Orbitofrontal Cortical Dysfunction in Akinetic Catatonia: A Functional Magnetic Resonance Imaging Study During Negative Emotional Stimulation

Abstract

Catatonia is a psychomotor syndrome characterized by concurrent emotional, behavioral, and motor anomalies. Pathophysiological mechanisms of psychomotor disturbances may be related to abnormal emotional-motor processing in prefrontal cortical networks. We therefore investigated prefrontal cortical activation and connectivity patterns during emotional-motor stimulation using functional magnetic resonance imaging (FMRI). We investigated 10 akinetic catatonic patients in a postacute state and compared them with 10 noncatatonic postacute psychiatric controls (age-, sex-, diagnosis-, and medication-matched) and 10 healthy controls. Positive and negative pictures from the International Affective Picture System were used for emotional stimulation. FMRI measurements covered the whole frontal lobe, activation signals in various frontal cortical regions were obtained, and functional connectivity between the different prefrontal cortical regions was investigated using structural equation modeling. Catatonic patients showed alterations in the orbitofrontal cortical activation pattern and in functional connectivity to the premotor cortex in negative and positive emotions compared to psychiatric and healthy controls. Catatonic behavioral and affective symptoms correlated significantly with orbitofrontal activity, whereas catatonic motor symptoms were rather related to medial prefrontal activity. It is concluded that catatonic symptoms may be closely related to dysfunction in the orbitofrontal cortex and consequent alteration in the prefrontal cortical network during emotional processing. Because we investigated postacute patients, orbitofrontal cortical alterations may be interpreted as a trait marker predisposing for development of catatonic syndrome in schizophrenic or affective psychosis.

Integrating rewards and cognition in the frontal cortex

“…While our study focused on a priori regions of interest specifically located within frontal cortex, preliminary post hoc analyses provided some evidence that other regions-such as the parahippocampal cortex and occipital cortex-were affected by the reward manipulation. Techniques such as structural equation modeling might offer important tools for understanding the relationship between ventral prefrontal regions and other regions involved in affective processing (Northoff et al, 2004). Map of mean raw signal intensity values; the coverage of these functional images is depicted in a voxelwise map.…”

Microglia ablation alleviates myelin-associated catatonic signs in mice

“…Reports on brain areas involved in catatonia are scarce. Available data point to frontal lobe regions, such as the pronounced catatonia in a case of butterfly glioma of the frontal corpus callosum (6) or frontal activation in akinetic catatonic patients detected by functional MRI (7).…”

Hyperactive action monitoring during motor-initiation in conversion paralysis: An event-related potential study

“…Reports on 'anterior cingulate cataplexy' date from half a century ago and refer to a loss of muscle tonus commonly induced by strong emotion (Ethelberg, 1950;Fuster, 1955;Levin, 1953). More recent investigations indeed showed that negative emotional stimulation induced hyperactivation in orbitofrontal cortex and a shift of main activation to ACC www.elsevier.com/locate/biopsycho Biological Psychology 71 (2006) [316][317][318][319][320][321][322][323][324][325] and medial prefrontal cortex in catatonic patients (Northoff et al, 2004). Also in animals the role of the ACC in the modulation of motor inhibition and freezing reactions has been well established (e.g.…”