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Luccarelli J, Kalinich M, Fricchione G, Smith F, Beach SR, Smith JR. Diagnostic and demographic factors of pediatric and adult catatonia hospitalizations: A 2016-2020 National Inpatient Sample Study. Acta Psychiatr Scand 2024; 150:234-244. [PMID: 39118275 DOI: 10.1111/acps.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/08/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Catatonia is a neuropsychiatric disorder that can occur in patients of any age, but it is uncertain whether patient demographics or underlying diagnoses differ between pediatric and adult patients. This study investigates patients of all ages diagnosed with catatonia during acute care hospitalizations in the United States over a 5-year period. METHOD The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients with a discharge diagnosis of catatonia between 2016 and 2020 with patients stratified by age as pediatric (≤18 years) or adult (>18 years). RESULTS Among 174,776,205 hospitalizations recorded in the NIS from 2016 to 2020, 61,990 (95% CI: 60,257 to 63,723; 0.035%) involved a diagnosis of catatonia. Of these, 3255 were for pediatric patients and 58,735 were for adult patients. Compared with adult patients, pediatric catatonia patients were more likely to be male and non-White. Diagnostically, psychotic disorders, encephalitis, and neurodevelopmental disorders were more common primary discharge diagnoses in pediatric patients, while adult patients more frequently were diagnosed with mood disorders. Length of stay was not significantly different between pediatric and adult catatonia hospitalizations. Physical restraints were commonly applied for patients with catatonia. CONCLUSION Pediatric and adult catatonia patients differed in sex, race, and diagnosis, although hospital length of stay was not different between pediatric and adult catatonia hospitalizations. These results may inform catatonia diagnosis in the hospital setting and point to disparities that could be targets of quality improvement efforts.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark Kalinich
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gregory Fricchione
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Felicia Smith
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Scott R Beach
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tennessee, USA
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Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J. Use of ECT for Children With and Without Catatonia: A Single-Site Retrospective Analysis. J ECT 2024; 40:154-161. [PMID: 38265759 PMCID: PMC11269523 DOI: 10.1097/yct.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVES The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. METHODS A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. RESULTS A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation. For all patients, Clinical Global Impressions-Improvement scale scores indicated that it was very likely for a subject to experience at least "much improvement" with the estimated probability of receiving a Clinical Global Impressions-Improvement scale score better than 3 of 0.852 (t.s. = 16.3; P < 0.001; 95% confidence interval, 0.711-0.931). All patients with catatonia demonstrated a positive clinical response and experienced a statistically significant reduction in total Bush-Francis Catatonia Rating Scale scores observed ( t = 11.9; df = 20; SD = 6.3; P < 0.001; 95% confidence interval, 12.6-17.9). No significant adverse events were reported for any patient in the cohort. However, 14 (38.9%) patients experienced prolonged seizures, all of which were terminated with propofol (mean, 49.7 mg). CONCLUSIONS This study provides further data supporting the safe and effective use of pediatric ECT in the treatment of various psychiatric conditions. However, more research is needed to determine the risk factors associated with prolonged seizures and the optimal seizure parameters in young people.
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Affiliation(s)
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Katherine Audrey Termini
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
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Luccarelli J, McCoy TH, York T, Baldwin I, Fricchione G, Fuchs C, Smith JR. The effectiveness of the lorazepam challenge test in pediatric catatonia: A multisite retrospective cohort study. Schizophr Res 2024; 270:410-415. [PMID: 38986388 PMCID: PMC11323129 DOI: 10.1016/j.schres.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Catatonia is a neuropsychiatric disorder associated with changes in behavior and affect. In adults, catatonia can respond rapidly to treatment with benzodiazepines as part of the "lorazepam challenge test." The acute effectiveness of benzodiazepine treatment in pediatric catatonia, however, has received less study. This study reports catatonia severity as measured by the Bush Francis Catatonia Rating Scale (BFCRS) in pediatric patients before and after treatment with lorazepam. METHODS Multicenter retrospective cohort study from 1/1/2018 to 6/1/2023 of patients aged 18 and younger with a clinical diagnosis of catatonia and assessment using the BFCRS before and after treatment with lorazepam. RESULTS Among 54 patients, median age was 16, and 26 (48.1 %) were female. Neurodevelopmental disabilities were present in 24 (44.4 %) of patients. Prior to treatment, patients had a mean BFCRS score of 16.6 ± 6.1, which significantly reduced to 9.5 ± 5.3 following treatment with lorazepam (mean paired difference 7.1; t = 9.0, df = 53, p < 0.001), representing a large effect size (Hedges's g = 1.20; 95 % CI: 0.85 to 1.55). No significant association was found between lorazepam dose or route of administration and clinical response, nor were age, sex, study site, the presence of a neurodevelopmental disorder, the presence of hyperactive catatonic features, or the time between treatment and reassessment associated with post-treatment BFCRS. CONCLUSIONS Lorazepam resulted in a rapid improvement in BFCRS score in pediatric patients, with a large effect size. Further research is needed into optimal dosing and route of administration of the lorazepam challenge test in pediatric patients.
