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Cattarinussi G, Gugliotta AA, Hirjak D, Wolf RC, Sambataro F. Brain mechanisms underlying catatonia: A systematic review. Schizophr Res 2024; 263:194-207. [PMID: 36404217 DOI: 10.1016/j.schres.2022.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Catatonia is a complex psychomotor disorder characterized by motor, affective, and behavioral symptoms. Despite being known for almost 150 years, its pathomechanisms are still largely unknown. METHODS A systematic research on PubMed, Web of Science, and Scopus was conducted to identify neuroimaging studies conducted on group or single individuals with catatonia. Overall, 33 studies employing structural magnetic resonance imaging (sMRI, n = 11), functional magnetic resonance imaging (fMRI, n = 10), sMRI and fMRI (n = 2), functional near-infrared spectroscopy (fNIRS, n = 1), single positron emission computer tomography (SPECT, n = 4), positron emission tomography (PET, n = 4), and magnetic resonance spectroscopy (MRS, n = 1), and 171 case reports were retrieved. RESULTS Observational sMRI studies showed numerous brain changes in catatonia, including diffuse atrophy and signal hyperintensities, while case-control studies reported alterations in fronto-parietal and limbic regions, the thalamus, and the striatum. Task-based and resting-state fMRI studies found abnormalities located primarily in the orbitofrontal, medial prefrontal, motor cortices, cerebellum, and brainstem. Lastly, metabolic and perfusion changes were observed in the basal ganglia, prefrontal, and motor areas. Most of the case-report studies described widespread white matter lesions and frontal, temporal, or basal ganglia hypoperfusion. CONCLUSIONS Catatonia is characterized by structural, functional, perfusion, and metabolic cortico-subcortical abnormalities. However, the majority of studies and case reports included in this systematic review are affected by considerable heterogeneity, both in terms of populations and neuroimaging techniques, which calls for a cautious interpretation. Further elucidation, through future neuroimaging research, could have great potential to improve the description of the neural motor and psychomotor mechanisms underlying catatonia.
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Affiliation(s)
- Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy
| | | | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robert C Wolf
- Department of General Psychiatry at the Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy.
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Serrat F, Iglesias-Gónzalez M, Sanagustin D, Etxandi M, de Pablo J, Cuevas-Esteban J. Catatonia and Cognitive Impairments: A Systematic Review. Front Psychiatry 2022; 13:877566. [PMID: 35845445 PMCID: PMC9279867 DOI: 10.3389/fpsyt.2022.877566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Catatonia is an underdiagnosed and undertreated neuropsychiatric syndrome characterized by catalepsy, negativism, mutism, muscular rigidity, and mannerism, often accompanied by autonomic instability and fever. Although there is growing interest in studying cognitive impairments before and after catatonia, little is known about the cognitive features of the syndrome. Methods This systematic review was registered at PROSPERO (CRD42022299091). Using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, we searched PubMed, ScienceDirect, and PsycArticles using a combination of the terms "Catatonia" and "Cognitive impairment" and "Executive function" and "Frontal lobe" and "Parietal lobe." Studies included original research articles enrolling patients with catatonic syndrome according to specified criteria. Fourteen studies were deemed relevant for inclusion. The abstraction form included age, assessment during acute episode, associated diagnosis, assessment procedure, and cognitive domains. Outcome measures were extracted. Results Executive functions and visuospatial abilities proved to be the most investigated domains. A great heterogeneity has been observed in the assessment tools used among the 14 evaluated studies. Findings showed that catatonic patients had worse performance than healthy and non-catatonic psychiatric patients in frontal and parietal cortical functions. Conclusion Because of the small number of studies in such heterogeneous areas and significant methodological limitations, the results should be regarded with caution. Future research assessing cognitive impairments on catatonic patients is needed. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299091], identifier [CRD42022299091].
