Psychogenic:  Research Article

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“Scared Stiff” Catatonia as an Evolutionary-Based Fear Rsponse.  

CITATION:  Moskowitz, A.K. (2004)  “Scared Stiff” Catatonia as an Evolutionary-Based Fear Rsponse.  Psychological Review Vol. 111, No. 4,  984-1002.

ABSTRACT:  Catatonia, long viewed as a motor disorder, may be better understood as a fear response, akin to the animal defense strategy tonic immobility (after G. G. Gallup & J. D. Maser, 1977). This proposal, consistent with K. L. Kahlbaum's (1874/1973) original conception, is based on similarities between catatonia and tonic immobility (“death feint”) as well as evidence that catatonia is associated with anxiety and agitated depression and responds dramatically to benzodiazepines. It is argued that catatonia originally derived from ancestral encounters with carnivores whose predatory instincts were triggered by movement but is now inappropriately expressed in very different modern threat situations. Found in a wide range of psychiatric and serious medical conditions, catatonia may represent a common “end state” response to feelings of imminent doom and can serve as a template to understand other psychiatric disorders.


Abrams, R.,  & Taylor, M. A. (1976). Catatonia. A prospective clinical study.   Archives of General Psychiatry, 33, 579-581.  

Abrams, R.,  & Taylor, M. A. (1977). Catatonia: Prediction of response to somatic treatments.   American Journal of Psychiatry, 134, 78-80.  

Abrams, R., Taylor, M. A.,  & Coleman Stolurow, K. A. (1979). Catatonia and mania: Patterns of cerebral dysfunction.   Biological Psychiatry, 14, 111-117.  

Ahuja, N.,  & Nehru, R. (1990). Neuroleptic malignant syndrome: A subtype of lethal catatonia?   [Letter to the editor].  Acta Psychiatrica Scandinavica, 82, 398.  

Aleman, A.,  & Kahn, R. S. (2002). Top-down modulation, emotion, and hallucination.   Behavioral and Brain Sciences, 25, 578. 

American Psychiatric Association (1994).  Diagnostic and statistical manual of mental disorders    (4th ed.). Washington, DC: Author.

American Psychiatric Association (2000).  Diagnostic and statistical manual of mental disorders    (4th ed., text. rev.). Washington, DC: Author.

Armony, J. L.,  & LeDoux, J. E. (1997). How the brain processes emotional information.   In A. C. McFarlane (Ed.), Psychobiology of posttraumatic stress disorder (Vol. 821, pp. 259–270). New York: New York Academy of Sciences.

Barnes, M. P., Saunders, M., Walls, T. J., Saunders, I.,  & Kirk, C. A. (1986). The syndrome of Karl Ludwig Kahlbaum.   Journal of Neurology, Neurosurgery & Psychiatry, 49, 991-996. 

Bernstein, L.,  & Levin, R. (1993). Catatonia responsive to intravenous lorazepam in a patient with cyclosporine neurotoxicity and hypomagnesemia.   Psychosomatics, 34, 102-103.  

Berrios, G. E. (1981). Stupor revisited.   Comprehensive Psychiatry, 22, 466-478.  

Billig, O.,  & Freeman, W. T. (1944). Fatal catatonia.   American Journal of Psychiatry, 100, 633-638. 
Birkhimer, L. J., Curtis, J. L.,  & Jann, M. W. (1985). Use of carbamazepine in psychiatric disorders.   Clinical Pharmacy, 4, 425-434. 
Blanchard, R. J.,  & Blanchard, D. C. (1990). An ethoexperimental analysis of defense, fear, and anxiety.   In G. Andrews (Ed.), Anxiety (Vol. 1, pp. 124–133). New Zealand: University of Otago Press.

Bleuler, E. (1950).  Dementia praecox or the group of schizophrenias    (J. Zinkin, Trans.). New York: International Universities Press. (Original work published 1911)

Braeunig, P., Krueger, S.,  & Shugar, G. (1999). Prevalence and clinical significance of catatonic symptoms in mania.   Fortschritte der Neurologie-Psychiatrie, 67, 306-317.  

Braeunig, P., Krueger, S., Shugar, G., Hoeffler, J.,  & Boerner, I. (2000). The Catatonia Rating Scale I—Development, reliability, and use.   Comprehensive Psychiatry, 41, 147-158.   

Brune, M. (2000). Rethinking Karl Ludwig Kahlbaum's contribution to biological psychiatry.   Australian & New Zealand Journal of Psychiatry, 34, 873-874. 

Brune, M. (2002). Toward an integration of interpersonal and biological processes: Evolutionary psychiatry as an empirically testable framework for psychiatric research.   Psychiatry—Interpersonal and Biological Processes, 65, 48-57. 

Bush, G., Fink, M., Petrides, G., Dowling, F.,  & Francis, A. (1996a). Catatonia. I. Rating scale and standardized examination.   Acta Psychiatrica Scandinavica, 93, 129-136.  

Bush, G., Fink, M., Petrides, G., Dowling, F.,  & Francis, A. (1996b). Catatonia. II. Treatment with lorazepam and electroconvulsive therapy.   Acta Psychiatrica Scandinavica, 93, 137-143.  

Bush, G., Petrides, G.,  & Francis, A. (1997). Catatonia and other motor syndromes in a chronically hospitalized psychiatric population.   Schizophrenia Research, 27, 83-92.   

Buss, D. M. (1995). Evolutionary psychology: A new paradigm for psychological science.   Psychological Inquiry, 6, 1-30.  