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Affiliation(s)
- James Luccarelli
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Thomas H McCoy
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN 37212, USA
| | - Gregory Fricchione
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA; Vanderbilt Kennedy Center, Vanderbilt University, 110 Magnolia Circle, Nashville, TN 37203, USA; Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN 37212, USA
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Kristiansen K, Vernal DL, Hulgaard DR. Expanding the phenotype of NEDAMSS with a psychiatric perspective: analysis of a new case, and a systematic review of the literature. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02522-7. [PMID: 39031186 DOI: 10.1007/s00787-024-02522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
Pathogenic variants in the IRF2BPL gene are associated with neurodevelopmental disorders with varying degrees of regression, loss of speech and epilepsy. The phenotype is also known as Neurodevelopmental Disorder with regression, Abnormal Movements, loss of Speech, and Seizures (NEDAMSS). The motor symptoms of this disorder share significant phenotypical characteristics with catatonia, a severe neuropsychiatric psychomotor syndrome. The objective of this article is to expand the knowledge on the presentation of NEDAMSS with a focus on psychiatric symptoms including catatonia. A systematic review of 32 case presentations of NEDAMSS, and a novel case report of a patient with NEDAMSS, exhibiting multiple psychiatric symptoms, including catatonia are presented. Psychiatric symptoms and disorders including affective disorders, psychotic symptoms, catatonia, and developmental disorders are reported in one third of the reviewed cases. Reported effects of pharmacological treatment on motor symptoms of NEDAMSS are very limited. Our case presents improvement in motor symptoms originally attributed to NEDAMSS, after treatment with Lorazepam following diagnosis with catatonia. Patients with NEDAMSS may present with both neurological and psychiatric symptoms. The clinical presentation of NEDAMSS motor symptoms and catatonia have similarities and thus poses significant challenges to the diagnostic process, with risk of incorrect or delayed treatment. The limited experience and the complex phenotype of NEDAMSS complicates pharmacological treatment and encourages caution, especially with the use of antipsychotic drugs in the presence of possible catatonic symptoms.
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Affiliation(s)
- Kimmie Kristiansen
- Mental Health Services in the Region of Southern Denmark, Child- and Adolescent Psychiatry, Esbjerg, Denmark.
| | - Ditte Lammers Vernal
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ditte Roth Hulgaard
- Mental Health Services in the Region of Southern Denmark, Child- and Adolescent Psychiatry, Esbjerg, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Children and Youth department, Lillebaelt Hospital, Kolding, Danmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Luccarelli J, Clauss JA, York T, Baldwin I, Vandekar S, McGonigle T, Fricchione G, Fuchs C, Smith JR. Exploring the Trajectory of Catatonia in Neurodiverse and Neurotypical Pediatric Hospitalizations: A Multicenter Longitudinal Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.06.24308554. [PMID: 38883751 PMCID: PMC11178013 DOI: 10.1101/2024.06.06.24308554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Objective Catatonia is a neuropsychiatric disorder that occurs in pediatric patients with a range of associated medical, psychiatric, and neurodevelopmental disorders (NDDs). This study describes hospital care of pediatric catatonia patients and compares treatments for neurotypical patients and those with NDDs. Methods Retrospective cohort study from 1/1/2018 to 6/1/2023 of two academic medical centers of patients aged 18 and younger with catatonia. Patients were retrospectively assessed using the clinical global impressions-improvement (CGI-I) by two independent reviewers. Results One hundred sixty-five patients were hospitalized for catatonia, of whom 50.3% had an NDD. Median age was 15. One hundred sixty-four patients were treated with a benzodiazepine, with a median maximum 24-hour dose of 6 mg lorazepam-equivalents, which did not differ for patients with and without NDDs. Electroconvulsive therapy (ECT) was utilized in 14.5% of patients. Median length of medical hospitalization was 5 days and hospitalizations were longer in neurotypical patients than in patients with NDDs. In an ordinal regression model, the probability of observing at least "much improvement" (CGI < 3) was 88.3% (95% CI: 82.4% to 92.3%), with NDD diagnosis associated with a lower odds of clinical response. Conclusions The probability of patients achieving a CGI-I score indicating at least "much improvement" was 88.3%. Administered benzodiazepine dose and ECT treatment were similar for all patients, but neurotypical patients had longer hospitalizations than those with NDDs and had a higher odds of a more favorable clinical response. Research under controlled conditions is needed to optimize and endure equitable catatonia treatment in youth.
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Affiliation(s)
- James Luccarelli
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jacqueline A. Clauss
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Gregory Fricchione
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Joshua R. Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, 37203
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Smith JR, York T, Baldwin I, Fuchs C, Fricchione G, Luccarelli J. Diagnostic features of paediatric catatonia: multisite retrospective cohort study. BJPsych Open 2024; 10:e96. [PMID: 38686558 PMCID: PMC11060083 DOI: 10.1192/bjo.2024.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/21/2024] [Accepted: 03/14/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Catatonia is a neuropsychiatric disorder characterised by psychomotor changes that can affect individuals across the lifespan. Although features of catatonia have been described in adults, the most common clinical symptoms among paediatric patients with catatonia are not well characterised. AIMS The goal of this study was to characterise the symptoms of catatonia demonstrated by paediatric patients, and to explore demographic and diagnostic factors associated with greater catatonia severity. METHOD We conducted a multicentre retrospective cohort study, from 1 January 2018 to 6 January 2023, of patients aged 18 and younger with a clinical diagnosis of catatonia and symptom assessment using the Bush Francis Catatonia Rating Scale (BFCRS). RESULTS A total of 143 patients met inclusion criteria. The median age was 15 (interquartile range: 13-16) years and 66 (46.2%) patients were female. Neurodevelopmental disabilities were present in 55 (38.5%) patients. Patients demonstrated a mean of 6.0 ± 2.1 signs of catatonia on the Bush Francis Catatonia Screening Item, with a mean BFCRS score of 15.0 ± 5.9. Among the 23 items of the BFCRS, six were present in >50% of patients (staring, mutism, immobility/stupor, withdrawal, posturing/catalepsy, rigidity), and four were present in <20% of cases (waxy flexibility, mitgehen, gegenhalten, grasp reflex). In an adjusted model, patients with neurodevelopmental disorders demonstrated greater BFCRS severity than those with other diagnoses. CONCLUSIONS Catatonia was diagnosed in a range of mental health conditions. Further research is needed to define optimal diagnostic criteria for catatonia in paediatric patients, and clarify the clinical course of the disorder.
