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
• 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 NMDA-
antagonist 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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