Cannon, W. B. (1928). The mechanism of emotional disturbance of bodily functions.   New England Journal of Medicine, 198, 877-884.  

Cannon, W. B. (1957). “Voodoo” death.   Psychosomatic Medicine, 19, 182-190.  

Carli, G. (1977). Animal hypnosis in the rabbit.   Psychological Record, 1, 123-143. 

Caroff, S. N. (1980). The neuroleptic malignant syndrome.   Journal of Clinical Psychiatry, 41, 79-83. 

Carroll, B. T. (1992). Catatonia on the consultation-liaison service.   Psychosomatics, 33, 310-315.  

Carroll, B. T. (1999). GABAa versus GABAb hypothesis of catatonia.   Movement Disorders, 14, 702-703. 

Carroll, B. T., Kennedy, J. C.,  & Goforth, H. W. (2000). Catatonic signs in medical and psychiatric conditions.   CNS Spectrums, 5, 58-65. 

Castillo, E., Rubin, R. T.,  & Holsboer-Trachsler, E. (1989). Clinical differentiation between lethal catatonia and neuroleptic malignant syndrome.   American Journal of Psychiatry, 146, 324-328.  

Chandler, J. D. (1991). Psychogenic catatonia with elevated creatine kinase and autonomic hyperactivity.   Canadian Journal of Psychiatry—Revue Canadienne de Psychiatrie, 36, 530-532. 

Clark, T.,  & Rickards, H. (1999). Catatonia. 1: History and clinical features.   Hospital Medicine (London), 60, 740-742. 

Cosmides, L.,  & Tooby, J. (1999). Toward an evolutionary taxonomy of treatable conditions.   Journal of Abnormal Psychology, 108, 453-464.   

Cottencin, O., Thomas, P., Vaiva, G., Rascle, C.,  & Goudemand, M. (1999). A case of agitated catatonia.   Pharmacopsychiatry, 32, 38-40. 

Delisle, J. D. (1991). Catatonia unexpectedly reversed by midazolam.   American Journal of Psychiatry, 148, 809. 

de Ryck, M.,  & Teitelbaum, P. (1984). Morphine catalepsy as an adaptive reflex state in rats.   Behavioral Neuroscience, 98, 243-261.   

Dias, R., Robbins, T. W.,  & Roberts, A. C. (1996, March 7). Dissociation in prefrontal cortex of affective and attentional shifts.   Nature, 380, 69-72.  

Dixon, A. K. (1998). Ethological strategies for defence in animals and humans: Their role in some psychiatric disorders.   British Journal of Medical Psychology, 71, 417-445.  

Eddy, T. J.,  & Gallup, G. G. (1990). Thermal correlates of tonic immobility and social isolation in chickens.   Physiology & Behavior, 47, 641-646. 

Ekman, P.,  & Friesen, W. V. (1978).  Facial Action Coding System.   Palo Alto, CA: Consulting Psychologist Press.
Escobar, R., Rios, A., Montoya, I. D., Lopera, F., Ramos, D., Carvajal, C.  et al. (2000). Clinical and cerebral blood flow changes in catatonic patients treated with ECT.   Journal of Psychosomatic Research, 49, 423-429.   

Ewell, A. H.,  & Cullen, J. M. (1981). Tonic immobility as a predator-defense in the rabbit (Oryctolagus cuniculus)   Behavioral and Neural Biology, 31, 483-489. 

Fanselow, M. S. (1991). The midbrain periaquaductal gray as a coordinator of action in response to fear and anxiety.   In R. Bandler (Ed.), The midbrain periaquaductal gray matter: Functional, anatomical and immunohistochemical organization (pp. 151–173). New York: Plenum.

Fanselow, M. S.,  & Lester, L. S. (1988). A functional behavioristic approach to aversively motivated behavior: Predatory imminence as a determinant of the topography of defensive behavior.   In M. D. Beecher (Ed.), Evolution and learning (pp. 185–212). Hillsdale, NJ: Erlbaum.

Fein, S.,  & McGrath, M. G. (1990). Problems in diagnosing bipolar disorder in catatonic patients.   Journal of Clinical Psychiatry, 51, 203-205.  

Fendt, M.,  & Fanselow, M. S. (1999). The neuroanatomical and neurochemical basis of conditioned fear.   Neuroscience & Biobehavioral Reviews, 23, 743-760. 

Fink, M. (1996). Neuroleptic malignant syndrome and catatonia: One entity or two?   Biological Psychiatry, 39, 1-4.   

Fink, M. (1997). Catatonia.   In J. L. Cummings (Ed.), Contemporary behavioral neurology (Vol. 16, pp. 289–309). Woburn, MA: Butterworth-Heinemann.

Fink, M. (2001). Catatonia: Syndrome or schizophrenia subtype? Recognition and treatment.   Journal of Neural Transmission, 108, 637-644. 

Fink, M.,  & Taylor, M. A. (1991). Catatonia: A separate category in DSM-IV?   Integrative Psychiatry, 7, 2-10.  

Fink, M.,  & Taylor, M. A. (2001). The many varieties of catatonia.   European Archives of Psychiatry & Clinical Neuroscience, 251, I8-I13. 

Fink, M.,  & Taylor, M. A. (2003).  Catatonia: A clinician's guide to diagnosis and treatment.   Cambridge, England: Cambridge University Press.

Fleischhacker, W. W., Unterweger, B., Kane, J. M.,  & Hinterhuber, H. (1990). The neuroleptic malignant syndrome and its differentiation from lethal catatonia.   Acta Psychiatrica Scandinavica, 81, 3-5.  