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Affiliation(s)
- Joshua R. Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Tennessee, USA; and Vanderbilt Kennedy Center, Vanderbilt University, Tennessee, USA
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Tennessee, USA
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Tennessee, USA
| | - Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Tennessee, USA
| | - Gregory Fricchione
- Harvard Medical School, Massachusetts, USA; and Department of Psychiatry, Massachusetts General Hospital, Massachusetts, USA
| | - James Luccarelli
- Harvard Medical School, Massachusetts, USA; and Department of Psychiatry, Massachusetts General Hospital, Massachusetts, USA
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Zappia KJ, Shillington A, Fosdick C, Erickson CA, Lamy M, Dominick KC. Neurodevelopmental Disorders Including Autism Spectrum Disorder and Intellectual Disability as a Risk Factor for Delayed Diagnosis of Catatonia. J Dev Behav Pediatr 2024; 45:e137-e142. [PMID: 38451868 DOI: 10.1097/dbp.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/30/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Catatonia is a distinct and severe medical syndrome comprising motor, somatic, and psychiatric symptoms that is reported in upwards of 17% of young patients with autism spectrum disorders. Clinical experience indicates catatonia is often under-recognized in this clinical population. Here we characterize the clinical presentation of catatonia in patients with and without neurodevelopmental disorders (NDDs) including autism, including the time from symptom onset to diagnosis of catatonia. METHOD Retrospective chart review of electronic medical records at a large, academic pediatric medical center identified 113 pediatric and young adult patients with a charted history of catatonia, as identified by an encounter diagnosis or problem list entry between September 2017 and September 2021. Workup, treatments, and diagnoses (psychiatric, neurodevelopmental, and genetic) were identified. RESULTS We observed a clear and substantial delay in identification of catatonia in those with NDDs (diagnosis after 330 days for those without psychosis) compared with neurotypical patients (∼16 days). Psychiatry involvement was associated with shorter delays. CONCLUSION Intellectual disability and autism are risk factors for significantly delayed diagnosis of catatonia. It is unknown whether delayed diagnosis contributes to the difficulty in treating catatonia in this patient population or whether the treatment difficulties relate instead to differential and ongoing biological mechanisms and underlying encephalopathy. Overall, these findings highlight the importance of increased recognition of catatonia symptoms in patients with NDDs and suggest early referral to psychiatric specialists may shorten the delay to diagnosis.
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Affiliation(s)
- Katherine J Zappia
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
| | - Amelle Shillington
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cara Fosdick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
| | - Martine Lamy
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
| | - Kelli C Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
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Smith JR, Baldwin I, Lim S, Luccarelli J. Symptoms of Catatonia Observed in Down Syndrome Regressive Disorder: A Retrospective Analysis. J Autism Dev Disord 2024:10.1007/s10803-024-06249-x. [PMID: 38386254 PMCID: PMC11339237 DOI: 10.1007/s10803-024-06249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Down Syndrome Regressive Disorder (DSRD) is a neuropsychiatric condition associated with severe symptomology and a negative impact on quality of life. DSRD frequently presents with catatonic symptoms. However, few studies have reported the specific catatonic symptoms that occur in DSRD. METHODS We conducted a retrospective analysis of medical records in a large health system in the southern United States to identify patients with diagnoses of DS with catatonic symptoms who presented for clinical care between 1/1/2018 and 12/1/2023. Patients were included in the study if they had a diagnosis of DSRD or met the criteria for DSRD using consensus guidelines on retrospective chart review, and catatonia as confirmed in clinical documentation and had a full Bush Francis Catatonia Rating Scale (BFCRS) documented at the time of initial catatonia diagnosis. RESULTS A total of nine patients who met the criteria for DSRD and catatonia using the BFCRS were identified. The average age of patients at the time of DSRD diagnosis was 21.1 years (SD = 13.87). The mean BFCRS score on initial evaluation was 17.3 (SD = 7.0) and the mean number of positive catatonia signs was 11.1 (SD = 1.5). Staring was present in all cases (n = 9, 100%), followed by mutism, grimacing, and rigidity (n = 7, 77.9%). CONCLUSIONS In a sample of nine patients with DSRD, all patients were diagnosed with catatonia. Catatonia is severe if undiagnosed and untreated. Future research is needed to assess specific symptoms of catatonia in DSRD, and longitudinal outcomes to assess optimal means of treatment.
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Affiliation(s)
- Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21St Avenue South, Suite 2200, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, Vanderbilt University, 110 Magnolia Circle, Nashville, TN, 37203, USA.
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN, 37212, USA
| | - Seri Lim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21St Avenue South, Suite 2200, Nashville, TN, 37212, USA
| | - James Luccarelli
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Legrand A, Moyal M, Deschamps C, Louveau C, Iftimovici A, Krebs MO, Héron B, Keren B, Afenjar A, Chaumette B. Catatonia and genetic variant in GABA receptor: A case report involving GABRB2. Schizophr Res 2024; 263:191-193. [PMID: 37517920 DOI: 10.1016/j.schres.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/02/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Adrien Legrand
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France
| | - Mylène Moyal
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France
| | - Claire Deschamps
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Cécile Louveau
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France
| | - Anton Iftimovici
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France
| | - Marie-Odile Krebs
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France
| | - Benedicte Héron
- Department of Pediatric Neurology, Armand Trousseau Hospital, AP-HP.Sorbonne University, Paris, France
| | - Boris Keren
- Department of medical genetics, Pitié-Salpêtrière Hospital, AP-HP.Sorbonne University, Paris, France
| | - Alexandra Afenjar
- APHP Sorbonne University, Reference Center for Intellectual Disabilities From Rare Causes, Department of Genetics and Medical Embryology, Armand Trousseau Hospital, F-75012 Paris, France
| | - Boris Chaumette
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014 Paris, France; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U1266, Paris, France; Department of Psychiatry, McGill University, Montreal, Canada.
