?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=WHAT+CATATONIA+CAN+TELL+US+ABOUT+%22TOP-DOWN+MODULATION%22%3A+A+NEUROPSYCHIATRIC+HYPOTHESIS&rft.creator=Northoff%2C+Georg&rft.subject=Neuropsychiatry&rft.description=Differentialdiagnosis+of+motor+symptoms%2C+as+for+example+akinesia%2C+may+be+difficult+since+they+may+be+either+of+neurologic%2C+as+for+example+Parkinson%C2%92s%2C+or+psychiatric%2C+as+for+example+catatonia%2C+origin+leading+to+a+so-called+%C2%84conflict+of+paradigms%C2%93.+Despite+different+origins+such+symptoms+may+clinically+be+more+or+less+similar+which+may+reflect+functional+brain+organisation+in+general+and+cortical-subcortical+relations+in+particular.+It+is+therefore+hypothesized+that+similarities+and+differences+between+Parkinson%C2%92s+as+a+motor+disorder+and+catatonia+as+a+psychomotor+disorder+may+be+accounted+for+by+functional+differences+between+%C2%84top-down+modulation%C2%93+and+%C2%84bottom-up+modulation%C2%93+between+prefrontal%2Ffrontal+cortex+and+basal+ganglia+implying+double+dissociation+between+both+diseases+with+regard+to+underlying+pathophysiology.+%0ACatatonia+can+be+characterized+by+concomittant+motor%2C+emotional%2C+and+behavioral+symptoms+which+may+be+accounted+for+by+dysfunction+in+orbitofrontal-prefrontal%2Fparietal+cortical+connectivity+as+a+form+of+%C2%84horizontal+i.e.+cortico-cortical+modulation%C2%93.+Furthermore+alteration+in+%C2%84top-down+modulation%C2%93+of+caudate+and+other+basal+ganglia+by+gaba-ergic+mediated+orbitofrontal+cortical+deficits+may+account+for+motor+symptoms+in+catatonia.+Parkinson%C2%92s+in+contrast+can+be+characterized+by+predominant+motor+symptoms+which+may+be+accounted+for+by+altered+%C2%84bottom-up+modulation%C2%93+between+dopaminergic+mediated+deficits+in+striatum+and+premotor%2Fmotor+cortex.+Due+to+connectional+asymmetry+i.e.+unidirectionality+in+prefronto-premotor%2Fmotor+cortical+connections%2C+there+is+no+further+dysregulation+in+other+prefrontal+cortical+areas+in+Parkinson%C2%92s+as+it+is+reflected+in+absence+of+major+psychiatric+symptoms+in+such+patients.+%0AIt+is+concluded+that+comparison+between+Parkinson%C2%92s+and+catatonia+may+reveal+the+nature+of+both+%C2%84top-down+modulation%C2%93+and+%C2%84bottom-up+modulation%C2%93+in+further+detail.+Furthermore+difference+between+Parkinson%C2%92s+as+a+motor+and+catatonia+as+a+psychomotor+disorder+may+be+accounted+for+by+pecularities+in+%C2%84horizontal+i.e.+cortico-cortical+modulation%C2%93+which%2C+unlike+%C2%84top-down+and+bottom-up+modulation%C2%93+as+forms+of+%C2%84vertical+modulation%C2%93%2C+may+be+unidirectional+and+thus+asymmetric+not+allowing+for+direct+modulation+of+prefrontal+cortical+areas+by+premotor%2Fmotor+cortex.+%0A%0AKey-words%3A+Catatonia+-+Parkinson%C2%92s+-+Top-down+modulation+-+Bottom-up+modulation+-+Horizontal+modulation%0A%0A%0A%0ADifferentialdiagnosis+of+motor+symptoms%2C+as+for+example+akinesia%2C+may+be+difficult+since+they+may+be+either+of+neurologic%2C+as+for+example+Parkinson%C2%92s%2C+or+psychiatric%2C+as+for+example+catatonia%2C+origin+leading+to+a+so-called+%C2%84conflict+of+paradigms%C2%93.+Despite+different+origins+such+symptoms+may+clinically+be+more+or+less+similar+which+may+reflect+functional+brain+organisation+in+general+and+cortical-subcortical+relations+in+particular.+It+is+therefore+hypothesized+that+similarities+and+differences+between+Parkinson%C2%92s+as+a+motor+disorder+and+catatonia+as+a+psychomotor+disorder+may+be+accounted+for+by+functional+differences+between+%C2%84top-down+modulation%C2%93+and+%C2%84bottom-up+modulation%C2%93+between+prefrontal%2Ffrontal+cortex+and+basal+ganglia+implying+double+dissociation+between+both+diseases+with+regard+to+underlying+pathophysiology.+%0AIt+is+concluded+that+comparison+between+Parkinson%C2%92s+and+catatonia+may+reveal+the+nature+of+both+%C2%84top-down+modulation%C2%93+and+%C2%84bottom-up+modulation%C2%93+in+further+detail.+Furthermore+difference+between+Parkinson%C2%92s+as+a+motor+and+catatonia+as+a+psychomotor+disorder+may+be+accounted+for+by+pecularities+in+%C2%84horizontal+i.e.+cortico-cortical+modulation%C2%93+which%2C+unlike+%C2%84top-down+and+bottom-up+modulation%C2%93+as+forms+of+%C2%84vertical+modulation%C2%93%2C+may+be+unidirectional+and+thus+asymmetric+not+allowing+for+direct+modulation+of+prefrontal+cortical+areas+by+premotor%2Fmotor+cortex.+%0A&rft.date=2000-11&rft.type=Other&rft.type=NonPeerReviewed&rft.format=text%2Fhtml&rft.identifier=http%3A%2F%2Fcogprints.org%2F1129%2F1%2Ftop-down-modulation.htm&rft.identifier=++Northoff%2C+Georg++(2000)+WHAT+CATATONIA+CAN+TELL+US+ABOUT+%22TOP-DOWN+MODULATION%22%3A+A+NEUROPSYCHIATRIC+HYPOTHESIS.+++++(Unpublished)++&rft.relation=http%3A%2F%2Fcogprints.org%2F1129%2F