Fricchione, G. L. (1985). Neuroleptic catatonia and its relationship to psychogenic catatonia.   Biological Psychiatry, 20, 304-313.  

Fricchione, G., Cassem, N. H., Hooberman, D.,  & Hobson, D. (1983). Intravenous lorazepam in neuroleptic-induced catatonia.   Journal of Clinical Psychopharmacology, 3, 338-342. 

Fricchione, G., Mann, S. C.,  & Caroff, S. N. (2000). Catatonia, lethal catatonia, and neuroleptic malignant syndrome.   Psychiatric Annals, 30, 347-355.  

Galliano, G., Noble, L. M., Travis, L. A.,  & Puechl, C. (1993). Victim reactions during rape/sexual assault: A preliminary study of the immobility response and its correlates.   Journal of Interpersonal Violence, 8, 109-114.  

Gallup, G. G. (1974). Animal hypnosis: Factual status of a fictional concept.   Psychological Bulletin, 81, 836-853.  

Gallup, G. G. (1977). Tonic immobility: The role of fear and predation.   Psychological Record, 27, 41-61.  

Gallup, G. G., Boren, J. L., Suarez, S. D., Wallnau, L. B.,  & Gagliardi, G. J. (1980). Evidence for the integrity of central processing during tonic immobility.   Physiology & Behavior, 25, 189-194. 

Gallup, G. G., Ledbetter, D. H.,  & Maser, J. D. (1976). Strain differences among chickens in tonic immobility: Evidence for an emotionality component.   Journal of Comparative & Physiological Psychology, 90, 1075-1081. 

Gallup, G. G. Jr.,  & Maser, J. D. (1977). Tonic immobility: Evolutionary underpinnings of human catalepsy and catatonia.   In M. E. P. Seligman (Ed.), Psychopathology: Experimental models (pp. 334–357). New York: W. H. Freeman.

Gallup, G. G. Jr.,  & Rager, D. R. (1996). Tonic immobility as a model of extreme stress of behavioral inhibition: Issues of methodology and measurement.   In M. Kavaliers (Ed.), Motor activity and movement disorders (pp. 57–80). Totowa, NJ: Humana Press.

Gelenberg, A. J. (1976). The catatonic syndrome.   Lancet, 1, 1339-1341. 

Gilbert, P. (Ed.) (1998). Evolutionary approaches to psychopathology   [Special issue].  British Journal of Medical Psychology, 71. 

Gilbert, P. (2001). Evolutionary approaches to psychopathology: The role of natural defences.   Australian & New Zealand Journal of Psychiatry, 35, 17-27. 

Gilbert, P.,  & Allan, S. (1998). The role of defeat and entrapment (arrested flight) in depression: An exploration of an evolutionary view.   Psychological Medicine, 28, 585-598.   

Gjessing, L. R. (1974). A review of periodic catatonia.   Biological Psychiatry, 8, 23-45.  

Gjessing, L. R., Harding, G. F. A., Jenner, F. A.,  & Johannessen, N. B. (1967). The EEG in three cases of periodic catatonia.   British Journal of Psychiatry, 113, 1271-1282. 

Gjessing, R. (1938). Disturbances of somatic functions in catatonia with a periodic course, and their compensation.   Journal of Mental Science, 84, 608-621.  

Goldar, J. C. (1988). Historical and clinical data on catatonia.   Acta Psiquiatrica y Psicologica de America Latina, 34, 197-209.  

Goldar, J. C.,  & Starkstein, S. E. (1995). Karl Ludwig Kahlbaum's concept of catatonia.   History of Psychiatry, 6, 201-207.  

Graeff, F. G. (1993). Role of 5-HT in defensive behavior and anxiety.   Reviews in the Neurosciences, 4, 181-211. 

Gray, J. A.,  & McNaughton, N. (2000).  The neuropsychology of anxiety    (2nd ed.). Oxford, England: Oxford University Press.

Greenfeld, D., Conrad, C., Kincare, P.,  & Bowers, M. B. Jr. (1987). Treatment of catatonia with low-dose lorazepam.   American Journal of Psychiatry, 144, 1224-1225.  

Gurrera, R. J. (1999). Sympathoadrenal hyperactivity and the etiology of neuroleptic malignant syndrome.   American Journal of Psychiatry, 156, 169-180.  

Hamilton, M. (1959). The assessment of anxiety states by rating.   British Journal of Medical Psychology, 32, 50-55.  

Harris, D.,  & Menza, M. A. (1989). Benzodiazepines and catatonia: A case report.   Canadian Journal of Psychiatry, 34, 725-727.  

Heim, C.,  & Nemeroff, C. B. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies.   Biological Psychiatry, 49, 1023-1039.   

Heim, C., Newport, D. J., Heit, S., Graham, Y. P., Wilcox, M., Bonsall, R.  et al. (2000). Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood   [Comment].  Journal of the American Medical Association, 284, 592-597.   

Hennig, C. W. (1978). Tonic immobility in the squirrel monkey (Saimiri sciureus)   Primates, 19, 333-342.  

Henry, C., Van den Bulke, D., Bellivier, F., Etain, B., Rouillon, F.,  & Leboyer, M. (2003). Anxiety disorders in 318 bipolar patients: Prevalence and impact on illness severity and response to mood stabilizer.   Journal of Clinical Psychiatry, 64, 331-335.  