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10
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Termini K, Anand E, Hickox T, Richter LD, Smith JR. Manifestation of Catatonia in an Adolescent With 22q11.2 Syndrome. J Am Acad Child Adolesc Psychiatry 2023; 62:1281-1286. [PMID: 37391128 PMCID: PMC10753029 DOI: 10.1016/j.jaac.2023.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/19/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023]
Abstract
In this Letter to the Editor, we present a case of 22q11.2 deletion syndrome that was diagnosed in an adolescent girl after the onset of acute catatonic symptoms. We discuss the challenges in diagnosing catatonia in children and patients with comorbid neurodevelopmental disorders (NDDs), especially in the setting of recent traumatic exposure. We then review treatment strategies in this patient population and conclude with our recommendations regarding genetic workup in acute catatonia. The patient and guardians have reviewed this article and provided informed consent for its publication. In addition, the authors used the CARE guidelines and checklist in writing this report (Supplement 1, available online).
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Affiliation(s)
| | - Ekta Anand
- Vanderbilt University, Nashville, Tennessee
| | | | | | - Joshua Ryan Smith
- Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Kennedy Center, Nashville, Tennessee.
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Patterson EM, Lim J, Fuchs P, Smith JR, Moussa-Tooks A, Ward HB. Use of First-Generation Antipsychotics in an Adolescent Male with Catatonic Schizophrenia. Harv Rev Psychiatry 2023; 31:267-273. [PMID: 37823777 DOI: 10.1097/hrp.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Emmy Masur Patterson
- From Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN (Drs. Patterson, Moussa-Tooks, and Ward); Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, TN (Dr. Lim); Sheppard Pratt Hospital, Baltimore, MD (Dr. Fuchs); Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN (Dr. Smith); Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN (Dr. Smith)
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12
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Shillington A, Zappia KJ, White L, Fosdick C, Erickson CA, Lamy M, Dominick KC. Genetic syndromes are prevalent in patients with comorbid neurodevelopmental disorders and catatonia. Am J Med Genet A 2023; 191:2716-2722. [PMID: 37642312 DOI: 10.1002/ajmg.a.63379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
Catatonia occurs at high rates in idiopathic and syndromic neurodevelopmental disorders. At our institution's multidisciplinary catatonia clinic, clinical genetic testing (including microarray, fragile X PCR and methylation, autism/ID expanded panels, and exome sequencing) was commonly completed as part of clinical workup on patients with co-occurring neurodevelopmental disorders and catatonia (performed in 36/48 cases or 75%). This testing identified a pathogenic or likely pathogenic finding in 15/36 patients (42%). Testing identified a VUS (variant of uncertain significance) in 9/36 patients (25%). On review of the VUS findings, 4/9 were felt to be suspicious and potentially diagnostic. Testing was negative for 12/36 patients (33%). Many of the variants identified in this cohort were found in genes involved in gamma aminobutyric acid (GABA) and glutamatergic synaptic signaling; imbalances of these neurotransmitters are hypothesized to be drivers of catatonia. More work is needed to further characterize the molecular underpinnings of catatonia in the setting of neurodevelopmental disorders, including expanding genetic testing to larger cohorts in the future.
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Affiliation(s)
- Amelle Shillington
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Katherine J Zappia
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lori White
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cara Fosdick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Martine Lamy
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelli C Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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13
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Dhossche D, de Billy C, Laurent-Levinson C, Le Normand MT, Recasens C, Robel L, Philippe A. Early-onset catatonia associated with SHANK3 mutations: looking at the autism spectrum through the prism of psychomotor phenomena. Front Psychiatry 2023; 14:1186555. [PMID: 37810596 PMCID: PMC10557257 DOI: 10.3389/fpsyt.2023.1186555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Individuals with Phelan-McDermid syndrome (PMS) present with a wide range of diagnoses: autism spectrum disorder, intellectual disability, or schizophrenia. Differences in the genetic background could explain these different neurodevelopmental trajectories. However, a more parsimonious hypothesis is to consider that they may be the same phenotypic entity. Catatonic disturbances occasionally reported from adolescence onwards in PMS prompts exploration of the hypothesis that this clinical entity may be an early-onset form of catatonia. The largest cohort of children with childhood catatonia was studied by the Wernicke-Kleist-Leonhard school (WKL school), which regards catatonia as a collection of qualitative abnormalities of psychomotricity that predominantly affecting involuntary motricity (reactive and expressive). The aim of this study was to investigate the presence of psychomotor signs in three young adults carrying a mutation or intragenic deletion of the SHANK3 gene through the prism of the WKL school conception of catatonia. Methods This study was designed as an exploratory case study. Current and childhood psychomotor phenomena were investigated through semi-structured interviews with the parents, direct interaction with the participants, and the study of documents reporting observations of the participants at school or by other healthcare professionals. Results The findings show catatonic manifestations from childhood that evolved into a chronic form, with possible phases of sub-acute exacerbations starting from adolescence. Conclusion The presence of catatonic symptoms from childhood associated with autistic traits leads us to consider that this singular entity fundamentally related to SHANK3 mutations could be a form of early-onset catatonia. Further case studies are needed to confirm our observations.
