Catatonia and the immune system: a review

Abstract

Catatonia is a psychomotor disorder featuring stupor, posturing, and echophenomena. This Series paper examines the evidence for immune dysregulation in catatonia. Activation of the innate immune system is associated with mutism, withdrawal, and psychomotor retardation, which constitute the neurovegetative features of catatonia. Evidence is sparse and conflicting for acute-phase activation in catatonia, and whether this feature is secondary to immobility is unclear. Various viral, bacterial, and parasitic infections have been associated with catatonia, but it is primarily linked to CNS infections. The most common cause of autoimmune catatonia is N-methyl-D-aspartate receptor (NMDAR) encephalitis, which can account for the full spectrum of catatonic features. Autoimmunity appears to cause catatonia less by systemic inflammation than by the downstream effects of specific actions on extracellular antigens. The specific association with NMDAR encephalitis supports a hypothesis of glutamatergic hypofunction in catatonia.

A Case of Catatonia in a Man With COVID-19

“…Other viral illnesses, including influenza, have been associated with catatonia. 5 In terms of objective medical data, including vital signs and laboratory tests, Mr. G's case was typical for COVID-19: fever, tachycardia, transaminase elevation, markers of inflammation such as elevated platelet count, and an elevated immature granulocyte count without leukocytosis. Mr. G's cerebrospinal fluid and brain magnetic resonance imaging were unremarkable, which is consistent with an early observation that most COVID-19 patients with neurologic features have unremarkable cerebrospinal fluid and nonspecific magnetic resonance imaging findings.…”

“…4 Among infectious causes of catatonia, many are known to be neurotropic pathogens; the pathogenesis may be through a direct toxic effect or an immune response. 5 Coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2, has contributed to considerable morbidity and mortality in 2020. 6 While respiratory symptoms are predominant in COVID-19, there have been reports of neurologic sequelae, including peripheral nervous system abnormalities such as hypogeusia and hyposmia and central nervous symptoms such as dizziness, headache, stroke, and delirium.…”

Catatonic features in children and adolescents with N-methyl-d-aspartate receptor antibody encephalitis

“…In total, 86% of children and adolescents with NMDARE had signs and symptoms consistent with catatonia, in keeping with previous reports of catatonia in 19-88% of NMDARE patients. 4,6,7 The symptomatology was complex, with 69% of affected patients manifesting both positive (hyperkinetic) and negative (hypokinetic) features. Only 33% were recognised as catatonic by the reporting physician.…”

Predicting the outcome of a comatose patient at the bedside

“…None of the intuitive poor prognostic indicators (MR brain scan abnormalities, refractory status epilepticus and mechanical ventilation for coma) panned out 43. Some patients may develop severe catatonia 44…”