1. Rebecca Dai Nicole Garces Joanna Wong
Catatonia
Rebecca Dai
Nicole Garces
Joanna Wong

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Outline
History (Joanna)
Diagnosis (Rebecca)
Characteristics
Subtypes
Comorbidity
Mechanisms (Nicole)
Treatments (Joanna)
How Catatonia is an ASC
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3. 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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9. 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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16. 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: , 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;
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;
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: , 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;
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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