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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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Baldwin I, Cho A, Orenstein G, Wilner N, Nicoli D, Smith JR. SYNGAP-1 Mutation And Catatonia: A Case Series And Systematic Review. J Child Adolesc Psychopharmacol 2024. [PMID: 39235394 DOI: 10.1089/cap.2024.0055] [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] [Indexed: 09/06/2024]
Abstract
Introduction: Hyperactive catatonia is often unrecognized in pediatric patients due to its clinical heterogeneity, though it is often seen in children with neurodevelopmental disabilities, especially autism spectrum disorder (ASD). Emerging evidence implicates hyperactive catatonia in more cases of self-injury and aggression in ASD than previously thought. Objectives: The study seeks to describe cases of hyperactive catatonia in SYNGAP-1 mutation and examine existing literature for symptomatic overlap between previously-described clinical and behavioral phenotypes of individuals with SYNGAP-1 mutations and catatonia. Methods: The study describes two cases of an adolescent and a young adult with SYNGAP-1 mutation and ASD presenting with hyperactive catatonia, which are the first reports of catatonia in individuals known to have a pathogenic variant in SYNGAP-1. A systematic review was undertaken during which 101 articles were screened. 13 articles were then examined for neurological and behavioral features present in participants with SYNGAP-1 mutations which are seen in catatonia. Results: The systematic review demonstrates that clinical features suggestive of catatonia are frequently seen among individuals with SYNGAP-1 mutations, including verbal impairment, psychomotor symptoms, aggression, oral aversion, and incontinence. These features were also present in the cases of catatonia in SYNGAP-1 mutations presented here. Both patients showed clinical improvement with use of a long-acting benzodiazepine, and one patient showed benefit from electroconvulsive therapy. Conclusions: This symptomatic overlap revealed in the systematic review, including symptoms seen in the reported cases, raises the possibility that diagnoses of catatonia may have been missed in the past in individuals with SYNGAP-1 mutations. Self-injurious behavior and aggression, which are hallmarks of hyperactive catatonia, are commonly part of the behavioral phenotype of SYNGAP-1-related disorders. Clinicians should consider catatonia as a cause of such symptoms in individuals with SYNGAP-1 mutations, as effective treatment can result in significant improvement in safety and quality of life.
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Affiliation(s)
- Isaac Baldwin
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alicia Cho
- Division of Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Gabe Orenstein
- Division of Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Natalie Wilner
- Division of Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Nicoli
- Division of Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Joshua Ryan Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tennessee, USA
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Smith JR, York T, Hart S, Patel A, Kreth HL, Spencer K, Grizzle KB, Wilson JE, Pagano L, Zaim N, Fuchs C. The Development a Pediatric Catatonia Clinical Roadmap for Clinical Care at Vanderbilt University Medical Center. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00085-5. [PMID: 39241984 DOI: 10.1016/j.jaclp.2024.08.003] [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: 04/16/2024] [Revised: 08/15/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Pediatric catatonia is associated with a high degree of morbidity and mortality in children. However, pediatric catatonia is highly responsive to treatment if rapidly identified and appropriate interventions are administered. To our knowledge, there are no current publications which propose a systematic approach for the management of pediatric catatonia. The aim of our report was to create multidisciplinary clinical care roadmap for catatonia in the inpatient pediatric setting within Vanderbilt University Medical Center (VUMC). METHODS At VUMC, we formed a team of pediatric providers from child and adolescent psychiatry, rheumatology, neurology, pediatric hospital medicine, and pediatric psychology. Our team met on a regular basis over the course of 2022 - 2024 to review the current literature on pediatric catatonia and develop a consensus for clinical assessment and management. RESULTS We determined consensus recommendations from our VUMC multidisciplinary team for the following domains of pediatric catatonia inpatient clinical care: initial assessment of pediatric catatonia in the inpatient pediatric settings, medical and psychiatric work up for pediatric catatonia, the lorazepam challenge in pediatric populations, behavioral and environmental considerations, and the use of electroconvulsive therapy and alternative psychopharmacologic interventions in pediatric catatonia. CONCLUSIONS Pediatric catatonia is a condition associated with a high degree of morbidity and mortality but is responsive to treatment if diagnosed and treated early. The inpatient pediatric medical setting provides a unique opportunity for identification and treatment. Our clinical care roadmap provides tools for inpatient clinicians at VUMC to identify pediatric catatonia and initiate an evidence-based approach to medical workup, management, and clinical care. This approach has the potential to significantly improve longitudinal outcomes and quality of life improvements for children at VUMC with catatonia and their families.
