Orbitofrontal cortical dysfunction and “sensori-motor regression”: A combined study of fMRI and personal constructs in catatonia

Objective: A close relationship between subjective experience and neurophysiological mechanisms could provide a new foundation for neurobiological correlates underlying psychodynamic processes in neuropsychiatric diseases. Pursuing a novel method-ological approach by combining both techniques we investigated catatonia a psychomotor syndrome with uncontrollable anxieties and akinesia i.e., “immobi-lization by anxieties” which, psychodynamically, can be characterized as a “sensori-motor regression” reflecting a basic somatic defense mechanism. However psychological and physiological mech-anisms of generation of such “sensori-motor regression” in catatonia remain unclear. We there-fore investigated in a combined study operationa-lized subjective psychological characteristics using Repertory-Grid Technique as well as prefrontal cortical activation pattern during emotional-motor stimulation using functional magnetic resonance imaging (fMRI). Method: We investigated 18 catatonic patients with an underlying affective or schizoaffective psychosis and compared them with age, sex, diagnosis, and medication matched non-catatonic psychiatric controls (n=69), and healthy controls (n=32). Subjective operationalized psychological characteristics were investigated using the Reper-tory Grid Technique (GRID) for personal constructs of the “self” in an acute and a post-acute state. In addition 10 catatonic patients, 10 psychiatric controls and 10 healthy controls underwent emo-tional stimulation with motor reaction during functional magnetic resonance imaging (fMRI). Results: Subjective operationalized psychological characteristics of both the acute and post-acute state could be characterized by significant lack of social contact, decreased self-esteem, and reduced emotional arousal compared to non-catatonic psychiatric and healthy controls. fMRI revealed significant dysfunctional activation patterns in orbitofrontal cortex and alterations in medial prefrontal and premotor cortex during negative emotional stimulation which correlated signifi-cantly (p=0.008±0.042) with affective, behavioral, and motor alterations in catatonia as well as with the GRID dimensions of self-esteem, emotional arousal, and social contact. Conclusions: Subjective operationalized psycholo-gical characteristics demonstrate the central im-portance of lack of emotional control as well as of alterations in interactions between emotional, social, and motor functions in catatonia. Orbito-frontal cortical dysfunction and related alterations in medial prefrontal and premotor cortical activity may account for lack of emotional control with consecutive “sensori-motor regression” as an “immobilization by anxieties” in catatonia. In general one may conclude that orbitofrontal cortical dysfunction may be closely related with regression to somatic defense mechanisms as paradigmatically observed in catatonia.