What catatonia can tell us about "top-down modulation"

A neuropsychiatric hypothesis

Research output: Contribution to journalArticle

185 Citations (Scopus)

Abstract

Differential diagnosis of motor symptoms, for example, akinesia, may be difficult in clinical neuropsychiatry. Symptoms may be either of neurologic origin, for example, Parkinson's disease, or of psychiatric origin, for example, catatonia, leading to a so-called "conflict of paradigms." Despite their different origins, symptoms may appear more or less clinically similar. Possibility of dissociation between origin and clinical appearance may reflect functional brain organisation in general, and cortical-cortical/subcortical relations in particular. It is therefore hypothesized that similarities and differences between Parkinson's disease and catatonia may be accounted for by distinct kinds of modulation between cortico-cortical and cortico-subcortical relations. Catatonia can be characterized by concurrent motor, emotional, and behavioural symptoms. The different symptoms may be accounted for by dysfunction in orbitofrontal-prefrontal/parietal cortical connectivity reflecting "horizontal modulation" of cortico-cortical relation. Furthermore, alteration in "top-down modulation" reflecting "vertical modulation" of caudate and other basal ganglia by GABA-ergic mediated orbitofrontal cortical deficits may account for motor symptoms in catatonia. Parkinson's disease, in contrast, can be characterized by predominant motor symptoms. Motor symptoms may be accounted for by altered "bottom-up modulation" between dopaminergic mediated deficits in striatum and premotor/motor cortex. Clinical similarities between Parkinson's disease and catatonia with respect to akinesia may be related with involvement of the basal ganglia in both disorders. Clinical differences with respect to emotional and behavioural symptoms may be related with involvement of different cortical areas, that is, orbitofrontal/parietal and premotor/motor cortex implying distinct kinds of modulation - "vertical" and "horizontal" modulation, respectively.

Original languageEnglish
Pages (from-to)555-577
Number of pages23
JournalBehavioral and Brain Sciences
Volume25
Issue number5
DOIs
Publication statusPublished - Oct 2002
Externally publishedYes

Fingerprint

Catatonia
signs and symptoms (animals and humans)
Motor Cortex
Parkinson Disease
Parkinson disease
Behavioral Symptoms
Basal Ganglia
Neuropsychiatry
gamma-Aminobutyric Acid
Nervous System
Psychiatry
Differential Diagnosis
Brain
nervous system
connectivity
brain

Keywords

  • Bottom-up modulation
  • Catatonia
  • Horizontal modulation
  • Parkinson's disease
  • Top-down modulation
  • Vertical modulation

ASJC Scopus subject areas

  • Ecology, Evolution, Behavior and Systematics
  • Neuroscience(all)
  • Psychology(all)
  • Neuropsychology and Physiological Psychology

Cite this

What catatonia can tell us about "top-down modulation" : A neuropsychiatric hypothesis. / Northoff, Georg.

In: Behavioral and Brain Sciences, Vol. 25, No. 5, 10.2002, p. 555-577.

Research output: Contribution to journalArticle

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