Hoch, A. (1921).  Benign stupors: A study of a new manic-depressive reaction type.   New York: Macmillan.
Hofer, M. A. (1970). Cardiac and respiratory function during sudden prolonged immobility in wild rodents.   Psychosomatic Medicine, 32, 633-647.  

Holcombe, V., Sterman, M. B., Goodman, S. J.,  & Fairchild, M. B. (1979). The immobilization response in rhesus monkey: A behavioral and electroencephalographic study.   Experimental Neurology, 63, 420-435.  

Horowitz, M. J. (1978).  Stress response syndromes.   New York: Jason Aronson.

Israel, M.,  & Beaudry, P. (1988). Carbamazepine in psychiatry: A review.   Canadian Journal of Psychiatry—Revue Canadienne de Psychiatrie, 33, 577-584. 

Johnson, D. (1984).  Just in case: A passenger's guide to safety and survival.   New York: Plenum.

Johnson, J. (1984). Stupor: A review of 25 cases.   Acta Psychiatrica Scandinavica, 70, 370-377.  

Johnson, J. (1993). Catatonia: The tension insanity.   British Journal of Psychiatry, 162, 733-738.  

Jones, I.,  & Blackshaw, J. K. (2000). An evolutionary approach to psychiatry.   Australian & New Zealand Journal of Psychiatry, 34, 8-13. 

Joseph, R. (1999). Frontal lobe psychopathology: Mania, depression, confabulation, catatonia, perseveration, obsessive compulsions, and schizophrenia.   Psychiatry, 62, 138-172.  

Kahlbaum, K. L. (1973).  Catatonia    (T. Pridan, Trans.). Baltimore: Johns Hopkins University Press. (Original work published 1874)

Kahn, R. S., van Pragg, H. M., Wetzler, S., Asnis, G. M.,  & Barr, G. (1988). Serotonin and anxiety revisited.   Biological Psychiatry, 23, 189-208.  

Kalin, N. H. (1993). The neurobiology of fear.   Scientific American, 268, 94-101. 

Kardiner, A.,  & Speigel, H. (1947).  War stress and neurotic illness.   New York: Hoeber.

Kendler, K. S., Kessler, R. C., Neale, M. C., Heath, A. C.,  & Eaves, L. J. (1993). The prediction of major depression in women: Toward an integrated model.   American Journal of Psychiatry, 150, 1139-1148.  

Kirby, G. H. (1913). The catatonic syndrome and its relation to manic-depressive insanity.   Journal of Nervous & Mental Disease, 40, 694-704. 

Klein, D. F. (1993). Panic may be a misfiring suffocation alarm.   In S. A. Montgomery (Ed.), Psychopharmacology of panic (Vol. 12, pp. 67–73). New York: Oxford University Press.

Klemm, W. R. (1971). Neurophysiologic studies of the immobility reflex (“animal hypnosis”)   Neurosciences Research, 4, 165-212. 

Klemm, W. R. (1989). Drug effects on active immobility responses: what they tell us about neurotransmitter systems and motor functions.   Progress in Neurobiology, 32, 403-422. 

Klemm, W. R. (2001). Behavioral arrest: In search of the neural control system.   Progress in Neurobiology, 65, 453-471. 

Kraepelin, E. (1899).  Psychiatrie: Ein Lehrbuch fur Studirende und Aerzte    (6th ed.) [Psychiatry: A textbook for students and physicians]. Leipzig, Germany: Verlag von Johann Ambrosius Barth.

Krishnan, K. R. (2003). Comorbidity and depression treatment.   Biological Psychiatry, 53, 701-706. 

Kritzinger, P. R.,  & Jordaan, G. P. (2001). Catatonia: An open prospective series with carbamazepine.   International Journal of Neuropsychopharmacology, 4, 251-257.   

Krueger, S.,  & Braeunig, P. (2000). Catatonia in affective disorder: New findings and a review of the literature.   CNS Spectrums, 5, 48-53. 

Krystal, H. (1993).  Integration and self healing: Affect, trauma, alexithymia.   Hillsdale, NJ: Analytic Press.
LeDoux, J. (1998). Fear and the brain: Where have we been, and where are we going?   Biological Psychiatry, 44, 1229-1238.   

Lee, J. W., Schwartz, D. L.,  & Hallmayer, J. (2000). Catatonia in a psychiatric intensive care facility: Incidence and response to benzodiazepines.   Annals of Clinical Psychiatry, 12, 89-96.   

Leite-Panissi, C. R. A., Coimbra, N. C.,  & Menescal-de-Oliveira, L. (2003). The cholinergic stimulation of the central amygdala modifying the tonic immobility response and antinociception in guinea pigs depends on the ventrolateral periaqueductal gray.   Brain Research Bulletin, 60, 167-178. 

Leite-Panissi, C. R., Rodrigues, C. L., Brentegani, M. R.,  & Menescal-de-Oliveira, L. (2001). Endogenous opiate analgesia induced by tonic immobility in guinea pigs.   Brazilian Journal of Medical & Biological Research, 34, 245-250.  

Lew, T. Y.,  & Tollefson, G. (1983). Chlorpromazine-induced neuroleptic malignant syndrome and its response to diazepam.   Biological Psychiatry, 18, 1441-1446.  

Lingjaerde, O. (1963). Contributions to the study of schizophrenia and the acute malignant deliria.   Journal of Oslo City Hospital, 14, 43-83. 

Ljubisavlijevic, V.,  & Schneider, P. (2002). Lethal catatonia.   Australian & New Zealand Journal of Psychiatry, 36, 563-564. 

