Patients with schizophrenia spectrum disorder (SSD) and a history of catatonia showed greater cognitive deficits in verbal fluency and processing speed than patients with SSD without catatonia. However, there were no differences in brain structure between the groups, according to findings published in Schizophrenia Research.

Presently, the pathophysiology of catatonia within the context of schizophrenia is unknown. Research to date has provided conflicting results on the cognitive deficits and brain regions affected in patients with schizophrenia and a history of catatonia. Neuroimaging may help elucidate the role of cognition in catatonia; however, studies have largely been performed in case reports and on a cross sectional basis.

This study compared cognition and brain structure in SSD patients with and without a history of catatonia, as well as healthy controls. The researchers selected participants from the Psychiatric Genotype/Phenotype Project repository and evaluated SSD patients using the Structured Clinical Interview for DSM-IV-TR (SCID). Diagnoses included schizophrenia (N=27), schizoaffective disorder (N=6), and schizophreniform disorder (N=53).

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For data analysis, SSD patients with catatonia were matched to SSD patients without catatonia and healthy control subjects based on age, sex, and MRI protocol. The researchers used the Screen for Cognitive Impairment in Psychiatry (SCIP) to measure cognitive function. They analyzed brain structure with voxel-based morphometry and T1-weighted MRI imaging.

Patients with SSD had greater cognitive deficits in all domains when compared to healthy controls, and SSD patients with a history of catatonia had greater deficits in the cognitive domains of immediate memory (t=2.07; P =.04), verbal fluency (t=2.77; P =.01), and processing speed (t=2.44; P =.02) compared to SSD patients with no history of catatonia.

Overall, patients with SSD had smaller grey matter volumes in the insula, anterior cingulate, medial frontal cortex, middle temporal gyrus and temporal pole, angular gyrus, and lingual gyrus when compared to healthy controls. However, there were no differences in grey matter volume between patients with SSD and a history of catatonia and those with SSD alone.

The study was limited by challenges in identifying SSD patients without a history of catatonia, as some patients may later develop catatonia after the study. Other limitations included the reliance on a subject repository, which limited the sample size.

“This is the largest sample of SSD patients with a history of catatonia to be examined with structural brain imaging,” the researchers noted, “prospective and longitudinal study designs are needed to capture the cognitive, affective and neural basis of catatonia”.


Dean DJ, Woodward N, Walther S, McHugo M, Armstrong K, Heckers S. Cognitive motor impairments and brain structure in schizophrenia spectrum disorder patients with a history of catatonia [published online ahead of print, 2020 May 15]. Schizophr Res. 2020;S0920-9964(20)30264-4.