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Affiliation(s)
- Joshua Ryan 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, Tennessee, 37212; Vanderbilt Kennedy Center, Vanderbilt University; 110 Magnolia Circle, Nashville, TN, 37203.
| | - 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, Tennessee, 37212
| | - Sarah Hart
- Division of Pediatric Hospital Medicine, Department of Pediatrics; Monroe Carell Jr Children's Hospital at Vanderbilt; 2200 Children's way, Nashville, Tennessee, 37232
| | - Anuj Patel
- Division of Pediatric Hospital Medicine, Department of Pediatrics; Monroe Carell Jr Children's Hospital at Vanderbilt; 2200 Children's way, Nashville, Tennessee, 37232
| | - Heather L Kreth
- Division of Pediatric Psychology, Department of Pediatrics; Monroe Carell Jr Children's Hospital at Vanderbilt; 2200 Children's way, Nashville, Tennessee, 37232
| | - Katherine Spencer
- Division of Pediatric Psychology, Department of Pediatrics; Monroe Carell Jr Children's Hospital at Vanderbilt; 2200 Children's way, Nashville, Tennessee, 37232
| | - Karisa Bree Grizzle
- Division of Pediatric Hospital Medicine, Department of Pediatrics; Monroe Carell Jr Children's Hospital at Vanderbilt; 2200 Children's way, Nashville, Tennessee, 37232
| | - Jo Ellen Wilson
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences; Vanderbilt University Medical Center, 1601 23(rd) Ave South, Nashville, Tennessee, 37212
| | - Lindsay Pagano
- Division of Pediatric Neurology, Department of Pediatrics; Monroe Carell Jr Children's Hospital at Vanderbilt; 2200 Children's way, Nashville, Tennessee, 37232
| | - Nadia Zaim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences; Johns Hopkins Hospital; 1800 Orleans Street, Baltimore, Maryland, 21287
| | - 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, Tennessee, 37212
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De Stefano L, Palffy A, Ghaziuddin N. Catatonia in Preadolescent Children. J ECT 2024; 40:162-168. [PMID: 38194591 DOI: 10.1097/yct.0000000000000986] [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] [Indexed: 01/11/2024]
Abstract
OBJECTIVE The aim of the study is to describe prepubescent catatonia in very young children, which is poorly documented in the current literature and, as a result, overlooked in medical settings. METHODS We examined a convenience sample of 10 patients at an academic center who were younger than 12 years and met criteria for catatonia. After institutional review board approval, we extracted from the electronic medical records demographic and diagnostic information, comorbidity, developmental history, and laboratory testing. Bush Francis Catatonia Rating Scales at initial presentation and other symptomatology were gathered in addition to treatment received. Fifty percent of patients in this group were seen and diagnosed with catatonia at their presentation in an outpatient clinic, whereas the remaining 50% were diagnosed upon hospitalization, by the psychiatry consultation liaison team. RESULTS All patients but one was diagnosed with a comorbid condition before the diagnosis of catatonia, including 70% with a previous diagnosis of autism spectrum disorder. Three patients had concurrent anti-N-methyl-D-aspartate receptor encephalitis, and one initially presented with seizures. All patients were treated for catatonia with lorazepam, and two patients additionally received electroconvulsive therapy. Regardless of the presence of early regression invariably associated with an autism spectrum diagnosis, secondary symptoms of regression were noted in each case at the time of diagnosing catatonia. CONCLUSIONS Similar to previous observations in adolescents, prepubescent catatonia seems strongly associated with neurodevelopmental disorders, secondary regression, variability in presentation, and comorbidity with other neurological conditions. Delayed recognition of catatonia can hinder rapid and effective treatment in young children.
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Affiliation(s)
- Lara De Stefano
- From the Psychiatry Department, University of Michigan, Ann Arbor MI
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Kark M, Gerwin R, Wolfrum L, Nilsson M, Bokat P, Perry E. Letter to the Editor Response: "Never Forget About Catatonia Secondary to Organic Conditions". J ECT 2024; 40:217-218. [PMID: 39012125 DOI: 10.1097/yct.0000000000001038] [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] [Indexed: 07/17/2024]
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Ohman RT, Atchison C, Patel ND, Killien EY. Clinical Reasoning: A 17-Year-Old Adolescent Boy With New Altered Mental Status in the Pediatric Intensive Care Unit. Neurology 2024; 103:e209709. [PMID: 38991195 PMCID: PMC11247388 DOI: 10.1212/wnl.0000000000209709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
We present the case of a 17-year-old adolescent boy admitted to the Pediatric Intensive Care Unit with an extensive necrotizing soft tissue infection who subsequently developed altered mental status and autonomic instability. Altered mental status is a common occurrence in critically ill children with a broad differential of etiologies. After ruling out organic causes of encephalopathy, management is typically focused on avoiding deliriogenic agents, including benzodiazepines. Dopamine antagonist medications may also be administered adjunctively to manage agitation or delirium that is refractory to other measures. We review the workup and differential diagnosis for altered mentation in critically ill children and discuss the current understanding of a rare etiology of altered mental status in the pediatric population.