Mahendra, B. (1981). Where have all the catatonics gone?   Psychological Medicine, 11, 669-671.  

Malizia, A. L. (2000).  Positron emitting ligands in the study of clinical psychopharmacology of anxiety and anxiety disorders.   Unpublished master's thesis, University of Briston, Briston, England.

Malizia, A. L., Cunningham, V. J., Bell, C. J., Liddle, P. F., Jones, T.,  & Nutt, D. J. (1998). Decreased brain GABA(A)-benzodiazepine receptor binding in panic disorder: Preliminary results from a quantitative PET study.   Archives of General Psychiatry, 55, 715-720.   

Mann, S. C., Caroff, S. N., Bleier, H. R., Welz, W. K. R., Kling, M. A.,  & Hayashida, M. (1986). Lethal catatonia.   American Journal of Psychiatry, 143, 1374-1381.  

Mann, S. C., Caroff, S. N., Keck, P. E.,  & Lazarus, A. (2003).  Neuroleptic malignant syndrome and related conditions    (2nd ed.). Arlington, VA: American Psychiatric Publishing.

Marks, I. M. (1987).  Fears, phobias, and rituals: Panic, anxiety, and their disorders.   New York: Oxford University Press.

Marks, I. M.,  & Nesse, R. M. (1994). Fear and fitness: An evolutionary analysis of anxiety disorders.   Ethology and Sociobiology, 15, 247-261. 

McCall, W. V., Shelp, F. E.,  & McDonald, W. M. (1992). Controlled investigation of the amobarbital interview for catatonic mutism   [Comment].  American Journal of Psychiatry, 149, 202-206.  

McElroy, S. L., Altshuler, L. L., Suppes, T., Keck, P. E., Frye, M. A., Denicoff, K. D.  et al. (2001). Axis I psychiatric comorbidity and its relationship to historical illness variables in 288 patients with bipolar disorder.   American Journal of Psychiatry, 158, 420-426.   

Menza, M. A.,  & Harris, D. (1989). Benzodiazepines and catatonia: An overview.   Biological Psychiatry, 26, 842-846.  

Mills, A. D.,  & Faure, J.-M. (1991). Divergent selection for duration of tonic immobility and social reinstatement behavior in Japanese quail (Coturnix coturnix japonica) chicks.   Journal of Comparative Psychology, 105, 25-38.   

Miu, A. C.,  & Olteanu, A. I. (2002). Catatonia in Alzheimer's disease: The role of the amygdalo-hippocampal circuits.   Behavioral and Brain Sciences, 25, 588-589. 

Monassi, C. R., Leite-Panissi, C. R.,  & Menescal-de-Oliveira, L. (1999). Ventrolateral periaqueductal gray matter and the control of tonic immobility.   Brain Research Bulletin, 50, 201-208.   

Mora, G. (1973).  Introduction to Kahlbaum's catatonia.   Baltimore: Johns Hopkins University Press.
Morrison, J. R. (1973). Catatonia: Retarded and excited types.   Archives of General Psychiatry, 28, 39-41. 

Nadel, L.,  & Jacobs, W. J. (1996). The role of the Hippocampus in PTSD, panic, and phobia.   In N. Kato (Ed.), The hippocampus: Functions and clinical relevance (pp. 455–463). Amsterdam: Elsevier Science.

Nash, R. F., Gallup, G. G.,  & Czech, D. A. (1976). Psychophysiological correlates of tonic immobility in the domestic chicken (Gallus gallus)   Physiology & Behavior, 17, 413-418. 

Nauta, W. J. H. (1971). The problem of the frontal lobe: A reinterpretation.   Journal of Psychiatric Research, 8, 167-187.  

Nauta, W. J. H. (1979). Expanding borders of the limbic system concept.   In R. Marino (Ed.), Functional neurosurgery (pp. 7–23). New York: Raven Press.

Nesse, R. M. (2001). The smoke detector principle. Natural selection and the regulation of defensive responses.   In A. R. Damasio, A. Harrington, J. Kagan, B. McEwen, H. Moss, & R. Shaikh (Eds.), Annals of the New York Academy of Sciences: Vol. 935. Unity of knowledge: The convergence of natural and human science (pp. 75–85). New York: New York Academy of Sciences.

Nesse, R. M.,  & Williams, G. C. (1994).  Why we get sick: The new science of Darwinian medicine.   New York: Vintage.

Nijenhuis, E. R. S., Vanderlinden, J.,  & Spinhoven, P. (1998). Animal defensive reactions as a model for trauma-induced dissociative reactions.   Journal of Traumatic Stress, 11, 243-260.  

Northoff, G. (2002). What catatonia can tell us about “top-down modulation”: A neuropsychiatric hypothesis.   Behavioral and Brain Sciences, 25, 555-604. 

Northoff, G., Braus, D. F., Sartorius, A., Khoram-Sefat, D., Russ, M., Eckert, J.  et al. (1999). Reduced activation and altered laterality in two neuroleptic naive catatonic patients during a motor task in functional MRI.   Psychological Medicine, 29, 997-1002.   

Northoff, G., Eckert, J.,  & Fritze, J. (1997). Glutamatergic dysfunction in catatonia? Successful treatment of three acute akinetic catatonic patients with the NMDA antagonist amantadine.   Journal of Neurology, Neurosurgery & Psychiatry, 62, 404-406. 