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Affiliation(s)
- Dirk Dhossche
- Department of Adolescent Psychiatry, Inland Northwest Behavioral Health, Spokane, WA, United States
| | - Clément de Billy
- CEMNIS – Noninvasive Neuromodulation Center, University Hospital Strasbourg, Strasbourg, France
| | - Claudine Laurent-Levinson
- Faculté de Médecine Sorbonne Université, Groupe de Recherche Clinique no. 15 – Troubles Psychiatriques et Développement (PSYDEV), Paris, France
- Centre de Référence des Maladies Rares à Expression Psychiatrique, Département de Psychiatrie de l’enfant et l’adolescent, Hôpital Pitié-Salpétrière, Paris, France
| | - Marie T. Le Normand
- Institut de l’Audition, Institut Pasteur, Paris, France
- Laboratoire de Psychopathologie et Processus de Santé, Université de Paris Cité, Paris, France
| | - Christophe Recasens
- Service universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Centre hospitalier Intercommunal de Créteil, Créteil, France
| | - Laurence Robel
- Unité de Psychopathologie de l’Enfant et de l’Adolescent, GHU Paris, Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Anne Philippe
- Université Paris Cité, Paris, France
- INSERM U1163 Institut Imagine, Paris, France
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14
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Smith JR, Baldwin I, York T, Anderson C, McGonigle T, Vandekar S, Wachtel L, Luccarelli J. Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis. FRONTIERS IN CHILD AND ADOLESCENT PSYCHIATRY 2023; 2:1208926. [PMID: 37397642 PMCID: PMC10312099 DOI: 10.3389/frcha.2023.1208926] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Introduction Pediatric catatonia is a highly co-morbid condition with treatment options often limited to electroconvulsive therapy (ECT) or lorazepam. However, lorazepam may not be readily available, and access to ECT is limited by restrictive legislation and stigma. This study aims to provide alternative treatment options for pediatric catatonia. Methods The study involved a single-site retrospective analysis of a private university hospital in the southern United States. The study included patients under eighteen with catatonia who received psychopharmacologic treatment with an agent other than lorazepam. The patients were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), and Kanner Catatonia Examination (KCE) at the time of initial evaluation and upon stabilization. A retrospective clinical global impressions-improvement (CGI-I) score was assigned by four authors. Results 102 pediatric patients diagnosed with catatonia were identified, and 31 met criteria for the study. 20 (65%) were white, 6 (19%) were Black, 4 (13%) were Hispanic, and 1 (3%) were Indian. Most patients (N = 18; 58%) were insured by Medicaid. The mean age at the time of catatonia diagnosis was 13.5 years. All patients were stabilized on either clonazepam or diazepam, with 21 (68%) requiring treatment with an additional medication of either an anti-epileptic, N-methyl-D-aspartate (NMDA) receptor antagonist, and aripiprazole or clozapine. Statistically significant reductions in the BFCRS [t = 11.2, df = 30, std = 6.3, p < 0.001, 95% CI = (7.8, 15.1)], KCS [t = 4.6, df = 38, p < 0.001, 95% CI = (12.0, 31.0)], and KCE [t = 7.8, df = 30, std = 1.8, p < 0.001, 95% CI = (1.9, 3.2)] were observed. For CGI-I the results showed that the estimated probability of observing a score better than no change (>4) is 0.976 [t.s. = 43.2, p < 0.001, 95% CI = (0.931,0.992)], indicating the average subject is expected to experience some improvement. Discussion In conclusion, all patients responded to these treatments with improvement in their catatonic symptoms. Alternative pharmacologic interventions for catatonia, including benzodiazepines other than lorazepam, valproic acid, NMDA receptor antagonists, and atypical antipsychotics were safe and effective in treating catatonia in this population.
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Affiliation(s)
- Joshua R. Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United States
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, United States
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United States
| | - Carina Anderson
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United States
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Lee Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - James Luccarelli
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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15
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Hauptman AJ, Cohen D, Dhossche D, Raffin M, Wachtel L, Ferrafiat V. Catatonia in neurodevelopmental disorders: assessing catatonic deterioration from baseline. Lancet Psychiatry 2023; 10:228-234. [PMID: 36708735 DOI: 10.1016/s2215-0366(22)00436-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 01/27/2023]
Abstract
Despite the inclusion of catatonia as a specifier of autism spectrum disorder in DSM-5, we-a team of child and adolescent neuropsychiatrists who specialise in paediatric catatonia and neurodevelopmental disorders-have identified a number of issues with the diagnosis and clinical management of catatonia in our patients. In this Personal View, we summarise the literature regarding catatonia in people with neurodevelopmental disorders, including autism spectrum disorder, describe our concerns, and offer a novel approach to addressing important issues with current diagnostic and treatment paradigms. We emphasise the need for a measure to diagnose and monitor people with catatonia and their history of neurodevelopmental disorders. This measure should consider previous complex and underlying motor, medical, functional, and neurobehavioural symptoms. We propose two concepts for understanding catatonia that relate to the baseline status of an individual: the personalised score at baseline, an estimate of premorbid neurobehavioral and motor symptoms, and the catatonic deterioration from baseline, an estimate of current features that are due to catatonia rather than an underlying neurodevelopmental disorder. We hope this measure will provide a practical tool for clinicians and researchers working with this underserved and high-risk population.
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Affiliation(s)
- Aaron J Hauptman
- Neurobehavioral Unit, Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David Cohen
- Institute of Intelligence Systems and Robotics, Sorbonne University, Paris, France; Pitié-Salpêtrière Hospital, Public Assistance-Paris Hospital, Institute of Child and Adolescent Developmental Pathologies, Paris, France
| | - Dirk Dhossche
- Inland Northwest Behavioral Health, Spokane, WA, USA
| | - Marie Raffin
- Pitié-Salpêtrière Hospital, Public Assistance-Paris Hospital, Institute of Child and Adolescent Developmental Pathologies, Paris, France
| | - Lee Wachtel
- Neurobehavioral Unit, Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vladimir Ferrafiat
- Reference Center for Inborn Errors of Metabolism and Reference Center for Intellectual Disabilities of Rare Causes, La Timone University Hospital, Public Assistance-Marseille Hospital, Marseille, France.
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16
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Paterson-Brown L, Scally N, Imeson D, Jones A, Shivamurthy V. Catatonic conundrum. Arch Dis Child Educ Pract Ed 2022:archdischild-2021-322353. [PMID: 36175109 DOI: 10.1136/archdischild-2021-322353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/01/2022] [Indexed: 11/04/2022]
Abstract
Differentiating between physical and psychological causes of confusion and psychosis poses a significant challenge to clinicians across all disciplines of medicine. This case report explores the clinical presentation and diagnostic journey of an adolescent girl. She presented to the emergency department with acutely altered behaviour and went on to re-present on multiple occasions over the following months with symptoms suggestive of psychosis. The team faced diagnostic difficulty differentiating between organic and non-organic causes of altered behaviour and mental state. This article explores the challenge faced by the team during the assessment and diagnosis of this patient.