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Affiliation(s)
- Robert T Ohman
- From the Division of Pediatric Critical Care Medicine (R.T.O., E.Y.K.), Department of Pediatrics, University of Washington, Seattle; Texas Children's Hospital (C.A.), Houston; and Department of Neurology (N.D.P.), Medical College of Wisconsin, Children's Hospital Wisconsin-Milwaukee
| | - Christie Atchison
- From the Division of Pediatric Critical Care Medicine (R.T.O., E.Y.K.), Department of Pediatrics, University of Washington, Seattle; Texas Children's Hospital (C.A.), Houston; and Department of Neurology (N.D.P.), Medical College of Wisconsin, Children's Hospital Wisconsin-Milwaukee
| | - Namrata D Patel
- From the Division of Pediatric Critical Care Medicine (R.T.O., E.Y.K.), Department of Pediatrics, University of Washington, Seattle; Texas Children's Hospital (C.A.), Houston; and Department of Neurology (N.D.P.), Medical College of Wisconsin, Children's Hospital Wisconsin-Milwaukee
| | - Elizabeth Y Killien
- From the Division of Pediatric Critical Care Medicine (R.T.O., E.Y.K.), Department of Pediatrics, University of Washington, Seattle; Texas Children's Hospital (C.A.), Houston; and Department of Neurology (N.D.P.), Medical College of Wisconsin, Children's Hospital Wisconsin-Milwaukee
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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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Jaimes-Albornoz W, Wu P, de Mendaza-Martínez de Icaya LG, Rozali F, Martínez-Querol M, Smith R, Isetta M, de Pellón Santamaria ÁR, Serra-Mestres J. Catatonia associated with pediatric postoperative cerebellar mutism syndrome. Childs Nerv Syst 2024; 40:2019-2032. [PMID: 38630268 DOI: 10.1007/s00381-024-06392-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/02/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To ascertain the presence of catatonia in cases of pediatric postoperative cerebellar mutism syndrome (PPCMS). METHOD A systematic review of PPCMS case reports of patients aged 0-17 years with sufficient clinical information to extract catatonic phenomena was undertaken following PRISMA guidelines. Standardized catatonia rating scales were applied to selected cases retrospectively to ascertain whether diagnostic criteria for catatonia were met. A case known to the authors is also presented. RESULTS Two hundred twenty-one suitable full-text articles were identified. Following screening and application of inclusion criteria, 51 articles were selected plus seven more from their references, reporting on 119 subjects. All cases met Bush and Francis (BF) diagnostic criteria for catatonia, 92.5% Pediatric Catatonia Rating Scale (PCRS), 52.9% ICD-11, and 44.5% DSM-5. All patients presented with mutism. The next most frequent signs were immobility/stupor (77.3%), withdrawal (35.3%), mannerisms (23.5%), and excitement/agitation (18.5%). Most cases presented with stuporous catatonia (75.6%). Catatonia most frequently occurred following resection of medulloblastoma (64.7%). Preoperative hydrocephalus occurred in 89 patients (74.8%). CONCLUSION Catatonia was frequent in this PPCMS sample, with a predominant stuporous variant; it should be considered in patients with PPCMS and assessed with reliable and validated instruments for prompt diagnosis and management.
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Affiliation(s)
- Walter Jaimes-Albornoz
- Psychiatry Service, Donostia University Hospital, Basque Health Service-Osakidetza, Paseo del Dr. Beguiristain 117, CP, 20014, San Sebastian, Spain
| | - Peter Wu
- Royal Hospital for Children & Young People, 50 Little France Crescent, Edinburgh, Scotland, UK, EH16 4TJ.
| | | | - Farah Rozali
- Queen Margaret Hospital, Whitefield Rd, Dunfermline, Scotland, UK, KY12 0SU
| | - María Martínez-Querol
- Psychiatry Service, Donostia University Hospital, Basque Health Service-Osakidetza, Paseo del Dr. Beguiristain 117, CP, 20014, San Sebastian, Spain
| | - Rowena Smith
- Royal Hospital for Children & Young People, 50 Little France Crescent, Edinburgh, Scotland, UK, EH16 4TJ
| | | | - Ángel Ruiz de Pellón Santamaria
- Psychiatry Service, Donostia University Hospital, Basque Health Service-Osakidetza, Paseo del Dr. Beguiristain 117, CP, 20014, San Sebastian, Spain
| | - Jordi Serra-Mestres
- ISEP Clinic Girona, Sta. Eugènia 85, 1er-1a, 17006, Girona, Catalunya, Spain
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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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Nadeem NJ, Moawad A, Howatson S, Ahmed A, Cassell D. Case report: Diagnostic challenges in an adolescent case of autistic catatonia. Front Psychiatry 2024; 15:1386949. [PMID: 38859882 PMCID: PMC11163276 DOI: 10.3389/fpsyt.2024.1386949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/12/2024] [Indexed: 06/12/2024] Open
Abstract
Catatonia is a complex neuropsychiatric syndrome involving a constellation of psychomotor disturbances including catalepsy, waxy flexibility, stupor, mutism, negativism, agitation, posturing, stereotypes, mannerisms, grimacing, echolalia, and echopraxia. Catatonia occurs in several conditions including psychotic, affective and neurodevelopmental disorders such as autism spectrum disorder (ASD). ASD is a neurodevelopmental disorder characterized by persistent deficits in communication, social interaction, restricted interests, repetitive behaviours and sensory sensitivities. Catatonia can occur in response to life stressors such as extreme fear or threat, interpersonal conflict, tragic events or following significant loss. Those with ASD may be particularly vulnerable to the negative impact of stressors and the link between catatonia and ASD is being increasingly recognized. The overlapping features of catatonia and ASD make it difficult to differentiate often resulting in delayed or missed diagnosis. Catatonia in ASD remains a significant clinical challenge; it is difficult to diagnose and can pose debilitating difficulties for those affected. Catatonia is a treatable condition and prompt recognition is vital in securing the best possible outcome. We report a complex and unique case of a 15-year-old boy who presented with severe cognitive and functional decline with a background history of significant bullying and deterioration in his mental state. This case posed a diagnostic conundrum leading to a diagnosis of underlying ASD, anxiety and trauma.
