BALL EXPERIMENTS IN 32 ACUTE AKINETIC CATATONIC PATIENTS - DEFICITS OF INTERNAL INITIATION AND GENERATION OF MOVEMENTS

We undertook ball experiments in 32 akinetic catatonic patients in ord er to determine specific functional deficits in the motor system in ak inetic catatonia. Standardized ball experiments (catching, throwing, s topping, kicking) were conducted in 32 acute akinetic catatonic patien ts (23 without neuroleptics on admission), diagnosed according to Lohr , Rosebush, and the Diagnostic and Statistical Manual of Mental Disord ers (3rd ed, revised) on days 0 and 21. Additionally, associated psych opathology was evaluated using different scales on days 0 and 21: the Global Assessment Scale, the Brief Psychiatric Rating Scale, the Hamil ton-Anxiety Scale, the scale for the assessment of negative symptoms ( SANS), and the Simpson scale for extrapyramidal side effects (SEPS). S ignificantly more patients were able to perform more externally guided tasks (catching, stopping) than internally guided tasks (throwing, ki cking). Patients showed significantly more posturing and awkward movem ents on day 0 than on day 21. There was a significantly positive corre lation between hypokinetic extrapyramidal features (SEPS) and negative symptoms with their cognitive alterations (SANS) on day 0. The findin gs suggest a deficit of internal initiation, as in parkinsonism, as we ll as a dysfunction in the generation of voluntary movements in akinet ic catatonia. We assume an underactivity in the dorsolateral prefronta l cortex and the supplementary motor area with consecutive down-regula tion of the cortical-striatal-thalamic circuit, the ''motor loop,'' in catatonia.