Catatonia and neuroleptic malignant syndrome: psychopathology and pathophysiology

  title={Catatonia and neuroleptic malignant syndrome: psychopathology and pathophysiology},
  author={Georg Northoff},
  journal={Journal of Neural Transmission},
  • G. Northoff
  • Published 1 December 2002
  • Psychology, Medicine
  • Journal of Neural Transmission
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… 

Catatonia and neuroleptic malignant syndrome: two sides of a coin?

Five cases of catatonia and NMS are described in order to approach the nosological question of whether the syndrome is to be considered a syndrome with a wide variety of causes and clinical signs or a distinct clinical entity and the clinical similarity between both syndromes.


In DSM-5, catatonia syndrome may be diagnosed as a specifier to major mood disorders, psychotic disorders, general medical conditions, and asCatatonia not otherwise specified, which allows diagnosing the syndrome in a large variety of psychiatric disorders.

Current nosological status, pathomechanism and treatment of catatonia

In the case of catatonia resistant to benzodiazepines, electroconvulsive therapy (ECT) is effective, and in order to increase the effectiveness of treatment, electro Convulsive therapy and benzidiazepines are used in parallel, which brings satisfactory results.

Catatonía: un síndrome neuropsiquiátrico

Current concepts of catatonia are reviewed, in reward of historical data, major etiologic causes, neurophysiopathology, diagnostic criteria and treatment, and treatment.

Catatonia: Our current understanding of its diagnosis, treatment and pathophysiology

Because catatonia is common, highly treatable, and associated with significant morbidity and mortality if left untreated, physicians should maintain a high level of suspicion for this complex clinical syndrome.

Catatonia, Neuroleptic Malignant Syndrome, and Cotard Syndrome in a 22-Year-Old Woman: A Case Report

Organic vulnerability to these syndromes, as well as their coexistence and clinical differentiation is discussed in the light of the data observed.

Motor Symptoms and Schizophrenia

The idea that motor symptoms are closely related to the neurodevelopmental disturbances of schizophrenia and a distinct syndromal dimension with its own pathophysiology is supported.

The Syndrome of Catatonia

Current data supports catatonic syndromes are still common, often severe and of modern clinical importance and it is found that prompt identification and treatment can produce a robust improvement in most cases.

Electroconvulsive therapy in catatonic patients: Efficacy and predictors of response.

Observations are consistent with the hypothesis that ECT is more effective in "top-down" variant of catatonia, in which the psychomotor syndrome may be sustained by a dysregulation of the orbitofrontal cortex, than in "bottom-up" variant, inWhich an extrapyramidal dysregulation may be prevalent.

Catatonia is not schizophrenia and it is treatable




Catatonia: syndrome or schizophrenia subtype?¶Recognition and treatment

  • M. Fink
  • Psychology, Medicine
    Journal of Neural Transmission
  • 2001
The benefits of treatment using benzodiazepines and electroconvulsive therapy to replace the customary use of antipsychotic drugs alone warrant the recommended change in concept and classification.

Catatonic signs in neuroleptic malignant syndrome.

ECT treatment and cerebral perfusion in Catatonia.

A 40-yr-old woman with a diagnosis of schizoaffective disorder developed catatonia in the context of a depressive episode and was treated with a five-treatment course of electroconvulsive therapy (ECT), which resulted in a complete resolution ofCatatonia and some resolution of her symptoms of depression.

Delayed onset of late movement-related cortical potentials and abnormal response to lorazepam in catatonia

Right lower prefronto-parietal cortical dysfunction in akinetic catatonia: a combined study of neuropsychology and regional cerebral blood flow

Findings are preliminary but suggest right lower prefronto-parietal cortical dysfunction in catatonia, which may be closely related to psychomotor disturbances.

Catatonia in depression: prevalence, clinical correlates, and validation of a scale.

The study showed the validity of the MRS for the diagnosis of catatonia in depressed patients, as well as the specificity of the DSM-IV criteria of the catatonic features specifier for mood disorders.

Reduced activation and altered laterality in two neuroleptic-naive catatonic patients during a motor task in functional MRI

Activation of the non-dominant side, left-handed activity in right-handed patients, results in a total reversal of the normal pattern of lateral activation suggesting a disturbance in hemispheric localization of activity during a catatonic state.

Glutamatergic dysfunction in catatonia? Successful treatment of three acute akinetic catatonic patients with the NMDA antagonist amantadine.

The therapeutic effect of amantadine showed a characteristic temporal pattern with most pronounced effects four to six hours after administration and recurrence of catatonic symptoms by 24 hours later, at least partially, which suggests the central importance of glutamatergic dysfunction in cat atonic syndrome.

Neuroleptic Malignant Syndrome during a Change from Haloperidol to Risperidone

Clinicians should closely monitor patients receiving both haloperidol and risperidone or combinations of similar medications, since completely stopping one antipsychotic before starting the second may place patients at risk for psychotic relapse.