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Affiliation(s)
- Nighat J. Nadeem
- General Adolescent Inpatient Unit, South West London and St George’s Mental Health National Health Service (NHS) Trust, London, United Kingdom
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Merino D, Gérard AO, Lavrut T, Askenazy F, Thümmler S, Montastruc F, Drici MD. Drug-related catatonia in youths: real-world insights from the WHO Safety Database. Eur Child Adolesc Psychiatry 2024; 33:1383-1393. [PMID: 37308606 PMCID: PMC11098911 DOI: 10.1007/s00787-023-02234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
Catatonia is characterized by psychomotor alterations and reduced contact with the environment. Initially linked to schizophrenia, it also occurs in mood disorders or organic conditions. In children, catatonia remains poorly delineated, despite dramatically increasing the risk of premature death. As data on pediatric drug-induced catatonia bears many uncertainties, we aimed to characterize its age-dependent patterns, using real-world data from the WHO safety database (VigiBase®).VigiBase® was queried for all reports of catatonia registered up to December 8th 2022. Reports involving patients <18 years were classified into 3 groups: ≤23 months, 2-11 years, and 12-17 years. Disproportionality analyses relied on the Reporting Odds Ratio (ROR), and the positivity of the lower end of the 95% confidence interval of the Information Component (IC) was required to suspect a signal. Catatonia was evoked in 421 pediatric reports. In infants, vaccines were leading. In children, the main signals involved haloperidol (ROR 104.3; 95% CI 45.6-238.5), ondansetron (ROR 40.5; 95% CI 16.5-99.5), and ciclosporin (ROR 27.4; 95% CI 13.8-54.1). In adolescents, chlorpromazine (ROR 199.1; 95% CI 134.8-294.1), benzatropine (ROR 193; 95% CI 104.1-361.6), and olanzapine (ROR 135.7; 95% CI 104.6-175.9) reached the highest RORs. In infants, catatonia was related to vaccines, it was ascribed to multiple drugs in children, and mainly to psychotropic drugs in adolescents. Less suspected drugs, such as ondansetron, were highlighted. Despite limitations inherent in spontaneous reporting systems, this study supports that a careful anamnesis is warranted to separate catatonia associated with medical conditions from drug-induced catatonia in pediatric patients.
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Affiliation(s)
- Diane Merino
- Department of Psychiatry, University Hospital of Nice, Nice, France
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France
| | - Alexandre O Gérard
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France
| | - Thibaud Lavrut
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France
| | - Florence Askenazy
- Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice, CHU-Lenval Nice, Nice, France
- CoBTek Laboratory, Université Côte d'Azur, 06000, Nice, France
| | - Susanne Thümmler
- Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice, CHU-Lenval Nice, Nice, France
- CoBTek Laboratory, Université Côte d'Azur, 06000, Nice, France
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital, Toulouse, France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital Center of Nice, Nice, France.
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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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13
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Benarous X, Walesa S, Guilé JM, Cravero C, Consoli A, Cohen D, Young H, Labelle R, Lahaye H. A systematic review of the psychometric properties of tools for measuring depression in youths with intellectual disability. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02405-x. [PMID: 38509427 DOI: 10.1007/s00787-024-02405-x] [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: 10/13/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
While youths with intellectual disability (ID) have increased vulnerability for depressive disorders, cognitive problems and combined functional barriers make them less prone to receive adequate treatments. A systematic review of the literature was conducted (PROSPERO Registration number: CRD42022347703) based on several databases from 1980 to 2022 to examine the quality of tools for measuring depression in children and adolescents with ID. The COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) checklist was used to assess several psychometric domains. Twelve studies evaluated the properties of six tools for measuring depression in youths with ID. The Center for Epidemiologic Studies Depression Scale-Intellectual Disability (CESD-ID) was the only scale with at least five domains of psychometric properties assessed to have strong or moderate evidence. Based on the reviewed findings, tools specifically developed for populations with developmental disabilities should be considered first in order to screen depression in youths with ID. Much work is required to confirm their validity in clinical samples with patients with a complex form of developmental disabilities. As a complement to self- and caregivers-report questionnaires, clinician rating scales were considered useful to catch the full picture of depression in youths with ID, in particular associated behavioral expressions. Their validity received little scrutiny and certainly deserve more attention to improve care practice of youths with ID.
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Affiliation(s)
- Xavier Benarous
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France.
| | | | | | - Cora Cravero
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | - Angèle Consoli
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | - David Cohen
- Pitié-Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | | | - Real Labelle
- Université du Québec À Montréal, Montréal, Canada
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14
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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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15
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Ferrafiat V, Wachtel L, Dhossche D, Hauptman A. Catatonia is an outpatient reality. What do we do now? Schizophr Res 2024; 264:233-235. [PMID: 38183961 DOI: 10.1016/j.schres.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/15/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Vladimir Ferrafiat
- Section de Psychiatrie du Développement Mental (SPDM-EMDM), Service des Troubles du Spectre de l'Autisme & apparentés, Département de Psychiatrie, centre hospitalier universitaire vaudois (CHUV), Switzerland; Faculté de biologie et de médecine, UNIL, Université de Lausanne, Switzerland
| | - Lee Wachtel
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Dirk Dhossche
- Inland Northwest Behavioral Health, Spokane, WA, USA
| | - Aaron Hauptman
- Kennedy Krieger Institute, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA.
