S-27-01

Catatonia in affective disorder

S. Krüger. Universitdtsklinikum Dresden Carl-Gustav Carus, Dresden, Germany

In this presentation, we intend to demonstrate that catatomc symptoms are more frequently associated with mixed affective states than commonly thought. Catatonic symptoms have been associated with mixed mania in the older psychiatric literature, however, to date no systematic studies have been performed to assess their frequency in these patients. To this effect, we assessed ninety-nine patients with bipolar disorder manic or mixed episode were assessed for the presence of catatonia. Thirty-nine patients fulfilled criteria for mixed mania of whom 24 were catatonic. Among the patients with pure mania, only 3 were catatonic. Eighteen catatonic patients with mixed mania required admission to the acute care unit (ACU). It is important to know, that the likelihood of overlooking catatonia in less severely ill patients with mixed mania is low and that it does not need to be routinely assessed on a general ward. In conclusion, catatonia is frequent in mania and linked to the mixed episode. Catatonia in mixed mania is likely to be found among the severely ill group of patients with mixed mania, who require emergency treatment.

S-27-02

Catatonic schizophrenia

G. Ungvari, S.K. Leung, F.S. Ng, H.-K. Cheung, T. Leung. Hungary

The frequency of catatonic syndrome in chronic schizophrenia and its association with socio-demographic, clinical, and treatment variables was determined in this study. A cross-sectional assessment of a randomly selected cohort of patients (n-225; mean age-42+7years; mean length of illness=20.4+7.5 years) with DSM-IV schizophrenia using standard rating instruments for catatonia, drug-induced extrapyramidal symptoms (EPS), and psychotic, depressive, and obsessive-compulsive symptoms was conducted. Using a rather narrow definition of catatonia (the presence of 4 or more signs/symptoms with at least one having a score '2' or above on the Bush-Francis Catatonia Rating Scale (BFCRS), 72 subjects (32%) met the criteria for the catatonia group. The frequency distribution of catatonic signs/symptoms in the catatonic group and in the whole sample was very similar, with mannerisms, grimacing, stereotypes, posturing, and mutism being the most frequent. In the logistic regression analysis, catatonic subjects had a significantly earlier age of onset, more negative symptoms, and were more likely to receive benzodiazepines than their non-catatonic counterparts. In multiple regression analysis, the severity of catatonia as indicated by the sum score of BFCRS was predicted only by earlier age of onset and negative symptoms. This study confirmed that, ifmethodieaUy assessed, catatonic signs and symptoms are prevalent in patients with chronic schizophrenia. Catatonia can be differentiated from EPS. Catatonic features indicate a generally poor prognosis in the chronic phase of schizophrenia.

S-27-03

Malignant catatonia

S. Mann, S. Caroff. University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA

Malignant catatonia (MC) represents a life threatening neuropsychiatric illness characterized by hyperthermia, catatonic stupor or excitement, altered consciousness and autonomic dysfunction. This disorder was recognized historically as a potential complication of acute psychotic illness. A comprehensive review of the world literature indicates that although the incidence of MC may have declined following the introduction of modern psychopharmacologic agents, it clearly continues to occur. Furthermore, our review suggests that MC is a syndrome rather than a specific disease. While most often an outgrowth of the major psychoses, MC also develops in association with diverse neurologic and medical conditions. From this perspective, neuroleptic malignant syndrome (NMS), a potentially fatal complication of antipsychotic drug treatment, may be viewed as a drug-induced form of MC. Our review also supports a conceptualization of catatonia as a continuum, with milder forms at one end and more severe forms involving hyperthermia (MC) at the other end. In addition, our findings suggest that simple catatonia, MC, and NMS share a common pathophysiology involving reduced dopaminergic neurotransmission within the basal ganglia-thalamocortical circuits. Electroconvulsive therapy is an effective and practical treatment for MC resulting from psychiatric and neuromedical conditions, including NMS. Antipsychotic drugs should be withheld whenever MC is suspected.

S-27-04

Malignant neuroleptic syndrome vs. catatonia

G. Petrides. Greece

S-27-05

Pathophysiology in catatonia: Orbitofrontal cortical dysfunction?

G. Northoff. Universitiit Magdeburg Klinik für Psychiatrie. Magdeburg, Germany

Catatonia is a psychomotor syndrome characterized by concurrent emotional, motor, and behavioural anomalies. Pathophysiological mechanisms of psychomotor disturbances may be related to abnormal emotional-motor processing in prefrontal cortical networks. We therefore investigated prefrontal cortical activation and connectivity patterns during emotional-motor stimulation using fMRI. We investigated 10 postacute akinetic catafonic patients and compared them with 10 non-catatonic psychiatric (same diagnosis without catatonia, same medication, same age and sex) and 10 healthy controls. Pictures for emotional stimulation were taken from the International Affective picture System (IAPS). Catatonic patients showed significant abnormalities in orbitofrontal cortex and its connectivity to premotor/motor cortex when compared to psychiatric ad healthy controls. Catatonic affective and behavioural symptoms correlated significantly with orbitofrontal cortical dysfunction. We conclude that catatonic symptoms might be closely related to altered emotional-motor processing in orbitofxontal-premotor cortical networks.