Rebecca Dai Nicole Garces Joanna Wong 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 9/19/2018 Free template from www.brainybetty.com

Definition of Catatonia Catatonia is a neuropsychiatric syndrome with a unique combination of mental, motor, vegetative and behavioral signs. 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com 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.” 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com 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 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com Subtypes Retarded Catatonia Excited Catatonia Periodic Catatonia Malignant Catatonia 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com Comorbidity Mood disorders Psychosis Drug intoxication Drug withdrawal Epilepsy Developmental disorder 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com Neurophysiology Neurochemical findings Dopaminergic system NMDA receptors Seratonin receptors GABA-A receptors 9/19/2018 Free template from www.brainybetty.com

GABA-A Receptors in Catatonic Patients Decreased binding in… Left sensorimotor cortex Right lateral orbitofrontal cortex Right posterior parietal cortex 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com Mechanisms cont’d Affective symptoms Medial orbitofrontal deactivation Lateral orbitofrontal/prefrontal activation OPPOSITE of normals 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com Mechanisms cont’d Motor symptoms Disturbed functional connectivity between orbitofrontal and premotor/motor cortex “top-down modulation” 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com Mechanisms cont’d Behavioral symptoms Decreased activation in lateral orbitofrontal cortex Lesion study shows repetitive behaviors like that in catatonia 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com 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 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com Treatments (cont.) Electroconvulsive Treatment (ECT) Antipsychotic Drugs Taken with care because can cause neuroleptic malignant syndrome 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com Treatment (cont.) Sedatives Offered to excited catatonic patients with delirious mania Note: Also can can cause malignant catatonia with withdrawal 9/19/2018 Free template from www.brainybetty.com

Altered State of Consciousness Lack of control in many motor and affective behaviors Dysfunction between cortical and subcortical connection Limits awareness 9/19/2018 Free template from www.brainybetty.com

Free template from www.brainybetty.com 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. 9/19/2018 Free template from www.brainybetty.com