Neurotransmitters – GABA
The neurotransmitter in the case of the patient’s syndrome is GABA (gamma-aminobutyric acid). GABA is an inhibitor neurotransmitter that has neuronal excitability, therefore managing brain activity and regulating awareness, stress, anxiety, and motor functioning, including muscling relaxation and tensioning (Edinoff et al., 2021). My rationale for selecting GABA for the patient’s syndrome is based on the symptoms the 35-year-old psychiatric male patient presents as well as their mental health status. Firstly, the patient is in a psychiatric hospital. This means that he has a mental and psychiatric problem. Secondly, the patient manifests symptoms such as immobility for several hours with his arm stretched outward. He also remained mute, unresponsive, and less aware of his surroundings. Even after being placed in a different, awkward posture, he maintained that posture for a long time without exhibiting any distress. These symptoms align with the manifestations of catatonic syndrome (catatonia).
Catatonia is considered a motor abnormality closely linked to mood, behavioral, and thought disorders and is most manifested by symptoms such as mutism, immobility, rigidity, and reduced physical awareness (Grover et al., 2019). Brain studies in people with catatonia assessing functional brain imaging after catatonic episodes have shown that the related emotional and physical dysregulation are linked to the GABAergic system (Haroche et al., 2020). Notably, the medications used in the long-term management of mental disorders, such as benzodiazepines and clozapine, increase GABA activity, while the withdrawal from such medication increases excitatory neurotransmission, which leads to the symptoms of catatonia (Edinoff et al., 2021). In this case, noting the patient is in a psychiatric hospital for either mood-, behavioral-, or thought-related disorders, he has probably been on drugs that affect neurotransmitter activity and is probably withdrawing from such medications. GABA is the only possible neurotransmitter that can lead to such psychomotor symptoms as compared to the other possible neurotransmitters.
References
Edinoff, A. N., Kaufman, S. E., Hollier, J. W., Virgen, C. G., Karam, C. A., Malone, G. W., Cornett, E. M., Kaye, A. M., Kaye, A. D., Hollier, S. E. ;, Virgen, J. W., Karam, C. G., Malone, C. A., Cornett, G. W. ;, Kaye, E. M. ;, & Kaye, A. M. ; (2021). Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges. Neurology International 2021, Vol. 13, Pages 570-586, 13(4), 570–586. https://doi.org/10.3390/NEUROLINT13040057
Grover, S., Sahoo, S., Chakravarty, R., Chakrabarti, S., & Avasthi, A. (2019). Comparative study of symptom profile of catatonia in patients with psychotic disorders, affective disorders, and organic disorders. Asian Journal of Psychiatry, 43, 170–176. https://doi.org/10.1016/J.AJP.2019.05.024
Haroche, A., Rogers, J., Plaze, M., Gaillard, R., Williams, S. C. R., Thomas, P., & Amad, A. (2020). Brain imaging in catatonia: Systematic review and directions for future research. Psychological Medicine, 50(10), 1585–1597. https://doi.org/10.1017/S0033291720001853
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Question 
A 35-year-old male patient in a psychiatric hospital had been standing immobile for several hours with one of his arms stretched upward. The patient was mute, unresponsive, and did not appear aware of his surroundings. When placed in another awkward posture, the patient maintained that posture for a long time without apparent distress. Which of the following neurotransmitters has been consistently implicated in the patient’s syndrome?
Neurotransmitters – GABA
A. Norepinephrine
B. Acetylcholine
C. Histamine
D. Dopamine
E. GABA
Please provide rationales and references to your selected answer choice.