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Affiliation(s)
- Francesc Serrat
- Servei de Psiquiatria, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Iglesias-Gónzalez
- Servei de Psiquiatria, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca Germans Trias i Pujol, Badalona, Spain
| | - David Sanagustin
- Servei de Psiquiatria, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mikel Etxandi
- Servei de Psiquiatria, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joan de Pablo
- Servei de Psiquiatria, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Cuevas-Esteban
- Servei de Psiquiatria, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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de França GC, Barreto HCDB, Paranhos T, Nunes JC, de Oliveira-Souza R. Case Report: Catatonic Stupor in Behavioral Variant Frontotemporal Dementia. Front Neurol 2022; 12:798264. [PMID: 35115996 PMCID: PMC8805594 DOI: 10.3389/fneur.2021.798264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022] Open
Abstract
Catatonia is a psychomotor syndrome common to several medical and neuropsychiatric disorders. Here, we report on the case of a 95-year-old woman who underwent a radical change in personality characterized by sexual disinhibition, and physical and verbal aggressiveness. Over several months, she developed verbal stereotypies, gait deterioration, and double incontinence. She eventually developed mutism and an active opposition to all attempts to be fed or cared for. Benzodiazepines, olanzapine and electroconvulsive therapy were of no benefit. Magnetic resonance imaging revealed asymmetric (more severe on the right) frontotemporal, parietal, and upper brainstem atrophy. She died from sepsis without recovering from stupor seven years after the onset of symptoms. We believe that the initial behavioral disinhibition was related to the frontotemporal injury, whereas catatonic stupor reflected the progression of the degenerative process to the parietal cortices. Our case adds to the small number of cases of catatonia as a symptom of degenerative dementia. It also supports the idea that damage to the parietal cortex gives rise to pathological avoidance of which catatonic stupor represents an extreme form.
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Affiliation(s)
- Gustavo Campos de França
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of the State of Rio de Janeiro, Gaffrée e Guinle Hospital, Rio de Janeiro, Brazil
| | - Henrique Carneiro de Barros Barreto
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of the State of Rio de Janeiro, Gaffrée e Guinle Hospital, Rio de Janeiro, Brazil
| | - Thiago Paranhos
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of Rio de Janeiro, Clementino Fraga Filho Hospital, Rio de Janeiro, Brazil
| | - Julio Cesar Nunes
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of the State of Rio de Janeiro, Gaffrée e Guinle Hospital, Rio de Janeiro, Brazil
| | - Ricardo de Oliveira-Souza
- The D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- The Federal University of the State of Rio de Janeiro, Gaffrée e Guinle Hospital, Rio de Janeiro, Brazil
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Watanabe R, Kawakami I, Onaya M, Higashi S, Arai N, Akiyama H, Hasegawa M, Arai T. Frontotemporal dementia with trans-activation response DNA-binding protein 43 presenting with catatonic syndrome. Neuropathology 2017; 38:281-287. [PMID: 29110334 DOI: 10.1111/neup.12442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 12/14/2022]
Abstract
Catatonia is a clinical syndrome characterized by symptoms such as immobility, mutism, stupor, stereotypy, echophenomena, catalepsy, automatic obedience, posturing, negativism, gegenhalten and ambitendency. This syndrome occurs mostly in mood disorder and schizophrenic patients, and is related to neuronal dysfunction involving the frontal lobe. Some cases of frontotemporal dementia (FTD) with catatonia have been reported, but these cases were not examined by autopsy. Here, we report on a FTD case which showed catatonia after the first episode of brief psychotic disorder. At the age of 58, the patient had a sudden onset of disorganized behavior and meaningless speech. Psychotropic drugs were effective for catatonic symptoms. However, after remission apathy, hyperorality, socially inappropriate behavior, hoarding, and an instinctive grasp reaction appeared and persisted. Brain MRI showed significant atrophy of the bilateral fronto-temporal lobes. A neuropathological examination revealed extensive trans-activation response DNA-binding protein 43 (TDP-43) positive neurocytoplasmic inclusions and dystrophic neurites in the brain, including the cerebral cortex, basal ganglia, and brainstem. Pathological diagnosis was frontotemporal lobar degeneration (FTLD) with TDP-43 (FTLD-TDP) type C, which was also confirmed by the band pattern of C-terminal fragments of TDP-43 on western blotting of sarkosyl-insoluble fractions extracted from the frozen brain. Dysfunction of the thalamus, globus pallidus, supplementary motor area, amygdala and cingulate cortex have been said to be related to the catatonic syndrome. In this case, these areas were affected, showing abnormal TDP-43-positive structures. Further studies are expected to confirm further clinical - pathological correlations to FTLD.
