Catatonia-like behavior and immune activation: a crosstalk between psychopathology and pathology in schizophrenia

Abstract

Abstract Background: in Kalhbaum's first description of catatonia, symptoms of the affective domain, such as blunted affect, were included in addition to motor symptoms. Recently some authors proposed to revisit the concept of catatonia by including symptoms such as blunted affect and psychomotor slowing. This study aimed to investigate the association between catatonic-like behavior (CLB) (emotional withdrawal, blunted affect, and psychomotor slowing) and inflammatory markers, such as neutrophil/lymphocytes ratio (NLR) and lymphocytes/monocytes ratio (LMR) in patients diagnosed with schizophrenia. Method: a sample of 25 patients with schizophrenia (10 females, 15 males) was recruited, and the Brief Psychiatric Rating Scale (BPRS) was used to assess the severity of emotional withdrawal, blunted affect, and psychomotor slowing. Findings: the correlation analysis (Spearman r) revealed a robust direct association between blunted affect and psychomotor slowing (r=0.79, P=0.00), and a significant direct correlation between CLB (emotional withdrawal, r=0.51, P=0.05; blunted affect r=0.58, P=0.05; motor retardation, r=0.56, P=0.05) and LMR (r=0.53, P=0.05). In addition, patients with a duration of illness (DOI) older than five years had a higher presence of CLB and a higher LMR than patients with a more recent diagnosis of the disease. Likely, patients with positive symptoms and in the prodromal and active stages of the disease have a different immune profile than patients in the residual stage and with a predominance of negative symptoms. Conclusions: psychomotor slowing and blunted affect are two significantly related features, representing the two-faced Janus of immobility. Furthermore, aggregating them in CLB is more predominant the longer the duration of schizophrenia and is associated with different a specific pattern of immune activation.