Catatonia Rebecca Dai Nicole Garces Joanna Wong Free

Catatonia Rebecca Dai Nicole Garces Joanna Wong Free template from www. brainybetty. com

Outline • History (Joanna) • Diagnosis (Rebecca) • Characteristics • Subtypes • Comorbidity • Mechanisms (Nicole) • Treatments (Joanna) • How Catatonia is an ASC 11/3/2020 Free template from www. brainybetty. com 2

Definition of Catatonia • Catatonia is a neuropsychiatric syndrome with a unique combination of mental, motor, vegetative and behavioral signs. 11/3/2020 Free template from www. brainybetty. com 3

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. ” 11/3/2020 Free template from www. brainybetty. com 4

Diagnosis • Duck Principle – if it looks, walks, and quacks like a duck, then it’s a duck. • Behavioral characteristics • • 11/3/2020 Mutism Stupor Negativism Posturing Echophenomena (Echolalia, Echopraxia) Stereotypy (palilalia) Ambitendency Free template from www. brainybetty. com 5

Subtypes • Retarded Catatonia • Excited Catatonia • Periodic Catatonia • Malignant Catatonia 11/3/2020 Free template from www. brainybetty. com 6

Comorbidity • Mood disorders • Psychosis • Drug intoxication • Drug withdrawal • Epilepsy • Developmental disorder 11/3/2020 Free template from www. brainybetty. com 7

Neurophysiology • Neurochemical findings – Dopaminergic system – NMDA receptors – Seratonin receptors – GABA-A receptors 11/3/2020 Free template from www. brainybetty. com 8

GABA-A Receptors in Catatonic Patients • Decreased binding in… – Left sensorimotor cortex – Right lateral orbitofrontal cortex – Right posterior parietal cortex 11/3/2020 Free template from www. brainybetty. com 9

Mechanisms cont’d • Affective symptoms – Medial orbitofrontal deactivation – Lateral orbitofrontal/prefrontal activation – OPPOSITE of normals 11/3/2020 Free template from www. brainybetty. com 10

Mechanisms cont’d • Motor symptoms – Disturbed functional connectivity between orbitofrontal and premotor/motor cortex – “top-down modulation” 11/3/2020 Free template from www. brainybetty. com 11

Mechanisms cont’d • Behavioral symptoms – Decreased activation in lateral orbitofrontal cortex • Lesion study shows repetitive behaviors like that in catatonia 11/3/2020 Free template from www. brainybetty. com 12

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 11/3/2020 Free template from www. brainybetty. com 13

Treatments (cont. ) • Electroconvulsive Treatment (ECT) • Antipsychotic Drugs • Taken with care because can cause neuroleptic malignant syndrome 11/3/2020 Free template from www. brainybetty. com 14

Treatment (cont. ) • Sedatives • Offered to excited catatonic patients with delirious mania » Note: Also can cause malignant catatonia withdrawal 11/3/2020 Free template from www. brainybetty. com 15

Altered State of Consciousness • Lack of control in many motor and affective behaviors • Dysfunction between cortical and subcortical connection – Limits awareness 11/3/2020 Free template from www. brainybetty. com 16

• • • 11/3/2020 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. , c 2004, 1 st 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 NMDAantagonist 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. Free template from www. brainybetty. com 17