In 1874, Karl Kahlbaum described catatonia as an independent syndrome characterized by motor, affective, and behavioral anomalies. In the following years, various catatonia concepts were established with all sharing the prime focus on motor and behavioral symptoms while largely neglecting affective changes. In 21st century, catatonia is a well-characterized clinical syndrome. Yet, its neurobiological origin is still not clear because methodological shortcomings of hitherto studies had hampered this challenging effort. To fully capture the clinical picture of catatonia as emphasized by Karl Kahlbaum, 2 decades ago a new catatonia scale was developed (Northoff Catatonia Rating Scale [NCRS]). Since then, studies have used NCRS to allow for a more mechanistic insight of catatonia. Here, we undertook a systematic review searching for neuroimaging studies using motor/behavioral catatonia rating scales/criteria and NCRS published up to March 31, 2019. We included 19 neuroimaging studies. Studies using motor/behavioral catatonia rating scales/criteria depict cortical and subcortical motor regions mediated by dopamine as neuronal and biochemical substrates of catatonia. In contrast, studies relying on NCRS found rather aberrant higher-order frontoparietal networks which, biochemically, are insufficiently modulated by gamma-aminobutyric acid (GABA)-ergic and glutamatergic transmission. This is further supported by the high therapeutic efficacy of GABAergic agents in acute catatonia. In sum, this systematic review points out the difference between motor/behavioral and NCRS-based classification of catatonia on both neuronal and biochemical grounds. That highlights the importance of Kahlbaum's original truly psychomotor concept of catatonia for guiding both research and clinical diagnosis and therapy.

中文翻译：

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回到Kahlbaum的精神运动（和GABA能）的起源：卡塔顿尼亚不仅仅是运动和多巴胺能综合症吗？

1874年，卡尔·卡鲍姆（Karl Kahlbaum）将卡塔尼亚描述为一种以运动，情感和行为异常为特征的独立综合症。在接下来的几年中，人们建立了各种各样的Catatonia概念，它们都主要关注运动和行为症状，而很大程度上忽略了情感变化。在21世纪，卡塔顿尼亚是一种特征鲜明的临床综合征。然而，其神经生物学起源仍不清楚，因为迄今为止研究的方法学缺陷已阻碍了这一具有挑战性的努力。为了全面捕捉卡尔·卡鲍姆（Karl Kahlbaum）强调的卡塔尼亚的临床情况，在20年前开发了一种新的卡塔尼亚量表（Northoff Catatonia Rating Scale，NCRS）。从那时起，研究已使用NCRS来对卡塔尼亚进行更深入的研究。这里，我们进行了系统评价，使用运动/行为性卡塔尼亚评分量表/标准和NCRS进行了神经影像学研究，直至2019年3月31日发布。我们纳入了19项神经影像学研究。使用运动/行为性卡塔尼亚评级量表/标准进行的研究描绘了多巴胺作为卡塔顿神经元和生化底物介导的皮质和皮质下运动区域。相比之下，依赖NCRS的研究发现，相当高异常的额叶额叶前额网络在生化上受到γ-氨基丁酸（GABA）-能和谷氨酸能传递的不足调节。GABA活性剂在急性卡他顿中的高治疗功效进一步证明了这一点。总共，该系统评价指出了神经元和生化方面基于运动/行为和基于NCRS的卡塔尼亚分类之间的差异。这凸显了Kahlbaum最初真正的卡塔托尼亚精神动能概念对于指导研究以及临床诊断和治疗的重要性。