B. Pflug

Catatonia as a psychomotor syndrome: a rating scale and extrapyramidal motor symptoms.

Catatonia was first described by Kahlbaum as a psychomotor disease with motor, behavioral, and affective symptoms. In keeping with this concept, we developed a rating scale for catatonia (Northoff Catatonia Scale [NCS]) with three different categories of symptoms (i.e., motor, behavioral, affective). Furthermore, the question of the relationship among catatonic symptoms, extrapyramidal motor symptoms, and neuroleptics was addressed in the present study.

Can response to partial sleep deprivation in depressed patients be predicted by regional changes of cerebral blood flow

The possible predictive value of regional cerebral perfusion patterns with respect to the response to partial sleep deprivation (PSD) was evaluated in 15 major depressive patients (mean age = 54.9 years, mean Hamilton depression score = 21.6). Patients were studied with single photon emission computed tomography with technetium-99 m-D,L-hexamethyl-propylene amine oxime. Scans were performed on the morning before and after (at 08.00 h) PSD. Responders to PSD had significantly higher perfusion in the right orbitofrontal cortex than did non-responders before PSD. Multiple regression analysis indicated that right orbitofrontal/basal cingulate perfusion (r = -0.77, P < 0.001) before PSD, and left inferior temporal perfusion (r = 0.59, P = 0.01) after PSD, were fairly accurate predictors of change in Hamilton depression scores. Thus, it appears that the orbitofrontal cortex and the cingulate are involved in PSD and may serve as predictors of therapeutic response.

Evaluation of the effects of total sleep deprivation on cerebral blood flow using single photon emission computerized tomography

HMPAO‐single photon emission computerized tomography (SPECT) is a useful technique in studying cerebral blood flow (CBF). This method is suitable to evaluate the differences of CBF with reference to total sleep deprivation (TSD) within 24 h because of the short half‐life of the radiopharmaceutical compound. In the present study, CBF before and after TSD was analysed in patients suffering from major depression. The morning before and after TSD, Tc‐HMPAO‐SPECT was performed in 20 patients. Hamilton Rating Scale for Depression scores and subjective ratings were obtained daily. Eleven patients responded to TSD; 9 were nonresponders. The main finding was a significant left temporal and mainly right parietal increase of CBF, which was observed in the responders only. CBF values and the severity of depression correlated inversely.

Catatonia : short-term response to lorazepam and dopaminergic metabolism

Therapeutic response to lorazepam and dopaminergic metabolism were investigated in 18 neuroleptically naive acute catatonic patients. They were diagnosed as catatonic according to criteria by Lohr and Rosebush and treated exclusively with lorazepam (2–4 mg) during the first 24 h. Dopaminergic metabolism (plasma HVA, plasma MHPG), anxiety (HAM-A) and parkinsonic/dyskinetic movements (SEPS, AIMS) were measured under standard conditions before initial treatment with lorazepam (day 0) and 24 h after initial treatment (day 1). On day 0 responders to lorazepam treatment (complete remission of catatonic syndrome after 24 h according to Rosebush and Lohr) showed significantly higher (P=0.004) plasma HVA (130.4±51.2 pmol/ml; means ± SD) than non-responders (no remission of catatonic syndrome after 24 h; 73.2±40.5 pmol/ml; means ± SD). On day 1 plasma HVA did not differ any more significantly between both groups Clinically, responders showed significantly higher HAM-A (P=0.025) and AIMS (P=0.022) scores as well as significantly lower SEPS (P=0.049) scores than non-responders on day 0. Hence catatonic short-term responders and non-responders to lorazepam can be distinguished with regard to plasma HVA, anxiety and dyskinetic/parkinsonic movements.

Subjective sleepiness and physiological sleep tendency in healthy young morning and evening subjects

SUMMARY  The Multiple Sleep Latency Test (MSLT) was performed twice after 8h and after 4h of night sleep in 15 healthy young subjects (mean age: 23 y). Seven subjects could be regarded as morning, 8 subjects as evening types. After 8h of sleep significantly more evening types napped at 08.00 hours and at 12.00 hours. Evening types rated themselves more sleepy on an hourly administered visual analogous scale (VAS). Sleep onset latencies (SOL) decreased, and the amount of Stages 1 and 2 increased in all subjects dependent on the sleep restriction condition. No significant differences between morningness and eveningness concerning SOL and structure of nap structure could be observed. After 4 h of sleep there was a marked increase in subjectively rated sleepiness during the morning hours in both groups.

Major differences in subjective experience of akinetic states in catatonic and Parkinsonian patients

Both catatonic and parkinsonian patients show severe motor deficits such as complete akinesia. In contrast to Parkinsons disease, mechanisms of akinetic states in catatonia remain unclear. In an attempt to define catatonic akinesia in a more detailed way we investigated subjective experience in 22 akinetic catatonic patients comparing them with 22 major depressive, 22 paranoid schizophrenic, 22 residual schizophrenic, and 22 akinetic parkinsonian patients. Catatonic patients were diagnosed according to standardised criteria. They were treated exclusively with lorazepam (2-4mg) during the first 24 hours and, according to their response on day 1, they were divided into responders and nonresponders. Subjective experience was investigated with a self-rated questionnaire, developed by us, for the subjective experience of psychological and motor functions in an acute akinetic state. Catatonic patients differed significantly in their subjective experience from parkinsonian, depressive, and schizophrenic patient...

