Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Center for Psychosocial Medicine, Department of General Psychiatry, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
Schizophr Res. 2020 Oct;224:82-87. doi: 10.1016/j.schres.2020.09.025. Epub 2020 Oct 9.
Catatonia is a severe psychomotor syndrome that frequently occurs in patients with schizophrenia spectrum disorders (SSD). Accumulating neuroimaging evidence suggests orbitofrontal, frontoparietal and cerebellar network dysfunction in catatonia. Very little is known about contributions of brainstem regions (as part of the dopaminergic-based subcortical-cortical motor circuit) to catatonia in SSD patients. Here, we used structural magnetic resonance imaging (MRI) at 3 T to examine volumes of brainstem regions in catatonic SSD patients compared to non-catatonic SSD patients. Catatonia severity was measured with the Northoff Catatonia Rating Scale (NCRS). The segmentation of the brainstem in order to investigate the volumes of medulla oblongata, pons, superior cerebellar pedunculus, and midbrain was carried out using FreeSurfer vers. 6.0. Catatonic patients (NCRS total score ≥ 3; at least 1 point in the three different symptom categories; i.e., motor, behavioral, and affective; n = 30) had significantly smaller midbrain volumes (p = 0.004, Bonferroni corr.) when compared to non-catatonic patients (NCRS total score = 0; n = 29). In catatonic patients, significant correlations were detected between NCRS motor scores and whole brainstem (p = 0.015, Bonferroni corr.) volumes. These results support a neuromechanistically important role of brainstem structures in catatonia in SSD, particularly in motor symptom expression.
紧张症是一种严重的精神运动综合征，常发生在精神分裂症谱系障碍（SSD）患者中。越来越多的神经影像学证据表明，紧张症患者存在眶额、额顶和小脑网络功能障碍。关于脑干区域（作为基于多巴胺的皮质下-皮质运动回路的一部分）对 SSD 患者紧张症的贡献，我们知之甚少。在这里，我们使用 3T 结构磁共振成像（MRI）检查了紧张症 SSD 患者与非紧张症 SSD 患者的脑干区域体积。使用 Northoff 紧张症评定量表（NCRS）测量紧张症严重程度。使用 FreeSurfer vers. 6.0 对脑干进行分割，以研究延髓、脑桥、上小脑脚和中脑的体积。与非紧张症患者（NCRS 总分=0；至少在三个不同的症状类别中得 1 分；即运动、行为和情感；n=29）相比，紧张症患者（NCRS 总分≥3；在三个不同的症状类别中至少得 1 分；即运动、行为和情感；n=30）的中脑体积明显较小（p=0.004，Bonferroni 校正）。在紧张症患者中，NCRS 运动评分与全脑干（p=0.015，Bonferroni 校正）体积之间存在显著相关性。这些结果支持了脑干结构在 SSD 紧张症中具有神经机制上重要的作用，特别是在运动症状表达方面。
