Cortical Contributions to Distinct Symptom Dimensions of Catatonia

Abstract

Catatonia is a central aspect of schizophrenia spectrum disorders (SSD) and most likely associated with abnormalities in affective, motor, and sensorimotor brain regions. However, contributions of different cortical features to the pathophysiology of catatonia in SSD are poorly understood. Here, T1-weighted structural magnetic resonance imaging data at 3 T were obtained from 56 right-handed patients with SSD. Using FreeSurfer version 6.0, we calculated cortical thickness, area, and local gyrification index (LGI). Catatonic symptoms were examined on the Northoff catatonia rating scale (NCRS). Patients with catatonia (NCRS total score ≥3; n = 25) showed reduced surface area in the parietal and medial orbitofrontal gyrus and LGI in the temporal gyrus (P < .05, corrected for cluster-wise probability [CWP]) as well as hypergyrification in rostral cingulate and medial orbitofrontal gyrus when compared with patients without catatonia (n = 22; P < .05, corrected for CWP). Following a dimensional approach, a negative association between NCRS motor and behavior scores and cortical thickness in superior frontal, insular, and precentral cortex was found (34 patients with at least 1 motor and at least 1 other affective or behavioral symptom; P < .05, corrected for CWP). Positive associations were found between NCRS motor and behavior scores and surface area and LGI in superior frontal, posterior cingulate, precentral, and pericalcarine gyrus (P < .05, corrected for CWP). The data support the notion that cortical features of distinct evolutionary and genetic origin differently contribute to catatonia in SSD. Catatonia in SSD may be essentially driven by cortex variations in frontoparietal regions including regions implicated in the coordination and goal-orientation of behavior.

Brain imaging in catatonia: systematic review and directions for future research

“…Positive associations were found between NCRS motor and behaviour scores and surface area and LGI in superior frontal, posterior cingulate, precentral and pericalcarine gyrus. According to the authors, this pattern (surface area and LGI differences between schizophrenia patients with or without catatonia) support the hypothesis of a vulnerability for catatonia among some schizophrenia patients (Hirjak et al, 2019 a ).…”

Patterns of co‐altered brain structure and function underlying neurological soft signs in schizophrenia spectrum disorders

“…Both regions are crucial for the “horizontal” (i.e., predominantly cortico‐cortical) modulation of cognitive control and regulation of emotional stimuli and motor behavior (Hirjak et al, , 2019; Northoff, ). Correspondingly, aberrant INA might lead to abnormalities in motor functioning, which can manifest itself as NSS or catatonia (Hirjak, Kubera, et al, ).…”

“…For the present investigation, we approached and examined a total of 37 (17 females) right‐handed patients satisfying DSM‐IV‐TR (Sass, Wittchen, & Zaudig, ) for schizophrenia ( n = 34; paranoid type) or schizoaffective disorder ( n = 3) and 37 (17 females) HC matched for age, gender, education, and handedness. Patients in this sample have been also included elsewhere (Hirjak, Kubera, et al, ). Patients were consecutively recruited from the Department of Psychiatry and Psychotherapy at the Central Institute of Mental Health in Mannheim, Germany.…”

“…In addition to severe sensorimotor symptoms such as catatonia, akathisia, and parkinsonism, patients with schizophrenia spectrum disorders (SSD) also exhibit subtle and clinically inconspicuous sensorimotor abnormalities (Hirjak et al, ; Hirjak, Kubera, Thomann, & Wolf, ; Hirjak, Meyer‐Lindenberg, Kubera, Thomann, & Wolf, ). These phenomena are referred to as neurological soft signs (NSS), which are subtle neurological abnormalities in the execution of motor or sensory tasks (Schroder et al, ; Schroder et al, ).…”

Emerging Knowledge From Noninvasive Imaging Studies: Is Ammonia Control Enough?

“…Diffusion weighted and diffusion tensor imaging (DWI and DTI) are used to study microstructural variance in WM fiber tracts [48], and proton magnetic resonance spectroscopy is used to measure brain metabolism in static and dynamic models [47]. Multimodal assessment batteries and data fusion give investigators a complex and varied perspective into the structural, functional, and biochemical parameters of the central nervous system in IEMs [49].…”