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Özbaran NB, Kayan E. Catatonia in a 8-year-old child with autism spectrum disorder: Case report. Asian J Psychiatr 2024; 92:103893. [PMID: 38183739 DOI: 10.1016/j.ajp.2023.103893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Nazlı Burcu Özbaran
- Department of Child and Adolescent Psychiatry, Ege University Faculty of Medicine, İzmir, Turkey
| | - Elif Kayan
- Department of Child and Adolescent Psychiatry, Ege University Faculty of Medicine, İzmir, Turkey.
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17
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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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18
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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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19
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Takher AS, Cosme RM. Unmasking the Enigma: A Case Report of Catatonia Unveiled As Munchausen by Proxy. Cureus 2023; 15:e43082. [PMID: 37680395 PMCID: PMC10482309 DOI: 10.7759/cureus.43082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Catatonia is a behavioral syndrome characterized by a variety of symptoms such as mutism, stupor, rigidity, negativism, and verbigeration. It can be caused by various psychiatric and general medical conditions. While the diagnosis in the pediatric population is relatively uncommon, emerging literature supports a higher prevalence of catatonia in children. We present a 12-year-old girl with a complex medical and psychosocial history, including a functional neurological disorder and concerns for child abuse and Munchausen syndrome by proxy imposed by her mother. The patient was initially admitted for medical management of vomiting and refusal to eat. Child psychiatry was consulted for further assessment and noted multiple catatonic symptoms with a Busch-Francis catatonia rating scale (BFCRS) score of 22. A subsequent 1 mg IV lorazepam challenge test showed improvement in the patient's symptoms with a repeat BFCRS score of 10. This case supports emerging literature suggesting a higher prevalence of catatonia in children and the importance of recognizing this syndrome and its wide array of underlying causes.
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Affiliation(s)
- Anoop S Takher
- Child Psychiatry, Rush University Medical Center, Chicago, USA
| | - Rosario M Cosme
- Child Psychiatry, Rush University Medical Center, Chicago, USA
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20
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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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21
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Xiao H, Meng Y, Liu S, Cao Y, Sun H, Deng G, Wang M, Zheng Y, Qiu C. Non-invasive brain stimulation for treating catatonia: a systematic review. Front Psychiatry 2023; 14:1135583. [PMID: 37260758 PMCID: PMC10227525 DOI: 10.3389/fpsyt.2023.1135583] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/12/2023] [Indexed: 06/02/2023] Open
Abstract
Background Non-invasive brain stimulation (NIBS) techniques offer new therapeutic options for modifying pathological neuroplasticity and have been proven to be beneficial in the treatment of neuropsychiatric disorders. Objective This study aimed to investigate the role of NIBS in treating catatonia. Materials and methods We conducted a systematic search to identify meta-analyses or systematic reviews on electroconvulsive therapy (ECT) and studies on the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on patients with catatonia from the PubMed, Web of Science, Embase, China National Knowledge Internet, Wanfang, and China Science and Technology Journal databases from inception until 31 July 2022. The methodological quality of the included studies was assessed with the AMSTAR2 or Joanna Briggs Institute Critical Appraisal tools. Paired t-tests and Wilcoxon signed-rank tests were used to compare changes in catatonia symptom scores after rTMS or tDCS. Results A total of 13 systematic reviews and one meta-analysis on ECT, two systematic reviews and 12 case reports on rTMS, and seven studies of 14 cases applying tDCS were identified. Systematic reviews of ECT consistently described improvement in catatonia symptoms across catatonia types and patient age groups. After treatment with rTMS (t = 4.489, p = 0.006) and tDCS (z = -3.065, p = 0.002), patients exhibited significant improvement. Conclusion ECT, rTMS, and tDCS were effective in treating catatonia. Early intervention with NIBS techniques may help improve catatonia symptoms in patients with schizophrenia. It may be advantageous to use rTMS or tDCS to maintain this improvement. NIBS techniques may thus represent a promising treatment for catatonia, but additional high-quality randomized controlled trials are needed.
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Affiliation(s)
- Hongqi Xiao
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yajing Meng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Shiyu Liu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yuan Cao
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Huan Sun
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Gaoju Deng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Mei Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yaozong Zheng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Changjian Qiu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
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van Balkom ID, Burdeus-Olavarrieta M, Cooke J, de Cuba AG, Turner A. Consensus recommendations on mental health issues in Phelan-McDermid syndrome. Eur J Med Genet 2023; 66:104770. [PMID: 37085014 DOI: 10.1016/j.ejmg.2023.104770] [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: 11/21/2022] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/23/2023]
Abstract
Phelan-McDermid syndrome is a rare genetic condition caused by a deletion encompassing the 22q13.3 region or a pathogenic variant of the gene SHANK3. The clinical presentation is variable, but main characteristics include global developmental delay/intellectual disability (ID), marked speech impairment or delay, along with other features like hypotonia and somatic or psychiatric comorbidities. This publication delineates mental health, developmental and behavioural themes across the lifetime of individuals with PMS as informed by parents/caregivers, experts, and other key professionals involved in PMS care. We put forward several recommendations based on the available literature concerning mental health and behaviour in PMS. Additionally, this article aims to improve our awareness of the importance of considering developmental level of the individual with PMS when assessing mental health and behavioural issues. Understanding how the discrepancy between developmental level and chronological age may impact concerning behaviours offers insight into the meaning of those behaviours and informs care for individuals with PMS, enabling clinicians to address unmet (mental health) care needs and improve quality of life.