Northoff, G., Koch, A., Wenke, J., Eckert, J., Boeker, H., Pflug, B.,  & Bogerts, B. (1999). Catatonia as a psychomotor syndrome: A rating scale and extrapyramidal symptoms.   Movement Disorders, 14, 404-416.

Northoff, G., Krill, W., Wenke, J., Gille, B., Russ, M., Eckert, J.  et al. (1998). Major differences in subjective experience of akinetic states in catatonic and parkinsonian patients.   Cognitive Neuropsychiatry, 3, 161-178.   

Northoff, G., Richter, A., Gessner, M., Baumgart, F., Leschinger, A., Danos, P.  et al.  (in press) Alteration in orbitofrontal and prefrontal cortical spatiotemporal activation pattern in catatonia during negative emotional stimulation: A combined fMRI/MEG study.   Schizophrenia Bulletin, . 

Northoff, G., Richter, A., Gessner, M., Tempelmann, C., Bargel, B., Bogerts, B.,  & Heinze, H. J. (2001). GABA-eric modulation of prefrontal cortical spatiotemporal activation pattern: A fMRI-MEG study with lorazepam challenge in catatonia.   Schizophrenia Research, 49, 182. 

Northoff, G., Steinke, R., Czcervenka, C., Krause, R., Ulrich, S., Danos, P.  et al. (1999). Decreased density of GABA-A receptors in the left sensorimotor cortex in akinetic catatonia: Investigation of in vivo benzodiazepine receptor binding.   Journal of Neurology, Neurosurgery & Psychiatry, 67, 445-450. 

Northoff, G., Steinke, R., Krug, M., Cervenka, C., Pfennig, A., Otto, H.,  & Bogerts, B. (1998). Left fronto-parietal dysfunction of GABA-A receptors and movement-related potentials in akinetic catatonia, a combined SPECT- and MRP study.   Schizophrenia Research, 29, 178. 

Northoff, G., Steinke, R., Nagel, D., Czerwenka, C., Grosser, O., Danos, P.  et al. (2000). Right lower prefronto-parietal cortical dysfunction in akinetic catatonia: A combined study of neuropsychology and regional cerebral blood flow.   Psychological Medicine, 30, 583-596.   

Northoff, G., Wenke, J., Demisch, L., Eckert, J., Gille, B.,  & Pflug, B. (1995). Catatonia: short-term response to lorazepam and dopaminergic metabolism.   Psychopharmacology, 122, 182-186.  

Nutt, D. J.,  & Malizia, A. L. (2001). New insights into the role of the GABA-A benzodiazepine receptor in psychiatric disorder.   British Journal of Psychiatry, 179, 390-396. 

Ohman, A. (1992). Fear and anxiety as emotional phenomena: Clinical, phenomenological, evolutionary perspectives, and information-processing mechanisms.   In M. Lewis & J. Haviland (Eds.), Handbook of the emotions (pp. 511–536). New York: Guilford Press.

Olsen, C. K., Hogg, S.,  & Lapiz, M. D. S. (2002). Tonic immobility in guinea pigs: A behavioural response for detecting an anxiolytic-like effect?   Behavioural Pharmacology, 13, 261-269.  

Orland, R. M.,  & Daghestani, A. N. (1987). A case of catatonia induced by bacterial meningoencephalitis.   Journal of Clinical Psychiatry, 48, 489-490.  

Oulis, P., Lykouras, L., Tomaras, V., Panayotopoulou, V., Gournellis, R.,  & Stefanis, C. (1997). DSM-IV catatonic features among psychiatric inpatients: A preliminary study.   European Psychiatry, 12, 412-414.  

Peralta, V.,  & Cuesta, M. J. (2001). Motor features in psychotic disorders. II—Development of diagnostic criteria for catatonia.   Schizophrenia Research, 47, 117-126.   

Peralta, V., Cuesta, M. J., Serrano, J. F.,  & Martinez-Larrea, J. A. (2001). Classification issues in catatonia.   European Archives of Psychiatry & Clinical Neuroscience, 251, I14-I16. 

Peralta, V., Cuesta, M. J., Serrano, J. F.,  & Mata, I. (1997). The Kahlbaum syndrome: A study of its clinical validity, nosological status, and relationship with schizophrenia and mood disorder.   Comprehensive Psychiatry, 38, 61-67.  

Perkins, R. J. (1982). Catatonia: The ultimate response to fear?   Australian & New Zealand Journal of Psychiatry, 16, 282-287. 

Petrides, G., Divadeenam, K. M., Bush, G.,  & Francis, A. (1997). Synergism of lorazepam and electroconvulsive therapy in the treatment of catatonia.   Biological Psychiatry, 42, 375-381.   

Pfuhlmann, B.,  & Stoeber, G. (2001). The different conceptions of catatonia: Historical overview and critical discussion.   European Archives of Psychiatry & Clinical Neuroscience, 251, I4-I7. 

Philbrick, K. L.,  & Rummans, T. A. (1994). Malignant catatonia.   Journal of Neuropsychiatry and Clinical Neurosciences, 6, 1-13. 

Platek, S. M.,  & Gallup, G. G. (2002). A self frozen in time and space: Catatonia as a kinesthetic analog to mirrored self-misidentification.   Behavioral and Brain Sciences, 25, 589-590. 

Popkin, M. K.,  & Tucker, G. J. (1992). “Secondary” and drug-induced mood, anxiety, psychotic, catatonic, and personality disorders: A review of the literature.   Journal of Neuropsychiatry and Clinical Neurosciences, 4, 369-385. 

Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage: A polyvagal theory.   Psychophysiology, 32, 301-318.  

