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Catatonia

Catatonia. Rebecca Dai Nicole Garces Joanna Wong. Outline. History (Joanna) Diagnosis (Rebecca) Characteristics Subtypes Comorbidity Mechanisms (Nicole) Treatments (Joanna) How Catatonia is an ASC . Definition of Catatonia.

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Catatonia

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  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 Free template from www.brainybetty.com

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

  4. 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.” Free template from www.brainybetty.com

  5. 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 Free template from www.brainybetty.com

  6. Subtypes • Retarded Catatonia • Excited Catatonia • Periodic Catatonia • Malignant Catatonia Free template from www.brainybetty.com

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

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

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

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

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

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

  13. 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 Free template from www.brainybetty.com

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

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

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

  17. 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. Free template from www.brainybetty.com

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