Table 1.
CT, SPECT, and MRI Studies Using Motor/Behavioral Catatonia Rating Scales in Mental Disorders
| Study | Sample characteristics | Motor assessment | Neuroimaging method | Important findings |
|---|---|---|---|---|
| Joseph et al45 | CAT: n = 5, age = 65.4 y; M:F = 2:3 | CAT had all mutism, akinesia, and catalepsy plus at least 2 of the 4 symptoms such as negativism, stereotyping, posturing, and mannerisms. | CT scans on Siemens Somatom 2 with a 256 × 256 matrix and 8-mm-thick slices | Catatonic patients showed atrophy of posterior fossa structures (vermis and brainstem). |
| SP: n = 5, age = 66 y; M:F = 2:3 | ||||
| Wilcox44 | CAT: n = 17 | Criteria for CAT were mutism, motor rigidity, irrational behavior, and the absence of frank neurological or metabolic disease | CT scans on a Picker-600 CT Scanner with a resolution power in the 1-mm range or better | Catatonia may be associated with cerebellar atrophy. |
| SP: n = 30 with noncatatonic SZ, n = 20 with psychotic affective disorder, n = 15 nonpsychiatric controls (matched for age and gender) | ||||
| Wilcox43 | CAT: n = 30 patients (8 bipolar—32.58 y, 11 schizophrenia—32.31 y, 6 schizoaffective—37.39 y, and 5 major depression—33.29 y of age), M:F = 16:14 | Criteria for CAT were mutism, presence of bizarre motor activity including posturing, decrease in motor activity, or catatonic excitement characterized by intense bursts of agitated stereotypy. | CT scans on a Picker-600 CT Scanner with a resolution power in the 1-mm range or better | CAT patients with schizophrenia had larger ventricular/brain ratios compared with nonschizophrenic CAT patients. |
| Ebert et al52 | CAT: N = 2 (48 and 24 y old) | DSM-III-R schizophrenia diagnosis | rCBF studied via SPECT with 99mTcHMPAO | Temporal hypoperfusion as a neural correlate of aberrant sensory input in catatonia |
| SP: N = 10 | ||||
| HC: n = 8 | ||||
| Satoh et al111 | CAT: N = 6, age = 29.7 ± 8.6 y; M:F = 3:3; DOI: 0.5–20 y | 6 schizophrenia patients who currently or at an earlier time had received a DSM-III-R subtype diagnosis of catatonic schizophrenia (symptoms included catatonic stupor or excitement, posturing, mannerisms, and negativism). | rCBF studied via SPECT with IMP | Low rCBF, as indexed by IMP perfusion, of the dorsal parietal lobe was found in CAT compared with SP. |
| SP: N = 13, age = 31.4 ± 11.6 y; M:F = 10:3; all patients medicated | ||||
| Galynker et al51 | CAT: n = 1, age = 40 y; female; DOI: 25 y | One schizoaffective patient presenting with severe psychomotor retardation, negativism, and waxy flexibility | rCBF studied via SPECT with 99mTcHMPAO | The patient with catatonia showed decreased perfusion in the left parietal and left motor cortices when compared with healthy controls. |
| HC: n = 8, age = 36.1 y, M:F = 5:3 | ||||
| Escobar et al49 | CAT: N = 9, age = 28.3 ± 5.8 y; M:F = 8:1; 5 patients with schizophrenia and 4 patients with mood disorder | Diagnosis of catatonia was done clinically, according to DSM-IV criteria. The severity was assessed with Modified Rogers Scale. | rCBF studied via SPECT with 99mTcHMPAO | No SPECT differences between the 2 diagnostic groups. Significant increase in rCBF in parietal, temporal, and occipital regions in patients with mood disorder and no significant changes in schizophrenia patients |
| Walther et al56 | CAT: N = 15, age = 35.9 ± 12.7 y; M:F = 11:4; education: 12.0 ± 4.0 y; CPZ: 461.3 ± 346.4; DAE: 153.4 ± 143.9 mo | Bush-Francis Catatonia Rating Scale. | 3 Tesla MRT, SPM8 (VBM toolbox) | Excited and retarded catatonia differed in SMA perfusion. Higher catatonia scores were associated with higher SMA perfusion. |
| SP: N = 27; age = 37.1 ± 10.6; M:F = 17:10; education: 14.2 ± 3.1 y; CPZ: 373.6 ± 359.4; DAE: 126.4 ± 127.2 mo | ||||
| HC: N = 41, age = 38.6 ± 13.6 y; M:F = 25:16; education: 14.1 ± 2.7 y | ||||
| Walther et al58 | SP: N = 46, age = 38.0 ± 11.5 y; M:F = 30:16; education: 13.5 ± 3.1 y; CPZ: 444.6 ± 337.0; DOI: 12.1 ± 12.4 y | Bush-Francis Catatonia Rating Scale and Modified Rogers Scale | 3 Tesla MRT, Functional Connectivity Toolbox (CONN, version 17.c) | Thalamocortical (bilateral M1 to left thalamus) hyperconnectivity was linked to catatonia in schizophrenia. |
| HC: N = 44, age = 38.0 ± 13.6 y; M:F = 25:16; education: 14.1 ± 2.7 y |
CAT, catatonic patients; SP, schizophrenic patients/other mental disorders; HC, healthy controls; IMP , 123I-iodoamphetamine; DOI, duration of illness; CPZ, chlorpromazine equivalent dose; OLZ, Olanzapine equivalent dose; CT, computer tomography; rCBF, regional cerebral blood flow; OFC, orbitofrontal cortex; SMA, supplementary motor area; M, male; F, female; y, years; mo, months.