Catatonia and FTD MALAKOUTI RASOUL HOSPITAL, GERIATRIC PSYCHIATRY.

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Presentation transcript:

Catatonia and FTD MALAKOUTI RASOUL HOSPITAL, GERIATRIC PSYCHIATRY

Subtypes of FTD Focal frontal atrophy Anterior portion of temporal atrophy Semantic dementia Progressive nonfluent aphasia

Akinesia Gait disturbances Rigidity Tremor, less frequent

Progressive non fluent aphasia Preserved comprehension Gestural apraxia Speech production impaired

Semantic dementia At early stage Speech production is fluent, gramatical Free of paraphasia Comprehension is impaired Prosopagnosia Object agnosia

FTD & catatonia share with: Paucity of speech Stereotype behavior Excesstive motor activity Echolalia Disinhibition of orbitomedial atrophy

Apathy due to Frontal lobe atrophy Semantic imairment due to atrophy of LT anterior temporal

SPECT Hypoperfusion of frontal lobe Hypo glucose metabolism of frontal and anterior temporal lobe Bitemporal and bifrontal glucose hypo.. Bithalamus hyper metabolism

Presented with depression and ended to FTD

At progressive stage: Stereotypic speech I don’t know to questions Balance problem, fallen Mild rigidity Grasp reflex myoclonus

Low DA in frontal Low GABA-A receptor Frontal anomalies Glutamat antagonist therapy in the treatment of catatonia

Possible relationships of catatonoid signs requiring future confirmation include insufficient GABA-A (multiple signs) D2 (mutism) excessive NMDA (immobility, rigidity), D2/D3 (mannerisms, verbal perseveration) 5HT1a (staring) receptor stimulation

Sequential therapeutic trials for catatonoid frontal signs in clinically-evident frontotemporal dementia benefits for lorazepam, amantadine, memantine, pramipexole, aripiprazole, quetiapine, citalopram, and donepezil, Citalopram and donepezil were poorly tolerated. Ramelteon was without effect. memantine appeared to improve cognition Parkinsonism (case 2) responded to pramipexole, but not amantadine or levodopa. Low-dose lorazepam and quetiapine required close monitoring.