Porges, S. W. (1997). Emotion: An evolutionary by-product of the neural regulation of the autonomic nervous system.   In I. I. Lederhendler (Ed.), Annals of The New York Academy of Sciences: Vol. 807. The integrative neurobiology of affiliation (pp. 62–77). New York: New York Academy of Sciences.

Porges, S. W. (2001). The polyvagal theory: Phylogenetic substrates of a social nervous system.   International Journal of Psychophysiology, 42, 123-146.   

Porges, S. W., Doussard-Roosevelt, J. A.,  & Maita, A. K. (1994). Vagal tone and the physiological regulation of emotion.   Monographs of the Society for Research in Child Development, 59, 250-283. 

Post, R. M., Putnam, F., Contel, N. R.,  & Goldman, B. (1984). Electroconvulsive seizures inhibit amygdala kindling: implications for mechanisms of action in affective illness.   Epilepsia, 25, 234-239. 

Rager, D. R., Gallup, G. G.,  & Beckstead, J. W. (1986). Chlordiazepoxide and tonic immobility: A paradoxical enhancement.   Pharmacology, Biochemistry & Behavior, 25, 1237-1243. 

Raitiere, M. N. (1986). Subcortical dysrhythmia and catatonia.   Biological Psychiatry, 21, 1351-1352.  

Ramos, C., Leite-Panissi, R., Monassi, R.,  & Menescal-de-Oliveira, L. (1999). Role of the amygdaloid nuclei in the modulation of tonic immobility in guinea pigs.   Physiology & Behavior, 67, 717-724. 

Rankel, H. W.,  & Rankel, L. E. (1988). Carbamazepine in the treatment of catatonia.   American Journal of Psychiatry, 145, 361-362.  

Rasmussen, K. G. (2003). Clinical applications of recent research on electroconvulsive therapy.   Bulletin of the Menninger Clinic, 67, 18-31.   

Ratner, S. C. (1958). Hypnotic reactions of rabbits.   Psychological Reports, 4, 209-210.  

Ratner, S. C. (1967). Comparative aspects of hypnosis.   In J. E. Gordon (Ed.), Handbook of clinical and experimental hypnosis (pp. 550–587). New York: Macmillan.

Ries, R. K. (1985). DSM-III implications of the diagnoses of catatonia and bipolar disorder.   American Journal of Psychiatry, 142, 1471-1474.  

Robinson, M. D. (1998). Running from William James' bear: A review of preattentive mechanisms and their contributions to emotional experience.   Cognition & Emotion, 12, 667-696. 

Rohland, B. M., Carroll, B. T.,  & Jacoby, R. G. (1993). ECT in the treatment of the catatonic syndrome.   Journal of Affective Disorders, 29, 255-261.  

Rosebush, P. (2003).  McMaster University faculty webpage.   Retrieved November 13, 2003, from: 

Rosebush, P. I., Hildebrand, A. M., Furlong, B. G.,  & Mazurek, M. F. (1990). Catatonic syndrome in a general psychiatric inpatient population: Frequency, clinical presentation, and response to lorazepam.   Journal of Clinical Psychiatry, 51, 357-362.  

Rosebush, P. I.,  & Mazurek, M. F. (1999). Catatonia: Re-awakening to a forgotten disorder.   Movement Disorders, 14, 395-397. 

Rosebush, P.,  & Stewart, T. (1989). A prospective analysis of 24 episodes of neuroleptic malignant syndrome.   American Journal of Psychiatry, 146, 717-725.  

Sahar, T., Shalev, A. Y.,  & Porges, S. W. (2001). Vagal modulation of responses to mental challenge in posttraumatic stress disorder.   Biological Psychiatry, 49, 637-643.   

Salam, S. A., Pillai, A. K.,  & Beresford, T. P. (1987). Lorazepam for psychogenic catatonia.   American Journal of Psychiatry, 144, 1082-1083.  

Salva, P.,  & Costa, J. (1995). Clinical pharmacokinetics and pharmacodynamics of zolpidem. Therapeutic implications.   Clinical Pharmacokinetics, 29, 142-153. 

Sanderson, W. C., Beck, A. T.,  & Beck, J. (1990). Syndrome comorbidity in patients with major depression or dysthymia: Prevalence and temporal relationships.   American Journal of Psychiatry, 147, 1025-1028. 

Sanderson, W. C., DiNardo, P. A., Rapee, R. M.,  & Barlow, D. H. (1990). Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder.   Journal of Abnormal Psychology, 99, 308-312.  

Sargeant, A. B.,  & Eberhardt, L. E. (1975). Death feigning by ducks in response to predation by red foxes (Vulpes fulva)   American Midland Naturalist, 94, 108-119. 

Savodnik, I. (2002). The disease status of catatonia.   Behavioral and Brain Sciences, 25, 590-591. 

Schmider, J., Standhart, H., Deuschle, M., Drancoli, J.,  & Heuser, I. (1999). A double-blind comparison of lorazepam and oxazepam in psychomotor retardation and mutism.   Biological Psychiatry, 46, 437-441. 
Schore, A. N. (1994).  Affect regulation and the origin of the self: The neurobiology of emotional development.   Hillsdale, NJ: Erlbaum.

Schore, A. N. (2001). The effects of early relational trauma on right brain development, affect regulation, and infant mental health.   Infant Mental Health Journal, 22, 201-269.   

Schore, A. N. (2002). Dysregulation of the right brain: A fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder.   Australian & New Zealand Journal of Psychiatry, 36, 9-30. 