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Affiliation(s)
- Ingrid Dc van Balkom
- Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands; Rob Giel Research Centre, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands.
| | - Monica Burdeus-Olavarrieta
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; School of Psychology, Universidad Autónoma, Madrid, Spain
| | - Jennifer Cooke
- Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, United Kingdom
| | - A Graciela de Cuba
- Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Alison Turner
- Phelan-McDermid Syndrome Foundation UK, 99 Highgate W Hill, London, N6 6NR, United Kingdom
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23
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Leslie AC, O’Sullivan M. The Triad of Childhood-Onset Schizophrenia, Autism Spectrum Disorder, and Catatonia: A Case Report. Schizophr Bull 2023; 49:239-243. [PMID: 36719136 PMCID: PMC10016408 DOI: 10.1093/schbul/sbac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Childhood-onset schizophrenia (COS) is a rare and severe form of schizophrenia with an estimated prevalence of 1/10,000. Schizophrenia and Autism spectrum disorder (ASD) have shared phenotypic features and shared genetic etiology. There is growing research surrounding the co-occurrence of psychomotor syndromes like catatonia with neurodevelopmental disorders like ASD or psychiatric disorders like schizophrenia. In 2013, Shorter and Wachtel described a phenomenon of the 'Iron Triangle' where COS, ASD, and catatonia often co-occur. The Iron Triangle theory is based on observation of historical case literature, which showed that all three diagnoses in the Iron Triangle were routinely assigned to children and adolescents. The pattern of this "Iron Triangle" suggests there may be a single underlying pathology resulting in a unique mixed form of catatonia, autism, and psychosis. We describe the case of a boy with sequential development of COS, ASD, and catatonia who also has syndromic facial and musculoskeletal features. This case highlights overlapping diagnostic features of these three disorders and can help us better understand how "hidden" features of catatonia may occur in patients with COS or ASD but go unrecognized, because they are grouped as features under autism/schizophrenia rather than a distinct diagnosis of catatonia. Further study is warranted to elucidate if this phenotypic pattern constitutes a new single diagnosis that is not well understood, an endophenotype of schizophrenia, or if this is the result of phenomenological overlap between catatonia, ASD, and COS.
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Affiliation(s)
- Alison C Leslie
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael O’Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
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24
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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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25
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Valerstain D, Zaydlin M, Bez Y, Coffey BJ. Clonazepam Treatment of Adolescent Catatonia in A Setting of Lorazepam-Related Hypotension. J Child Adolesc Psychopharmacol 2023; 33:34-37. [PMID: 36799960 DOI: 10.1089/cap.2022.29233.bjc] [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: 02/18/2023]
Affiliation(s)
- Dennis Valerstain
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
| | - Michelle Zaydlin
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
| | - Yasin Bez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
| | - Barbara J Coffey
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychiatry, Jackson Health System, Miami, Florida, USA
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26
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Walther S, Weiss F. [Catatonia Through the Ages - from Kahlbaum to the ICD-11]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:52-68. [PMID: 36693365 DOI: 10.1055/a-1942-3995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
For decades, the psychomotor syndrome of catatonia was considered exclusively a subtype of schizophrenia. The use of antipsychotics and changes in the teaching content in the further training of psychiatrists led to the fact that catatonia was hardly recognized anymore. Yet catatonia is in principle well treatable. The new status in ICD-11 will probably allow to better teach, recognize, and treat catatonia in the future.
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27
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Moyal M, Plaze M, Baruchet A, Attali D, Cravero C, Raffin M, Consoli A, Cohen D, Haroche A, Chaumette B. Efficacity of tDCS in catatonic patients with Phelan McDermid syndrome, a case series. Brain Stimul 2022; 15:1432-1434. [PMID: 36309344 DOI: 10.1016/j.brs.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- Mylène Moyal
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014, Paris, France; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR S1266, Paris, France.