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Affiliation(s)
- Lucy Paterson-Brown
- Paediatric Rheumatology Department, Evelina London Children's Hospital Paediatrics, London, UK
| | - Niamh Scally
- General Paediatric Department, Croydon University Hospital, Croydon, UK
| | - Dorrie Imeson
- Liaison Child and Adolescent Psychiatry, Evelina London Children's Hospital, London, UK
| | - Alexandra Jones
- Paediatric Rheumatology Department, Evelina London Children's Hospital Paediatrics, London, UK
| | - Vinay Shivamurthy
- Paediatric Rheumatology Department, Evelina London Children's Hospital Paediatrics, London, UK
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17
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Moore S, Amatya DN, Chu MM, Besterman AD. Catatonia in autism and other neurodevelopmental disabilities: a state-of-the-art review. NPJ MENTAL HEALTH RESEARCH 2022; 1:12. [PMID: 38609506 PMCID: PMC10955936 DOI: 10.1038/s44184-022-00012-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/26/2022] [Indexed: 04/14/2024]
Abstract
Individuals with neurodevelopmental disabilities (NDDs) may be at increased risk for catatonia, which can be an especially challenging condition to diagnose and treat. There may be symptom overlap between catatonia and NDD-associated behaviors, such as stereotypies. The diagnosis of catatonia should perhaps be adjusted to address symptom overlap and to include extreme behaviors observed in patients with NDDs, such as severe self-injury. Risk factors for catatonia in individuals with NDDs may include trauma and certain genetic variants, such as those that disrupt SHANK3. Common etiologic features between neurodevelopmental disabilities and catatonia, such as excitatory/inhibitory imbalance and neuroimmune dysfunction, may partially account for comorbidity. New approaches leveraging genetic testing and neuroimmunologic evaluation may allow for more precise diagnoses and effective treatments.
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Affiliation(s)
- Shavon Moore
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA
- Rady Children's Hospital San Diego, Division of Behavioral Health Services, San Diego, CA, USA
| | - Debha N Amatya
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA
- UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Michael M Chu
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA
- Rady Children's Hospital San Diego, Division of Behavioral Health Services, San Diego, CA, USA
- Children's Hospital of Orange County, Division of Child and Adolescent Psychiatry, Orange, CA, USA
- University of California Irvine, Department of Psychiatry, Irvine, CA, USA
| | - Aaron D Besterman
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA.
- Rady Children's Hospital San Diego, Division of Behavioral Health Services, San Diego, CA, USA.
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA.
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18
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Luccarelli J, Kalinich M, Fernandez-Robles C, Fricchione G, Beach SR. The Incidence of Catatonia Diagnosis Among Pediatric Patients Discharged From General Hospitals in the United States: A Kids' Inpatient Database Study. Front Psychiatry 2022; 13:878173. [PMID: 35573347 PMCID: PMC9106281 DOI: 10.3389/fpsyt.2022.878173] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Catatonia is a neuropsychiatric condition occurring across the age spectrum and associated with great morbidity and mortality. While prospective cohorts have investigated catatonia incidence among psychiatric patients, no studies have comprehensively explored the incidence of catatonia in general hospitals. We examine the incidence of catatonia diagnosis, demographics of catatonia patients, comorbidities, and inpatient procedures utilized among pediatric patients hospitalized with catatonia in the United States. METHODS The Kids' Inpatient Database, a national all-payors sample of pediatric hospitalizations in general hospitals, was examined for the year 2019. Hospitalizations with a discharge diagnosis of catatonia were included in the analysis. Hospitalizations with catatonia as the primary discharge diagnosis were compared to hospitalizations with catatonia as a secondary discharge diagnosis. RESULTS A total of 900 (95% CI: 850-949) pediatric discharges (291 with catatonia as a primary diagnosis, 609 with catatonia as a secondary diagnosis) occurred during the study year. Mean age was 15.6 ± 2.6 years, and 9.9% were under age 13. Comorbidities were common among patients with catatonia, with psychotic disorders (165; 18.3%), major depressive disorder (69; 7.7%), bipolar disorder (39; 4.3%) and substance-related disorders (20; 2.2%) as the most common primary diagnoses. There was significant comorbidity with neurologic illness, developmental disorders, autism spectrum disorder, and inflammatory conditions. In total 390 catatonia discharges (43.3%) included at least one procedure during admission. CONCLUSIONS catatonia is rarely diagnosed in pediatric patients in general hospitals but is associated with significant and severe psychiatric and medical comorbidities. Further research is needed into the optimal diagnosis, workup, and treatment of catatonia in pediatric patients.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Mark Kalinich
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Carlos Fernandez-Robles
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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19
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Medjkane F, Bohet M, Ister M, Cohen D, Parenti A, Janati M, Mention K, Dobbelaere D, Jardri R. Onset of psychiatric signs and impaired neurocognitive domains in inherited metabolic disorders: A case series. JIMD Rep 2021; 58:29-36. [PMID: 33728244 PMCID: PMC7932863 DOI: 10.1002/jmd2.12133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/22/2020] [Accepted: 05/08/2020] [Indexed: 11/08/2022] Open
Abstract
Inherited metabolic disorders (IMDs) can present with psychiatric signs that vary widely from one disease to another. This picture is further complicated by the fact that these features occur at very different illness time points, which may further delay appropriate diagnosis and treatment. In this case series of 62 children and adolescents suffering from IMDs, we clustered psychiatric signs (on the basis of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders classification) as well as impaired cognitive domains (on the basis of the Research Domain Criteriamatrix) according to their mean age of onset (5.7 ± 4 years). We observed consistent patterns of occurrence across disorders. Externalizing symptoms, sleep problems, and cross-domain self-regulation deficits were found to precede the IMD diagnosis. Repetitive thoughts and behaviors as well as emotional dysregulation were found to occur around the disease onset. Finally, late-onset features included dissociative or eating disorders, together with impaired emotion knowledge. Clinicians should specifically look for the co-occurrence of age-specific atypical signs, such as treatment resistance or worsening with psychotropic medication in the earliest stages and symptom fluctuation, confusion, catatonia, or isolated visual hallucinations. We believe that the combined characterizations of psychiatric signs and impaired neurocognitive domains may enable the earliest detection of IMDs and the appropriate care of these particular manifestations. KEY POINTS Psychiatric signs are common in inherited metabolic disorders (IMDs) and may occur in the same age-range as other clinical manifestations.Three clusters of psychiatric signs and two clusters of neurocognitive domains can be defined according to their mean age of onset.Warning signs to be used in liaison psychiatry should include age-specific cognitive impairments.
