Clinical Neuroimaging Findings in Catatonia: Neuroradiological Reports of MRI Scans of Psychiatric Inpatients With and Without Catatonia

Abstract

ObjectiveCatatonia is a debilitating psychomotor disorder. Previous neuroimaging studies have used small samples with inconsistent results. We aimed to describe the structural neuroradiological abnormalities in clinical MRI brain scans of patients with catatonia and compare them to psychiatric inpatients without catatonia. We report the largest study of catatonia neuroimaging to date. MethodsIn this retrospective case-control study, neuroradiological reports of psychiatric inpatients who had undergone MRI brain scans for clinical reasons were examined. Abnormalities were classified by lateralisation, localisation and pathology. The primary analysis was prediction of catatonia by the presence of an abnormal MRI scan, adjusted for age, sex, Black ethnicity and psychiatric diagnosis. ResultsScan reports from 79 patients with catatonia and 711 other psychiatric inpatients were obtained. Mean age (SD) in the cases was 36.4 years (17.3) and 44.5 (19.9) in the comparison group. Radiological abnormalities were reported in 27 out of 79 cases (34.2%) and in 338 out of 711 in the comparison group (47.5%), OR 0.57 (0.35 to 0.93), aOR 1.11 (0.58 to 2.14). Among the cases, most abnormal scans had bilateral abnormalities (n=23, 29.1%), involved the forebrain (25, 31.6%) and involved atrophy (17, 21.5%). ConclusionsPatients with catatonia are commonly reported to have brain MRI abnormalities, which largely consist of diffuse cerebral atrophy rather than focal lesions, but there is no evidence that these abnormalities are more common than in other psychiatric inpatients undergoing neuroimaging, after adjustment for demographic variables. Study limitations include a heterogeneous control group and selection bias in requesting scans.

Catatonia Psychopathology and Phenomenology in a Large Dataset

“…We have previously identified a large cohort of 1,456 patients with catatonia from the CRIS database and have described their demographics, clinical characteristics, recreational drug use, laboratory test results and structural neuroimaging findings ( 24 – 26 ). In brief, this cohort was selected by sequentially conducting a search in the free text of the notes for the string “cataton*,” using a natural language processing app to remove clearly irrelevant entries followed by investigators manually screening notes.…”

Catatonia Due to General Medical Conditions in Psychiatric Patients: Implications for Clinical Practice

“…In the largest study of catatonia neuroimaging on psychiatric inpatients to date, it was found that magnetic resonance imaging (MRI) scan abnormalities were common in patients with catatonia, and mostly consisted of diffuse cerebral atrophy rather than focal lesions. However, the rates of those abnormalities did not differ between patients with catatonia and other psychiatric inpatients [17]; thus, structural neuroimaging findings cannot be used as biomarkers in catatonia. On the other hand, studies with the use of functional MRI neuroimaging have found a cerebral blood flow increase in the left supplementary motor area and lateral premotor cortex in acute and remitted patients with periodic catatonia, suggesting that these findings could be used as diagnostic biomarkers [18].…”

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

“…A systematic review of structural and functional brain imaging in catatonia, which identified 137 case reports and 18 studies with multiple patients (pooled n = 186), found that more than 75% of cases of catatonia were associated with non-focal brain imaging abnormalities affecting several brain regions, and associated with a variety of underlying conditions, including neuroinflammatory conditions (SLE, encephalitis) ( Haroche et al, 2020 ). The most common abnormalities in catatonia are generalised atrophy and non-specific white matter abnormalities ( Haroche et al, 2020 ; Jeyaventhan et al, 2022 ; Magnat et al, 2022 ).…”

“…In terms of focal neurological lesions in catatonia, there are case reports of catatonia associated with lesions to the frontal, parietal and temporal lobes, basal ganglia, diencephalon and cerebellum and lesions around the third ventricle. However, larger studies have found that most of the structural neuroimaging abnormalities in catatonia consist of generalised atrophy or non-specific white matter abnormalities ( Jeyaventhan et al, 2022 ; Magnat et al, 2022 ).…”