| | - Marion Plaze
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014, Paris, France; Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, UMR S1266, Paris, France
| | - Ambre Baruchet
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014, Paris, France
| | - David Attali
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014, Paris, France; Physics for Medicine Paris, INSERM U1273, CNRS UMR 8063, ESPCI Paris, PSL University, F-75012, Paris, France
| | - Cora Cravero
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France; Interdepartmental Mobile Unit for Complex Situations in Autism (UMI 75-92), Elan Retrouvé Foundation, F-75015, Paris, France
| | - Marie Raffin
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France; GRC-15, Dimensional Approach of Child and Adolescent Psychotic Episodes, Faculté de Médecine, Sorbonne Université, Paris, France
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France; GRC-15, Dimensional Approach of Child and Adolescent Psychotic Episodes, Faculté de Médecine, Sorbonne Université, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France; CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne Université, UPMC, Paris, France
| | - Alexandre Haroche
- GHU PARIS Psychiatrie & Neurosciences, Sainte-Anne Hospital, F-75014, 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, UMR S1266, Paris, France; Department of Psychiatry, McGill University, Montreal, Canada
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28
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Andersson P, Wachtel LE, Lundberg J, Jamshidi E, Bring J, Rask-Andersen M, Jarbin H, Jokinen J, Desai Boström AE. Youth with severe mental illness and complex non-somatic motor abnormalities: conflicting conceptualizations and unequal treatment. NPJ MENTAL HEALTH RESEARCH 2022; 1:13. [PMID: 37521496 PMCID: PMC9533273 DOI: 10.1038/s44184-022-00013-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/11/2022] [Indexed: 11/08/2022]
Abstract
Two emerging diagnostic concepts promote distinct treatments for youth with acute-onset motor abnormalities and severe concurrent psychiatric symptoms: Pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric catatonia. Both have institutional approval in parts of Europe and in the USA, meriting an unconditional comparison of supporting evidence. Here we report results of qualitative and quantitative analyses of literature and Swedish National Registry Data suggesting that (1) catatonic patients are liable to fulfilling diagnostic criteria for PANS, (2) three conservatively assessed PANS case-reports present with possible unrecognized catatonia, (3) lithium and electroconvulsive therapy usage frequencies in Swedish minors (exclusively recommended for severe mental illness) are strongly intercorrelated and unequally distributed across Swedish counties, (4) established severe mental disorders are rarely overtly considered amongst PANS-specific research and (5) best-available evidence treatments appear markedly superior for pediatric catatonia compared to PANS in both childhood and adolescence. Prioritizing treatments for pediatric catatonia in concerned subjects could markedly improve treatment outcomes.
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Affiliation(s)
- Peter Andersson
- Department of Clinical Neuroscience/Psychology, Karolinska Institute, Stockholm, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Lee E. Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD USA
| | - Johan Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Esmail Jamshidi
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | | | - Mathias Rask-Andersen
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Håkan Jarbin
- Department of Clinical Sciences Lund, Section of Child and Adolescent Psychiatry, Lund University, Lund, Sweden
- Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
| | - Jussi Jokinen
- Department of Clinical Neuroscience/Psychology, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Adrian E. Desai Boström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
- Department of Women’s and Children’s Health/Neuropediatrics, Karolinska Institutet, Stockholm, Sweden
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29
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Jaimes-Albornoz W, Lee E, Serra-Mestres J, Isetta M, Ferrafiat V. Catatonia in pediatric obsessive-compulsive disorder: report of two cases. Eur Child Adolesc Psychiatry 2022; 31:1645-1648. [PMID: 34091778 DOI: 10.1007/s00787-021-01811-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/21/2021] [Indexed: 12/01/2022]
Abstract
Catatonia is a psychomotor syndrome which may occur in a wide variety of medical, neurological, and psychiatric conditions. In pediatrics, this condition is rare and is associated with high morbidity and mortality if not correctly diagnosed and treated. Catatonia in obsessive-compulsive disorder is an infrequent association that has been understudied and underdiagnosed. To add to the knowledge on this unusual clinical presentation, two pediatric patients are reported and discussed together with the other two cases described in the literature. These four cases in total of catatonia associated with OCD confirm that it is a relationship that is infrequently reported, possibly because of lack of awareness in clinicians that catatonia can also be caused by OCD, and because the similarity between some catatonic signs and some compulsive phenomena may compound the identification of the former. Most cases of catatonia in this small series seemed to have responded to the optimization of the treatment for OCD. This highlights the clinical importance of an accurate diagnosis of catatonia when associated with OCD.
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Affiliation(s)
- Walter Jaimes-Albornoz
- Psychiatry Service, Basque Health Service-Osakidetza, Hospital Universitario Donostia, Dr. Beguiristain 117, 20014, San Sebastian, Gipuzkoa, Spain.
| | - EunJoo Lee
- Child and Adolescent Unit, Southern California Permanente Medical Group, 1511 West Garvey Avenue North, West Covina, CA, 91790, USA
| | - Jordi Serra-Mestres
- Department of Old Age Psychiatry, Central & North West London NHS Foundation Trust, Woodland Centre, Hillingdon Hospital, Uxbridge, UB8 3NN, UK
| | - Marco Isetta
- Library and Knowledge Services, Central & North West London NHS Foundation Trust, St Charles' Hospital, 125 Exmoor Street, London, W10 6DZ, UK
| | - Vladimir Ferrafiat
- Department of Child and Adolescent Psychiatry, Université de Rouen, Hôpital Charles Nicolle, 1 rue de Germont, 76000, Rouen, France
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30
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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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31
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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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32
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Badura Brzoza K, Główczyński P, Błachut M. Paralyzed by Fear?-A Case Report in the Context of Narrative Review on Catatonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10161. [PMID: 36011796 PMCID: PMC9407999 DOI: 10.3390/ijerph191610161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/06/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
In ICD-11, catatonia is a complex syndrome that includes psychomotor disorders (negativity, catalepsy, wax flexibility, mutism, automatism, mannerisms, or echolalia) and volitional processes affect modulation and action planning, which leads to hypofunctional, hyperfunctional, or parafunctional motor action. This is a very important clue that this state can be associated with both mental and somatic diseases. In order to create a narrative review, authors analyzed the diagnostic criteria of ICD-10 and ICD-11 and searched the PubMed medical base for articles on the diagnosis and different approaches to the treatment of catatonia. The treatment of catatonia is not standardized. It is based on the use of benzodiazepines, GABAa receptor antagonists, NMDA receptor antagonists, D2 receptor antagonist, and electroconvulsive therapy (ECT). The authors also would like to present the case of a patient in whom the diagnosis of catatonia was not so clear according to the diagnostic criteria, emphasizing the importance of the key diagnosis for the patient's recovery. The authors would also like to point out that the topic of catatonia should be of interest not only to psychiatrists, but also to doctors of other specialties, who may encounter cases of catatonia complicating somatic states in hospital wards.