Plasma homovanillic acid concentrations in catatonia

We investigated the dopamine metabolite plasma homovanillic acid (plasma HVA) levels in 37 catatonic patients on the day of admission before initial medication as well as in 17 healthy controls. In a prospective study catatonic syndrome was diagnosed according to criteria of Lohr and Wiesniwski (1987) and Rosebush et al (1990) whereas comorbid diagnosis was made by Diagnostic and Statistical Manual of Mental Disorders, 3rd ed, revised (DSM III/R) (APA 1987). On the day of admission blood samples were taken before initial medication. Compared to controls (80.1 +/- 40.1 pmol/mliter) catatonic patients showed significantly (P = 0.0286) increased plasma HVA (140.9 +/- 53.6 pmol/mliter). Catatonic patients free of neuroleptic medication (n = 21) differed significantly (p = 0.0416) from controls whereas neuroleptically treated catatonics (n = 16) did not. Our findings of increased plasma HVA in catatonia are explained by an alteration in either mesolimbic or mesocortical dopaminergic function, as is assumed in the case of schizophrenia. As an alternative, it may be due to increased nigrostriatal function, which can lead, as shown in animal experiments with the dopamine agonist amphetamine, to hypokinetic states resembling catatonia in humans.

Increase of serum creatine phosphokinase in catatonia: an investigation in 32 acute catatonic patients

We investigated serum creatine phosphokinase (CPK) and associated parkinsonic (SEPS) and dyskinetic (AIMS) movements in 32 hospital admitted acute catatonic patients. Thirty-two (N = 24 without neuroleptics on admission) catatonic patients were compared with 32 non-catatonic dyskinetic psychiatric patients, 32 non-catatonic non-dyskinetic psychiatric patients and 32 healthy controls. CPK was significantly higher (P = 0.015) in catatonics (mean 255.75, S.D. +/- 226.54) than in healthy controls (38.6, +/- 27.4) and non-catatonic non-dyskinetic psychiatric patients (57.1, +/- 120.8) whereas there was no significant difference between catatonics and non-catatonic dyskinetic psychiatric patients (453.4, +/- 128.5). There were significantly positive correlations between CPK and AIMS, as well as significantly negative correlations between CPK and SEPS, in all three groups. Our results suggest that increased serum CPK in catatonia may be related to occurrence of dyskinetic movements. Furthermore, we were able to distinguish a parkinsonic (low CPK, low AIMS, high SEPS) and a dyskinetic (high CPK, high AIMS, low SEPS) subtype in catatonia.

Dopamine D2 receptor occupancy measured by single photon emission computed tomography with 123I-Iodobenzamide in chronic schizophrenia.

Single photon emission computed tomography (SPECT) with 123I-iodobenzamide (123I-IBZM) was used to study 22 chronic schizophrenic patients. The patients, who were receiving maintenance therapy with typical neuroleptics, had not shown any significant improvement since their admission to the hospital. Basal ganglia/frontal cortex ratios of the uptake of 123I-IBZM did not show significant differences on the basis of neuroleptic dosage in chlorpromazine equivalents. There were, however, significant differences in 123I-IBZM uptake in the basal ganglia among patients characterized by negative, mixed and positive symptoms of schizophrenia. Although only a small number of patients had shown a positive response to treatment by the time of discharge, D2 receptor blockade was significantly higher in responders than in nonresponders. In addition, there was an inverse correlation between reduced activation as measured by the Brief Psychiatric Rating Scale and the basal ganglia/frontal cortex ratio. These findings suggest a complex pathogenetic link between the blockade of dopamine D2 receptors and psychopathology in chronic schizophrenic patients. SPECT studies with 123I-IBZM appear to have prognostic value in identifying chronic schizophrenic patients who respond poorly to neuroleptic treatment.

Eine Feldstudie zur psychosozialen Situation Wohnungsloser in Frankfurt am Main

ZusammenfassungIn einer Feldstudie wurden 71 wohnungslose Männer im mittleren Alter von 34,5 Jahren mit einem halbstandardisierten Interview untersucht. Soziodemographisch fallen niedriger Schulabschluß (47,9% erreichten den Hauptschulabschluß, 18,3% verließen die Schule ohne Abschluß), hohe Arbeitslosigkeit und geringes Einkommen auf. Haupteinnahmequelle waren regelmäßige staatliche Hilfen. Die meist unverheirateten und kinderlosen Probanden führten selten in ihrem Leben eine längerdauernde Partnerschaft. Psychosoziale Konflikte (59,2%) wurden am häufigsten als Ursache für das Hineingeraten in Wohnungslosigkeit genannt. Hier betrug das Durchschnittsalter 28,1 Jahre. Neben interpersonellen Konflikten waren Entlassung aus dem Gefängnis und Arbeitslosigkeit die erstgenannten Ursachen der aktuellen Phase der Wohnungslosigkeit. 42,3% berichteten von psychiatrischen Kliniksaufenthalten, v.a. im Zusammenhang mit Alkoholabusus. Die erhobenen Befunde weisen darauf hin, daß wohnungslose Männer frühzeitig in ihrer biographischen Entwicklung in soziale Isolation geraten und der Anteil an psychiatrischer Morbidität hoch ist.SummaryIn a current field-study a sample of 71 homeless men (mean age 35,4 years) was investigated with a semi-standardized interview. Sociodemographically, a low education level, a high unemployment rate and low income were noted. The income was gained mainly through regular social welfare support. Mostly unmarried and without children, the participants seldom lived in a stable partnership during their life. Psychosocial conflicts (59,2%) were one of the most important causes for homelessness at an average age of 28,1 years. Interpersonal conflicts, release from jail and loss of job were the most frequently reported causes of current homelessness. 42,3% had been treated in psychiatric hospitals in the past, the majority because of alcoholism. In summary the current findings indicate that homeless men experience social isolation early during their maturation and that the frequency of psychiatric disorders is high.