Neurophysiological resting-state EEG markers of catatonia in schizophrenia and mood disorders
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Key points
Question
Is catatonia, hypothesized to involve disrupted excitation–inhibition balance and cortical dysconnectivity, associated with quantitative abnormalities on resting-state EEG?
Findings
In this retrospective, case-control, transdiagnostic hospital-based cohort of patients with schizophrenia and/or mood disorders, we analyzed resting-state EEG data comparing individuals with (n=102) and without (n=519) catatonia. Patients with catatonia showed significant increase in delta power, decrease in alpha power, increase in gamma power, significant reduction in peak alpha frequency and longer mean duration of microstate C.
Meaning
Power spectral density, alpha peak frequency, and microstate disruption in catatonia suggest a neurodevelopmentally-related excitation/inhibition dysregulation and support the use of routine clinical EEG for developing diagnostic biomarkers.
Importance
Catatonia is a severe psychomotor syndrome that complicates many psychiatric, neurodevelopmental, and non-psychiatric conditions. Identifying reliable diagnostic biomarkers remains a key challenge to improve early intervention and reduce morbimortality. Since its pathophysiology may involve cortical dysconnectivity, electroencephalography (EEG) could provide accessible disease-associated measures, such as power spectral density (PSD - reflecting excitation/inhibition balance), peak alpha frequency (PAF - related to deviations in neurodevelopmental trajectories), and C and D microstates (previously linked respectively to self-referential and externally-oriented attentional modes). However, EEG is yet to be used for this purpose.
Objective
To leverage routine clinical EEG recordings to identify neurophysiological markers associated with catatonia. We postulate to find anomalies in PSD distribution, a decrease in peak alpha frequency, and increases in the representation of C over D microstate classes.
Design
This study is a case-control retrospective transdiagnostic hospital-based cohort of patients with schizophrenia and/or mood disorders.
Participants
We analyzed resting-state EEG data from patients diagnosed with schizophrenia or mood disorders, both with (n=102) and without (n=519) catatonia. EEG data were preprocessed using a well-validated multistep automated pipeline.
Exposures/measures
Linear regression models assessed associations between catatonia status and PSD, PAF and microstates, adjusting for age, sex, medication (computed as olanzapine, fluoxetine, and diazepam equivalents), and comorbid neurodevelopmental or neurological conditions.
Results
Patients with catatonia showed increased delta power (T = 2.37, p FDR = 0.03), decreased alpha power (T = –3.55, p FDR = 0.002) and increased gamma power (T = 3.14, p FDR = 0.008), reduced PAF (T = –2.60, p = 0.03), and longer mean duration of microstate C (T = 2.17, p = 0.03). Results were consistent in the subgroup not receiving benzodiazepines.
Conclusion and relevance
Routine clinical EEG revealed quantitative neurophysiological differences between patients with and without catatonia in a transdiagnostic population with psychotic and mood disorders. Power spectral density, alpha peak frequency and microstate anomalies in catatonia shed light on its underlying pathophysiology, suggesting a probable neurodevelopmentally-related excitation/inhibition dysregulation. Importantly, this indicates that routine clinical EEG could be used for diagnostic biomarker development, which would ultimately improve early detection and treatment.
