complete resolution of symptoms.
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Affiliation(s)
- Subhashie Wijemanne
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
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Sienaert P, Dhossche DM, Vancampfort D, De Hert M, Gazdag G. A clinical review of the treatment of catatonia. Front Psychiatry 2014; 5:181. [PMID: 25538636 PMCID: PMC4260674 DOI: 10.3389/fpsyt.2014.00181] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/26/2014] [Indexed: 02/05/2023] Open
Abstract
Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.
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Affiliation(s)
- Pascal Sienaert
- Department of Mood Disorders and Electroconvulsive Therapy, University Psychiatric Center, KU Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- *Correspondence: Pascal Sienaert, Department of Mood Disorders and Electroconvulsive Therapy, University Psychiatric Center, KU Leuven (University of Leuven), Campus Kortenberg, Leuvensesteenweg 517, Kortenberg 3070, Belgium e-mail:
| | - Dirk M. Dhossche
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Marc De Hert
- University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Gábor Gazdag
- Center for Psychiatry and Addiction Medicine, Szent István and Szent László Hospitals, Budapest, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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