Factor Structure of Catatonia in Catatonic Depression

Introduction

Depression with catatonic features is a relatively common condition that can pose difficulties in nosological assessment and lead to life-threatening complications.

Objectives

To determine the structure of catatonia associated with depression, and its subtypes.

Methods

The exploratory factor analysis with maximum likelihood (MLE) data extraction and varimax rotation was used in a sample of 96 patients with depressive, bipolar or schizophrenia spectrum disorders, who were depressed and who met the criteria for catatonia according to the Bush-Francis Catatonia Screening Instrument (BFCSI).

Results

The factor analysis revealed four factors of catatonia in depression, accounting for 57.3% of the variance. “Agitated” factor (eigenvalue 5.65, 18.2% of the variance) includes agitation, impulsivity, emotional lability, verbigeration, sudden muscular tone alterations, ambitendency, perseveration and stereotypy. “Hypokinetic” factor (eigenvalue 5.05, 16.3% of the variance) includes mutism, withdrawal, stupor, staring, negativism, rigidity, posturing and gegenhalten. “Proskinetic” factor (eigenvalue 3.65, 11.8% of variance) includes automatic obedience, mitgehen, echophenomena, catalepsy and waxy flexibility. “Parakinetic” factor (eigenvalue 3.41, 11.0% of variance) includes grimacing, flat affect, compulsive emotions, mannerisms and compulsive behavior. “Agitated catatonia” is a more specific subtype and is usually associated with bipolar disorder. “Hypokinetic catatonia” is the most common but less specific subtype. “Proskinetic catatonia” in depression does not occur apart from other subtypes of catatonia. “Parakinetic catatonia” is most commonly associated with schizophrenia spectrum disorders.

Conclusions

Our study shows the heterogeneity of catatonic features in depression and facilitates the nosological diagnosis of catatonic depression.

Disclosure

No significant relationships.

Histopathological characteristics and post-operative follow-up of patients with potentially radiogenic papillary thyroid carcinoma depending on oncocytic changes availability in the tumor cells

AIM

To compare the frequency of main histopathological characteristics, 131І thyroid radiation doses, invasive properties and post-operative follow-up of patients of different age groups with potentially radiogenic papillary thyroid carcinoma (PTC) with the presence and absence of oncocytic changes in tumor cells.

MATERIALS AND METHODS

PTC removed in 483 patients from high risk age-group for radiogenic thyroid cancer development (children and adolescents at the time of Chornobyl accident who lived in the northern regions of Ukraine: Kyiv, Zhytomyr, and Chernihiv regions) have been studied microscopically.

RESULTS

The frequency of PTC with the presence of oncocytic changes (OCh) in tumor cells increased significantly with increasing of patients' age at the time of surgery: from 8.3% in children 4-14 years old to 54.3% in adults 39-48 years old (ptrend < 0.0001). The presence of such changes is associated with papillary and solid-trabecular dominant tumor growth pattern in more than 90% of cases in each age group. The mean 131І thyroid dose in the whole series of PTC patients with OCh was significantly lower compared to the same index in PTC patients without OCh (493.7 mGy and 765.8 mGy, respectively, p < 0.0001). In addition, regional metastases recurrences were revealed more frequently in patients with OCh in primary PTC compared with patients without OCh in primary tumor (7.2% vs 1.5%, p = 0.0022).

CONCLUSIONS

Significantly increasing age-trend of OCh in PTC of patients affected by the Chornobyl fallout and operated at age from 4 to 48 years, as well as opposite decreasing linear age-trend of 131І thyroid dose may reflect a gradual increase of sporadic PTCs frequency in the potentially radiogenic series with time elapsed since accident. The frequency of oncocytic insensitive to radioiodine therapy of lymph node metastases recurrences also increased with patients age and OCh availability in primary PTC.