Catatonia

1
Catatonia

• Rebecca Dai
• Nicole Garces
• Joanna Wong

2
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 its 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 contd

• Affective symptoms
• Medial orbitofrontal deactivation
• Lateral orbitofrontal/prefrontal activation
• OPPOSITE of normals

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Mechanisms contd

• Motor symptoms
• Disturbed functional connectivity between
  orbitofrontal and premotor/motor cortex
• top-down modulation

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Mechanisms contd

• 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 Clinicians 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 CatatoniaA Psychomotor Syndrome.
  Stuttgart, Enke Publisher, 1997.
• Northoff G Brain imaging in catatonia current
  findings and a pathophysiological model. CNS
  Spectr 534-46, 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 62404-406, 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.