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Affiliation(s)
- Ryohei Watanabe
- Dementia Reserch Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Department of Psychiatry, University of Tsukuba, Ibaraki, Japan
| | - Ito Kawakami
- Dementia Reserch Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mitsumoto Onaya
- Department of Pschiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Shinji Higashi
- Department of Psychiatry, University of Tsukuba, Ibaraki, Japan
| | - Nobutaka Arai
- Laboratory of Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Haruhiko Akiyama
- Dementia Reserch Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Masato Hasegawa
- Dementia Reserch Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, University of Tsukuba, Ibaraki, Japan
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Utumi Y, Iseki E, Arai H. Three patients with mood disorders showing catatonia and frontotemporal lobes atrophy. Psychogeriatrics 2013; 13:254-9. [PMID: 24164753 DOI: 10.1111/psyg.12027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/28/2013] [Accepted: 06/03/2013] [Indexed: 12/12/2022]
Abstract
Here we report the cases of three patients with mood disorders showing catatonia and frontotemporal lobe atrophy. Catatonia is a syndrome linked to frontal dysfunction that most frequently occurs in patients with mood disorders. The diagnostic criteria of catatonia and frontotemporal dementia partly overlap. In the present patients, catatonia might be closely related to frontal dysfunction caused by frontotemporal lobe atrophy. With regard to therapeutics for catatonia, we found that administering a low dose of lorazepam alone or after electroconvulsive therapy may be useful for treating and preventing catatonia. We also found that administering glutaminate antagonists such as memantine may be useful for treating lorazepam-resistant catatonia.
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Affiliation(s)
- Yushi Utumi
- Department of Psychiatry, Juntendo Koshigaya Hospital, Juntendo University School of Medicine, Saitama, Japan; Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan
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Lauterbach EC, Kuppuswamy PS, Greenway LL. Differential pharmacological responses of catatonia-like signs in frontotemporal dementia. Neurocase 2010; 16:436-50. [PMID: 20859826 DOI: 10.1080/13554791003623326] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sequential therapeutic trials for catatonoid frontal signs in clinically-evident frontotemporal dementia (n = 2) revealed differential benefits for lorazepam, amantadine, memantine, pramipexole, aripiprazole, quetiapine, citalopram, and donepezil, although certain signs also worsened. Citalopram and donepezil were poorly tolerated. Ramelteon was without effect. While memantine appeared to improve cognition in case 1, this remains to be established by more reliable neuropsychological testing. Parkinsonism (case 2) responded to pramipexole, but not amantadine or levodopa. Possible relationships of catatonoid signs requiring future confirmation include insufficient GABA-A (multiple signs) and D2 (mutism) and excessive NMDA (immobility, rigidity), D2/D3 (mannerisms, verbal perseveration), and 5HT1a (staring) receptor stimulation. Low-dose lorazepam and quetiapine required close monitoring.
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Suzuki K, Takano T, Matsuoka H. A case of catatonia resembling frontotemporal dementia and resolved with electroconvulsive therapy. World J Biol Psychiatry 2010; 10:245-7. [PMID: 17965995 DOI: 10.1080/15622970701701021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We describe a case of catatonia in a 51-year-old man in whom the catatonic symptoms could not be distinguished from symptoms of frontotemporal dementia (FTD) until they were resolved with electroconvulsive therapy (ECT). When it is difficult to distinguish between catatonia and FTD in patients with frontal dysfunction associated with frontal lobe atrophy, we believe that sequential administration of benzodiazepines and ECT is important for therapeutic diagnosis because the risk of missing a diagnosis of catatonia outweighs the risks associated with administration of benzodiazepines and/or ECT.
