Catatonia and neuroleptic malignant syndrome: psychopathology and pathophysiology |
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Authors: | Northoff G |
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Institution: | (1) Department of Behavioral Neurology, Beth Israel Deaconnes Medical Center, Harvard University, Boston, MA, U.S.A., US |
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Abstract: | Summary. Catatonia was originally described as a psychomotor syndrome in the 19th century by Kahlbaum including motor, affective and behavioral symptoms. Later, at the beginning of the 20th century, catatonia
was rather considered as the motoric manifestation of schizophrenia. Accordingly, neuropathological research focused predominantly
on those neuroanatomical substrates, i.e. the basal ganglia being primarily involved in the generation of movements. Even
though some authors observed minor alterations in the basal ganglia, consistent findings in these subcortical structures could
not be obtained.
Since neuroleptics can induce catatonic-like symptoms i.e. neuroleptic malignant syndrome (NMS), there has been a recent re-emergence
in clinical and scientific interest in catatonia. However, exact psychopathological and pathophysiological characterization
of both NMS and catatonia remains unclear.
Clinically, catatonia and NMS show more or less similar motor symptoms i.e. akinesia. These may be accounted for by dysregulation
in cortical-subcortical circuits between motor/premotor cortex and basal ganglia i.e. the so-called “motor loop”. While in
NMS the “motor loop” may be dysregulated by neuroleptic blockade of subcortical striatal D-2 receptors one may rather assume
cortical gaba-ergic alteration in catatonia. The premotor/motor cortex and consecutively the “motor loop” may be dysregulated
by gaba-ergic abnormalities in orbitofrontal cortex. Gaba-ergic cortical dysfunction may account for affective and behavioural
abnormalities in catatonia which cannot be observed as such in NMS. Consequently, one may characterize catatonia as a cortical
“psychomotor syndrome” while NMS may rather be regarded as subcortical “motor syndrome”.
Received January 10, 2002; accepted May 15, 2002 Published online July 26, 2002
Author's address: G. Northoff, MD, PhD, PhD, Harvard University, Beth Israel Deaconnes Medical Center, Department of Behavioral
Neurology, Kirstein Building KS 454, 330 Brookline Avenue, 02215 Boston, Ma, USA, e-mail: gnorthof@caregroup.harvard.edu |
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Keywords: | : Catatonia versus NMS psychomotor verus motor cortical versus subcortical top-down versus bottom-up modulation |
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