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Background: Catatonia is an underdiagnosed psychomotor syndrome that can occur in the context of various mental and somatic diseases. Malignant catatonia is particularly relevant in the context of intensive medical care. Clear recommendations in guidelines are missing. Objective: To present the current state of the diagnosis and treatment of catatonia, especially malignant catatonia. Material and methods: The literature was evaluated with respect to acute catatonic conditions, with a special focus on the differential diagnosis, relevance to intensive medical care and treatment of catatonia. Results: In psychiatric inpatients, catatonic syndromes are relatively frequent with a prevalence between 9% and 17%, and in neurological patients somewhat less frequent with a prevalence of 3.3%. There is a clear recommendation for pharmacological treatment with lorazepam. Additional electroconvulsive therapy (ECT) should be considered as early as possible, especially in cases not responding to benzodiazepines. Response rates to ECT have been shown to be 80–100%. In malignant catatonia, ECT should be performed immediately as an emergency indication. Conclusion: Several factors lead to the underdiagnosis of catatonia. It is problematic that even life-threatening malignant catatonia is often not recognized as such, although there is a mortality of about 50% if untreated. The best treatment outcome is achieved with a combination of benzodiazepines and ECT. The treatment of severe malignant catatonia represents an emergency indication for ECT. [ABSTRACT FROM AUTHOR]

Acamprosate and naltrexone are established strategies for pharmacologic relapse prevention in patients with alcohol dependence. Regarding pharmacodynamic and pharmacokinetic considerations the combination of both agents for this indication is a reasonable treatment option that has been described to be safe and effective in clinical studies. However, this combination is uncommon in clinical practice. We report the case of a patient with severe alcohol and benzodiazepine dependence who achieved the longest interval of abstinence under combined treatment with acamprosate and naltrexone since the development of addiction. In addition, the currently available evidence regarding efficacy, safety and tolerability of both agents is discussed. In summary the combined treatment with both agents should be considered in patients who did not achieve abstinence under monotherapy unless contraindications are present. [ABSTRACT FROM AUTHOR]

Cognitive deficits are among the core symptoms of patients with Huntington's disease (HD). While impaired attention, visuospatial processing, and memory can be observed during early stages of the illness, HD patients exhibit deficits in executive function on tests requiring planning, problem solving, and cognitive flexibility with progression of the disease. Cognitive dysfunction is already present in individuals who carry the HD gene mutation but remain presymptomatic for motor and cognitive disturbances. This review provides an overview and a discussion of functional neuroimaging findings on cognitive dysfunction in patients with HD and presymptomatic HD gene mutation carriers. In HD patients, currently available evidence suggests a functional deficit of multiple cortical and subcortical regions extending beyond volumetric abnormalities. Early dysfunction of lateral prefrontal and cingulate regions has been shown in individuals with presymptomatic HD, while compensatory responses of posterior brain regions may occur closer to the onset of manifest clinical symptoms. While functional neuroimaging techniques may substantially contribute to defining neurodegenerative disease phenotypes and to identifying neural biomarkers in presymptomatic individuals, the extant data on cognitive function in HD patients and HD gene carriers however is sparse and has to be expanded through further studies. [ABSTRACT FROM AUTHOR]