technetium-tc-99m-bicisate and Catatonia

Associations between large cavum septum pellucidum and functional psychosis disorders, especially schizophrenia, have been reported. We report a case of late-onset catatonia associated with enlarged CSP and cavum vergae. A 66-year-old woman was presented with altered mental status and stereotypic movement. She was initially treated with aripiprazole and lorazepam. After 4 weeks, she was treated with electroconvulsive therapy. By 10 treatments, echolalia vanished, and catatonic behavior was alleviated. Developmental anomalies in the midline structure may increase susceptibility to psychosis, even in the elderly.

Topics: Aged; Antipsychotic Agents; Aripiprazole; Brain; Catatonia; Cysteine; Electroconvulsive Therapy; Female; Humans; Hypnotics and Sedatives; Lorazepam; Magnetic Resonance Imaging; Organotechnetium Compounds; Piperazines; Quinolones; Radiopharmaceuticals; Septum Pellucidum; Somatoform Disorders; Tomography, Emission-Computed, Single-Photon

This case report describes the successful response to electroconvulsive therapy (ECT) in a patient with an unusual presentation of catatonia, whose onset occurred in the context of an extremely severe form of refractory obsessive-compulsive disorder (OCD). We correlated the clinical improvement in catatonic and OCD symptoms with specific changes in brain function as shown by regional cerebral blood flow scans, neurological soft signs examination, and neuropsychological testing. All assessments were conducted before and after the ECT course. The results strongly suggest that a right hemisphere dysfunction was the neural correlate of our patient's symptoms, and that ECT, by reverting this abnormality, may serve as an effective therapeutic approach for refractory catatonic OCD.

Topics: Behavior; Brain; Catatonia; Cerebrovascular Circulation; Cysteine; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Nervous System Diseases; Neurologic Examination; Neuropsychological Tests; Obsessive-Compulsive Disorder; Organotechnetium Compounds; Psychiatric Status Rating Scales; Psychophysiology; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Young Adult

Catatonia is a psychomotor syndrome that can be characterized by behavioural, affective and motor abnormalities. In order to reveal further underlying pathophysiological mechanisms of psychomotor disturbances in catatonia we investigated neuropsychological function and regional cerebral perfusion (r-CBF) in a combined study.. Ten catatonic patients were investigated with Tc-99mECD brain SPECT and compared with 10 psychiatric (similar age, sex, medication and underlying psychiatric diagnosis but without catatonic syndrome) and 20 healthy controls. Neuropsychological measures included tests for general intelligence, attention, executive functions and right parietal visual-spatial abilities. Correlational analyses were performed between neuropsychological measures, catatonic symptoms and r-CBF.. Catatonic patients showed a significant decrease of r-CBF in right lower and middle prefrontal and parietal cortex compared with psychiatric and healthy controls as well as significantly poorer performance in visual-spatial abilities associated with right parietal function. Correlational analysis revealed significant correlations between visual-spatial abilities and right parietal r-CBF only in psychiatric and healthy controls but not in catatonic patients. In contrast, attentional measures correlated significantly with motor symptoms, visual-spatial abilities and right parietal r-CBF in catatonia only but not in psychiatric or in healthy controls.. Findings are preliminary but suggest right lower prefronto-parietal cortical dysfunction in catatonia, which may be closely related to psychomotor disturbances.

Topics: Adult; Case-Control Studies; Catatonia; Cerebral Cortex; Cysteine; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Parietal Lobe; Psychomotor Disorders; Radiopharmaceuticals; Regional Blood Flow; Tomography, Emission-Computed, Single-Photon