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Affiliation(s)
- François Medjkane
- CHU LilleService de Psychiatrie Enfants et Adolescents, Centre de Référence des Maladies Rares à Expression Psychiatrique, Hôpital FontanLilleFrance
| | - Marine Bohet
- CHU LilleService de Psychiatrie Enfants et Adolescents, Centre de Référence des Maladies Rares à Expression Psychiatrique, Hôpital FontanLilleFrance
| | | | - David Cohen
- Département de Psychiatrie Enfants et AdolescentsAP‐HP, GH Pitié‐SalpêtrièreParisFrance
- Institut des Systèmes Intelligents et de RobotiquesCNRS UMR‐7222, UPMC, Sorbonne UniversitésParisFrance
| | - Aesa Parenti
- CHU LilleService de Psychiatrie Enfants et Adolescents, Centre de Référence des Maladies Rares à Expression Psychiatrique, Hôpital FontanLilleFrance
| | - Majda Janati
- CHU LilleService de Psychiatrie Enfants et Adolescents, Centre de Référence des Maladies Rares à Expression Psychiatrique, Hôpital FontanLilleFrance
| | - Karine Mention
- Reference Centre for Inherited Metabolic Diseases in Child and Adulthood, University Children's Hospital Jeanne de Flandre and RADEMELille CedexFrance
| | - Dries Dobbelaere
- Reference Centre for Inherited Metabolic Diseases in Child and Adulthood, University Children's Hospital Jeanne de Flandre and RADEMELille CedexFrance
| | - Renaud Jardri
- CHU LilleService de Psychiatrie Enfants et Adolescents, Centre de Référence des Maladies Rares à Expression Psychiatrique, Hôpital FontanLilleFrance
- University of Lille, INSERM U‐1172CHU Lille, Lille Neuroscience and Cognition Centre (LiNC), Plasticity and Subjectivity team (PSY team)LilleFrance
- CHU LillePsychiatry Unit of the Clinical Investigation Centre (CIC‐1403), CURE Platform, Fontan HospitalLilleFrance
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20
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Ferrafiat V, Riquin E, Freri E, Granata T, Nardocci N, Medjkane F, Corfiotti C, Tozzo A, Pellerin H, Benarous X, Haroche J, Amoura Z, Duverger P, Jardri R, Gerardin P, Cohen D, Consoli A, Raffin M. Psychiatric autoimmune conditions in children and adolescents: Is catatonia a severity marker? Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110028. [PMID: 32619473 DOI: 10.1016/j.pnpbp.2020.110028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Patients with autoimmune encephalitis (AE) are likely to exhibit an acute onset of severe psychiatric features, including psychosis and/or catatonia. Based on the high prevalence of catatonia in AE and our clinical experience, we hypothesized that catatonia might be a marker of severity requiring more aggressive treatment approaches. METHODS To reach a sufficient number of cases with brain-autoimmune conditions, we pooled two samples (N = 58): the first from the French National Network of Rare Psychiatric diseases and the second from the largest Italian neuro-pediatrics center for encephalopathies. Autoimmune conditions were diagnosed using a multidisciplinary approach and numerous paraclinical investigations. We retrospectively compared patients with and without catatonia for psychiatric and non-psychiatric clinical features, biological and imaging assessments, type of immunotherapy used and outcomes. RESULTS The sample included 25 patients (43%) with catatonia and 33 (57%) without catatonia. Forty-two patients (72.4%) had a definite AE (including 27 anti-NMDA receptor encephalitis) and 16 (27.6%) suspected autoimmune encephalitis. Patients with catatonia showed significantly more psychotic features [18 (72%) vs 9 (27.3%), p < 0.001)] and more movement disorders [25 (100%) vs 20 (60.6%), p < 0.001] than patients without catatonia. First line (corticoids, immunoglobulin and plasma exchanges) and second line (e.g., rituximab) therapies were more effective in patients with catatonia, with 24 (96%) vs 22 (66.7%) (p = 0.006) and 17 (68%) vs 9 (27.3%) (p = 0.002), respectively. However, those with catatonia received more combinations of first and second line treatments and had more relapses during outcomes. CONCLUSION Despite its exploratory design, the study supports the idea that autoimmune catatonia may be a marker of severity and morbidity in terms of initial presentation and relapses, requiring the need for early and aggressive treatment.
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Affiliation(s)
- Vladimir Ferrafiat
- Department of Child and Adolescent Psychiatry, Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; Department of Child and Adolescent Psychiatry, Université de Rouen, Hôpital Charles Nicolle, 1 rue de Germont, 76000 Rouen, France.
