There are indications that atypical antipsychotics may be useful in non-MC. As a consequence, one should not only focus on the possible extrapyramidal and autonomic side effects of these drugs, but also on the possible beneficial effects on certain brain functions and on the catatonic symptomatology. However, randomized controlled trials are needed to evaluate the effect of these drugs, and caution is advisable, since cases of NMS have been linked to treatment with atypical antipsychotics. There is no evidence to prescribe atypical antipsychotics in MC.
Anterograde amnesia in Wernicke-Korsakoff syndrome is associated with diencephalic lesions, mainly in the anterior thalamic nuclei. Whether diencephalic and temporal lobe amnesias are distinct entities is still not clear. We investigated episodic memory for faces using functional MRI (fMRI) in eight controls and in a 34-year-old man with Wernicke-Korsakoff syndrome and diencephalic lesions but without medial temporal lobe (MTL) involvement at MRI. fMRI was performed with a 1.5 tesla unit. Three dual-choice tasks were employed: (i) face encoding (18 faces were randomly presented three times and subjects were asked to memorize the faces); (ii) face perception (subjects indicated which of two faces matched a third face); and (iii) face recognition (subjects indicated which of two faces belonged to the group they had been asked to memorize during encoding). All activation was greater in the right hemisphere. In controls both the encoding and recognition tasks activated two hippocampal regions (anterior and posterior). The anterior hippocampal region was more activated during recognition. Activation in the prefrontal cortex was greater during recognition. In the subject with Wernicke-Korsakoff syndrome, fMRI did not show hippocampal activation during either encoding or recognition. During recognition, although behavioural data showed defective retrieval, the prefrontal regions were activated as in controls, except for the ventrolateral prefrontal cortex. fMRI activation of the visual cortices and the behavioural score on the perception task indicated that the subject with Wernicke-Korsakoff syndrome perceived the faces, paid attention to the task and demonstrated accurate judgement. In the subject with Wernicke-Korsakoff syndrome, although the anatomical damage does not involve the MTL, the hippocampal memory encoding has been lost, possibly as a consequence of the hippocampal-anterior thalamic axis involvement. Anterograde amnesia could therefore be the expression of damage to an extended hippocampal system, and the distinction between temporal lobe and diencephalic amnesia has limited value. In the subject with Wernicke-Korsakoff syndrome, the preserved dorsolateral prefrontal cortex activation during incorrect recognition suggests that this region is more involved in either the orientation or attention at retrieval than in retrieval. The lack of activation of the prefrontal ventrolateral cortex confirms the role of this area in episodic memory formation.
Working memory plays a role in various forms of psychopathology. However, working memory consists of multiple theoretical components that may be differently taxed by various specific types of task, and brain activation differences between patients and healthy controls may result from differences in task performance. This makes it difficult to interpret such results in terms of disease-related dysfunctions in affected regions or networks. The aim of the current study was to determine the brain activation related to the updating of spatiotemporal content of working memory, in such a way that performance-related confounds in future clinical studies would be minimized. Nineteen healthy volunteers performed a task involving a continuous updating process during fMRI measurement. A frontostriatal network including medial and lateral prefrontal cortex, inferior frontal cortex, premotor cortex, supplementary motor cortex, thalamus and putamen was found to be related to the updating process. The results constrain the set of brain regions plausibly related to the specific updating component of working memory. Further, the task design may be of use in future studies of pathological conditions such as schizophrenia due to the minimization of potential confounds.
SUMMARYCatatonia is a syndrome of motor dysregulation, usually associated with psychiatric, neurological, systemic and drug-related diseases. Retarded and excited types exist, both of which often go unrecognised in clinical practice. We describe a 64-year-old woman who gradually developed insomnia, started communicating less, complained of feeling restless and ended up injuring relatives. Initiation of symptoms followed a fibula fracture. The patient was diagnosed with excited-type catatonia with prominent combativeness because of minor trauma and rapidly recovered after lorazepam treatment instatement. Our case demonstrates that catatonia can follow minor traumatic injury and how excited-type catatonic features may go unrecognised in general practitioner and specialist settings. Moreover, we show that catatonia may be recurrent, necessitating long-term treatment and very gradual lorazepam tapering.
BACKGROUND
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