International classification of diseases (ICD)-11 is expected to be operative on the first day of January 2022. The key principle in this revision is simplification of the coding structure, electronic tooling, along with incorporation of advancements that occurred over past 30 years, since the publication of ICD-10. For a classification of mental disorders, development of the ICD-11 has been the most global, multilingual, multidisciplinary, and participative revision process by far. Adoption of a life-span approach, incorporation of a dimensional approach, provision of consistent and systematically characterized information as per recent evidence, and culture-related guidance along with effort for destigmatization are the salient features of this revision. In this review, we highlighted the process of developing the clinical description and diagnostic guidelines (CDDG), discussed the new disorders that were added with rationale, and last described the salient features of disorder grouping, pointing the key changes from ICD-10.
We report for the first time, functional MRI markers of the acute retarded catatonic state and its response to benzodiazepines.
In this cross-sectional MRI study, we have compared the resting state whole-brain, within-network and seed (left precentral gyrus)-to-voxel connectivity, as well as cortical complexity between a sample of patients in acute retarded catatonic state (n = 15) and a demographically-matched healthy control sample (n = 15). Additionally, we examined whether the above variables were different between responders (n = 9) and non-responders (n = 6) to lorazepam.
Acute retarded catatonia was characterized by reduced functional connectivity, most robustly within the sensorimotor network, diffuse long-range hyperconnectivity, and seed-to-voxel hyperconnectivity in the frontoparietal and cerebellar regions. The lorazepam responders showed long-range as well as seed-to-voxel functional hyperconnectivity in comparison to the non-responders. Seed (left precentral gyrus)-to-voxel connectivity was positively correlated to the catatonia motor ratings. The catatonia sample showed reduced vertex-wise cortical complexity in the right insular cortex and contiguous areas.
We have identified neuroimaging markers that characterize the acute retarded catatonic state and predict treatment response. We discuss how these novel findings have important translational implications for understanding the pathophysiology of catatonia and for predicting treatment response to benzodiazepines.
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