| | - Elise Riquin
- Department of Child and Adolescent Psychiatry, Hôpital Universitaire d'Angers, 4 Rue Larrey, 49100 Angers, France
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Nardo Nardocci
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - François Medjkane
- Department of Child and Adolescent Psychiatry, Université Lille Nord de France, CHRU de Lille, F-59037 Lille Cedex, France
| | - Claire Corfiotti
- Department of Child and Adolescent Psychiatry, Université Lille Nord de France, CHRU de Lille, F-59037 Lille Cedex, France
| | - Alessandra Tozzo
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Huges Pellerin
- Department of Child and Adolescent Psychiatry, Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Xavier Benarous
- Department of Child and Adolescent Psychiatry, Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Julien Haroche
- French National Reference Center for Rare Systemic AutoImmune Disorders, E3M Institute, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Zahir Amoura
- French National Reference Center for Rare Systemic AutoImmune Disorders, E3M Institute, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Philippe Duverger
- Department of Child and Adolescent Psychiatry, Hôpital Universitaire d'Angers, 4 Rue Larrey, 49100 Angers, France
| | - Renaud Jardri
- Department of Child and Adolescent Psychiatry, Université Lille Nord de France, CHRU de Lille, F-59037 Lille Cedex, France
| | - Priscille Gerardin
- Department of Child and Adolescent Psychiatry, Université de Rouen, Hôpital Charles Nicolle, 1 rue de Germont, 76000 Rouen, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; GRC 15 PSYDEV. Troubles psychiatriques et développement. Sorbonne Université, Paris, France
| | - Marie Raffin
- Department of Child and Adolescent Psychiatry, Sorbonne Université, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France; GRC 15 PSYDEV. Troubles psychiatriques et développement. Sorbonne Université, Paris, France
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Absoud M, Malik O. Catatonia: An under-recognised treatable neuropsychiatric syndrome in developmental disorders. Eur J Paediatr Neurol 2020; 25:4. [PMID: 32107106 DOI: 10.1016/j.ejpn.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Absoud
- Children's Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, King's Health Partners Academic Health Science Centre, UK.
| | - Osman Malik
- Children's Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, King's Health Partners Academic Health Science Centre, UK
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Guinchat V, Cravero C, Lefèvre-Utile J, Cohen D. Multidisciplinary treatment plan for challenging behaviors in neurodevelopmental disorders. HANDBOOK OF CLINICAL NEUROLOGY 2020; 174:301-321. [PMID: 32977887 DOI: 10.1016/b978-0-444-64148-9.00022-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Among symptoms that patients with neurodevelopmental disorders can exhibit, challenging behaviors (CBs) are some of the more complex to face, both for caregivers and the patients themselves. They are more frequent in individuals with severe autism spectrum disorders and intellectual disability, and during the transition period from late childhood to young adulthood. Here, we offer an overview of the therapeutic approaches proven worthy in managing CB. Topics include nonpharmacologic treatments (such as behavioral and family interventions), drug prescriptions, and specific intensive care for life-threatening situations, including inpatient stay in specialized neurobehavioral units. Then, we focus on rare, complex, and resistant clinical presentations, mainly based on the authors' clinical experience. We propose a multimodal intervention framework for these complex presentations, embracing developmental and dimensional approaches. A case presentation illustrates the proposed framework, with the aim of serving readers and health practitioners that are facing such cases.
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Affiliation(s)
- Vincent Guinchat
- Psychiatric Section of Mental Development, Psychiatric University Clinic, Lausanne University Hospital, Prilly-Lausanne, Switzerland.
| | - Cora Cravero
- Service de Psychiatrie de l'Enfant et de l'Adolescent, APHP.Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jean Lefèvre-Utile
- Service de Psychiatrie de l'Enfant et de l'Adolescent, APHP.Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, APHP.Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Institut des Systèmes Intelligents et Robotiques, Sorbonne Université, Paris, France
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Grover S, Suman A, Shouan A. Catatonia in a young woman with intellectual disability and vitamin D deficiency managed with electroconvulsive therapy. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2020. [DOI: 10.4103/jmhhb.jmhhb_22_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Miles JH, Takahashi N, Muckerman J, Nowell KP, Ithman M. Catatonia in Down syndrome: systematic approach to diagnosis, treatment and outcome assessment based on a case series of seven patients. Neuropsychiatr Dis Treat 2019; 15:2723-2741. [PMID: 31571888 PMCID: PMC6759875 DOI: 10.2147/ndt.s210613] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The goal is to expand our knowledge of catatonia occurring in adolescents and young adults with Down syndrome (DS) by describing the first prospective, consecutive, well-characterized cohort of seven young people with DS diagnosed with catatonia and treated between 2013 and 2018, and to assess each patient's treatment responses. Longitudinal assessment of each patient's response to treatment is intended to provide clinicians and psychiatrists a firm foundation from which assess treatment efficacy. STUDY DESIGN Young adults with Down syndrome were consecutively enrolled in the study as they were diagnosed with catatonia. A comprehensive data set included medical, laboratory, developmental, demographic, family, social and genetic data, including query into disorders for which individuals with DS are at risk. Catatonia was diagnosed based on an unequivocal history of regression, positive Bush-Francis Catatonia Rating Scale and positive response to intravenous lorazepam. Patients' longitudinal progress was monitored using the Catatonia Impact Scale (CIS) developed for this purpose. RESULTS Seven consecutive DS patients, who presented with unequivocal regression were diagnosed with catatonia and treated for 2.7-6 years using standard-of-care therapies; primarily GABA agonist, lorazepam, electroconvulsive therapy (ECT) and glutamate antagonists (dextromethorphan/quinidine, memantine, minocycline). Responses to each treatment modality were assessed at clinic visits and through weekly electronic CIS reports. CONCLUSION Seven young adults with DS were diagnosed with catatonia; all responded to Lorazepam and/or ECT therapy with good to very good results. Though ECT most dramatically returned patients to baseline, symptoms often returned requiring additional ECT. Dextromethorphan/quinidine, not used until mid-2017, appeared to reduce the reoccurrence of symptoms following ECT. Though all seven patients improved significantly, each continues to require some form of treatment to maintain a good level of functioning. Findings of a significant number of autoimmune disorders and laboratory markers of immune activation in this population may guide new diagnostic and treatment opportunities.
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Affiliation(s)
- Judith H Miles
- Department of Child Health, University of Missouri Healthcare, Columbia, MO, USA
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Nicole Takahashi
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Julie Muckerman
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Kerri P Nowell
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
- Department of Health Psychology, University of Missouri Healthcare, Columbia, MO, USA
| | - Muaid Ithman
- Department of Psychiatry, University of Missouri Health Care, Columbia, MO, USA
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