Seligman, M. E. P. (1971). Phobias and preparedness.   Behavior Therapy, 2, 307-320. 

Shalev, A., Hermesh, H.,  & Munitz, H. (1989). Mortality from neuroleptic malignant syndrome.   Journal of Clinical Psychiatry, 50, 18-25. 

Starkstein, S. E., Petracca, G., Teson, A., Chemerinski, E., Merello, M., Migliorelli, R.,  & Leiguarda, R. (1996). Catatonia in depression: Prevalence, clinical correlates, and validation of a scale.   Journal of Neurology, Neurosurgery & Psychiatry, 60, 326-332. 

Stoeber, G.,  & Ungvari, G. S. (Eds.) (2001).  [Special issue].  European Archives of Psychiatry and Clinical Neurosciences, 251.  (Suppl. 1).

Suarez, S. D.,  & Gallup, G. G. (1979). Tonic immobility as a response to rape in humans: A theoretical note.   The Psychological Record, 29, 315-320.  

Svorad, D. (1957). “Animal hypnosis” (Totstellreflex) as experimental model for psychiatry: Electroencephalographic and evolutionary aspect.   Archives of Neurology & Psychiatry, 77, 533-539. 

Takahashi, S.,  & Gjessing, L. R. (1972). Studies of periodic catatonia: IV. Longitudinal study of catecholamine metabolism, with and without drugs.   Journal of Psychiatric Research, 9, 293-314. 

Tamam, L.,  & Ozpoyraz, N. (2002). Comorbidity of anxiety disorder among patients with bipolar I disorder in remission.   Psychopathology, 35, 203-209.   

Taylor, M. A. (1990). Catatonia: A review of a behavioral neurologic syndrome.   Neuropsychiatry Neuropsychology & Behavioral Neurology, 3, 48-72. 

Taylor, M. A.,  & Fink, M. (2003). Catatonia in psychiatric classification: A home of its own.   American Journal of Psychiatry, 160, 1233-1241.   

Thomas, P., Rascle, C., Mastain, B., Maron, M.,  & Vaiva, G. (1997). Test for catatonia with zolpidem.   Lancet, 349, 702. 

Thompson, R. K. R., Foltin, R. W., Boylan, R. J., Sweet, A., Graves, C. A.,  & Lowitz, C. E. (1981). Tonic immobility in Japanese quail can reduce the probability of sustained attack by cats.   Animal Learning & Behavior, 9, 145-149. 

Tooby, J.,  & Cosmides, L. (1990). The past explains the present: Emotional adaptations and the structure of ancestral environments.   Ethology and Sociobiology, 11, 375-424. 

UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: A systematic review and meta-analysis.   Lancet, 361, 799-808.   

Ungvari, G. S., Chiu, H. F. K., Chow, L. Y., Lau, B. S. T.,  & Tang, W. K. (1999). Lorazepam for chronic catatonia: A randomized, double-blind, placebo-controlled cross-over study.   Psychopharmacology, 142, 393-398.   

Ungvari, G. S., Kau, L. S., Wai-Kwong, T.,  & Shing, N. F. (2001). The pharmacological treatment of catatonia: An overview.   European Archives of Psychiatry & Clinical Neuroscience, 251, I31-I34.  (Suppl. 1)
Ungvari, G. S., Leung, H. C. M.,  & Lee, T. S. (1994). Benzodiazepines and the psychopathology of catatonia.   Pharmacopsychiatry, 27, 242-245.  

Ungvari, G. S., Leung, C. M., Wong, M. K.,  & Lau, J. (1994). Benzodiazepines in the treatment of catatonic syndrome.   Acta Psychiatrica Scandinavica, 89, 285-288.  

Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values.   American Psychologist, 47, 373-388.   

Wakefield, J. C. (1999). Evolutionary versus prototype analyses of the concept of disorder.   Journal of Abnormal Psychology, 108, 374-399.   

Wetzel, H., Heuser, I.,  & Benkert, O. (1987). Stupor and affective state: Alleviation of psychomotor disturbances by lorazepam and recurrence of symptoms after Ro 15-1788.   Journal of Nervous & Mental Disease, 175, 240-242. 

Wetzel, H., Heuser, I.,  & Benkert, O. (1988). Benzodiazepines for catatonic symptoms, stupor, and mutism.   Pharmacopsychiatry, 21, 394-395. 

Whishaw, I. Q., Schallert, T.,  & Kolb, B. (1979). The thermal control of immobility in developing infant rats: Is the neocortex involved?   Physiology & Behavior, 23, 757-762. 

White, D. A. C. (1992). Catatonia and the neuroleptic malignant syndrome—A single entity?   British Journal of Psychiatry, 161, 558-560.  

White, D. A. C.,  & Robins, A. H. (2000). An analysis of 17 catatonic patients diagnosed with neuroleptic malignant syndrome.   CNS Spectrums, 5, 58-65. 

Young, L. T., Cooke, R. G., Robb, J. C., Levitt, A. J.,  & Joffe, R. T. (1993). Anxious and non-anxious bipolar disorder.   Journal of Affective Disorders, 29, 49-52.  

Zaw, Z. F.,  & Bates, G. D. (1997). Replication of zolpidem test for catatonia in an adolescent.   Lancet, 349, 1914. 

Zimmerman, M., Chelminski, I.,  & McDermut, W. (2002). Major depressive disorder and Axis I diagnostic comorbidity.   Journal of Clinical Psychiatry, 63, 187-193.