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van der Heijden FMMA, Tuinier S, Pepplinkhuizen L, Verhoeven WMA. Catatonia: the rise and fall of an intriguing psychopathological dimension. Acta Neuropsychiatr 2002; 14:111-6. [PMID: 26984151 DOI: 10.1034/j.1601-5215.2002.140303.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND For at least 125 years the discussion about the clinical relevance of catatonic symptoms in psychiatry continues. It started from the original description by Kahlbaum and was revived by modern factor analytical studies, that identified the catatonic dimension in about 10% of newly admitted patients. OBJECTIVE Over a period of 2 years, four patients with an acute episodic psychosis and prominent catatonic symptoms were examined. METHODS A clinical description is given of the psychopathology and classification is performed according to the various diagnostic instruments. RESULTS All patients showed a circular fluctuation of their psychoses, with motor symptoms ranging from the excited to the inhibited pole within one episode. Their clinical pictures also comprised mood swings and anxieties as well as hallucinatory and delusional experiences, whereas the course of disease was characterized by complete recovery without residual symptoms. CONCLUSIONS The significance of catatonic symptoms is not recognized in the current taxonomies despite the fact that this has major pharmacological treatment implications.
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Affiliation(s)
| | - S Tuinier
- 1Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - L Pepplinkhuizen
- 2Erasmus University, Faculty of Medicine and Mental Sciences, Rotterdam, the Netherlands
| | - W M A Verhoeven
- 1Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
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9
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Ahuja N. Organic catatonia: a review. Indian J Psychiatry 2000; 42:327-46. [PMID: 21407969 PMCID: PMC2962733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Catatonia is a clinical syndrome associated with a wide variety of psychiatric, medical and neurological disorders. Despite several reports in the literature of a wide range of medical and neurological diseases causing catatonia, there has been a tendency to consider catatonia as purely psychiatric disorder. The review attempts to look at the concept of organic catatonia from a historical viewpoint, including its place in the psychiatric classification, discusses the various etiological causes of organic catatonia, and them goes through some important management issues in organic catatonia. The review suggests that organic catatonic disorder must be first considered in every patient with catatonic signs, particularly in a patient with new onset catatonia.
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Affiliation(s)
- N Ahuja
- MD., Assistant Professor, Department of Psychiatry, G S Pant Hospital and Maulana Azad Medical College, New Delhi
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Abstract
This paper presents a neurologic formulation for the clinical features of the schizophrenic syndrome, and tests it against a systematic, region by region review of available postmortem neuroanatomical and neuropharmacological data. Based on this review a model is proposed that postulates a developmental lesion affecting the midline neurotransmitter-specific ascending projection systems. Due to the facilitatory role these systems play in the development of the brain regions to which they project, such a lesion is one parsimonious, and testable, explanation for virtually all the clinical, laboratory, and pathological findings reported to date in schizophrenia research. A case is made for establishing a global antemortem-postmortem collaboration using a Latin square design; the alternative may be that, as has happened in the past, the best efforts of dilligent researchers around the world may lead to little improvement in our understanding of schizophrenia.
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Affiliation(s)
- R M Shapiro
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104
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Lloyd KG, Pichat P. GABA synapses, depression, and antidepressant drugs. PSYCHOPHARMACOLOGY SERIES 1987; 3:113-26. [PMID: 3029751 DOI: 10.1007/978-3-642-71288-3_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Karl Ludwig Kahlbaum was the first to describe catatonia in 1868. There has been a tendency to consider catatonia as a psychiatric disease despite many case reports demonstrating a wide range of medical and neurological as well as psychiatric causes. We present our accumulated experience of the catatonic syndrome. Most cases (36%) were associated with affective illness but five cases (20%) had a defined organic disorder. A significant minority had no identifiable cause and there was only one case of schizophrenia. The idiopathic and affective groups had a high incidence of recurrent catatonic episodes and many had a family history of a similar problem. The prognosis was excellent, except for the few patients who presented with the acute and rapidly progressive form of the syndrome which led to acute renal failure.
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