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33
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Miller J, Sowar K, Abbott CC, Christie WA, Carubia BA, Geppert C. Crossing State Lines: Ethical and Clinical Considerations in Treating a Child With Catatonia. J Am Acad Child Adolesc Psychiatry 2022; 61:583-585. [PMID: 35181465 DOI: 10.1016/j.jaac.2022.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
Catatonia is a complex constellation of symptoms presenting with abnormalities in movement and behavior and arises from multiple medical, neurologic, and psychiatric conditions. In recent years, there has been a call to move catatonia from a classifier to a diagnosis of its own in the DSM-5.1,2 Catatonia is often underdiagnosed in the hospital and carries with it substantial morbidity and mortality.3 Malignant catatonia, characterized by autonomic instability, hyperactivity, mutism, and stuporous exhaustion, is a medical emergency requiring intensive care.4 Early diagnosis and treatment are imperative, as untreated malignant catatonia may be fatal in up to 10% to 20% of cases, sometimes only days from onset.5 The combination of lorazepam and electroconvulsive therapy (ECT) is a safe and effective treatment for catatonia in both adults and children, although the body of literature pertaining to children remains limited.6,7 In addition, there are multiple case reports of improvement in catatonia with ECT regardless of etiology.8 However, laws in some US states prohibit ECT's use despite evidence of its effectiveness and safety in children and adolescents.9 Here, we describe a case presentation that was both prolonged and complicated by state laws pertaining to the use of ECT in children and adolescents.
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Affiliation(s)
- Jeremy Miller
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora.
| | - Kristina Sowar
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
| | - Christopher C Abbott
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
| | - William A Christie
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
| | - Beau A Carubia
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
| | - Cynthia Geppert
- The University of New Mexico School of Medicine, Albuquerque; The University of Colorado School of Medicine, Aurora
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34
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Neuroleptic Malignant Syndrome in Children with Autism Spectrum Disorder (ASD): A Case Report and Brief Review of Recent Literature. CHILDREN 2021; 8:children8121201. [PMID: 34943397 PMCID: PMC8700593 DOI: 10.3390/children8121201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022]
Abstract
Neuroleptic malignant syndrome (NMS) is a rare, life-threatening, idiosyncratic adverse reaction to antipsychotic drugs. Despite the increasing rates in the prescription of antipsychotics in pediatric patients with autism spectrum disorder (ASD), little is known about the occurrence and hallmarks of NMS in this specific population. NMS appears to be part of the larger catatonia domain, based on the frequent relationship between ASD and catatonia, on the shared, when not overlapping, clinical features with malignant catatonia, and on the effectiveness of catatonia treatments on the NMS/MC symptoms. The intrinsic difficulties of exploring NMS in ASD in controlled studies accounts for the subsequent lack of available information. Based on recent reports and on our case report, clinical features of NMS in the pediatric ASD population appear to be the same as the non-ASD population. Further studies are needed to confirm these results.
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35
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Micaldi SC, Dao CW, Napier DN, Samson J. A Case of Pediatric Catatonia. Kans J Med 2021; 14:261-264. [PMID: 34671444 PMCID: PMC8523101 DOI: 10.17161/kjm.vol14.14985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/06/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Susan Ciccolari Micaldi
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Christopher W Dao
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Dannette N Napier
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Joycy Samson
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine-Wichita, Wichita, KS
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Døssing E, Pagsberg AK. Electroconvulsive Therapy in Children and Adolescents: A Systematic Review of Current Literature and Guidelines. J ECT 2021; 37:158-170. [PMID: 34424874 DOI: 10.1097/yct.0000000000000761] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
ABSTRACT There is a lack of studies regarding the efficacy of electroconvulsive therapy (ECT) in children and adolescents. In this study, we aimed to assess benefits and harms of ECT in children and adolescents with major psychiatric diseases. We conducted a systematic search in PubMed, EMBASE, and PsycINFO for peer-reviewed articles written in English regarding the use of ECT as treatment for major psychiatric diseases in children and adolescents. This study consists of 192 articles, mostly case studies (n = 50), reviews and overview articles (n = 52), and retrospective studies (n = 30). We present an overview of evidence for ECT in children and adolescents with mood disorders, catatonia, schizophrenia, intellectual disability, self-injurious behavior, and other indications. This article is also a summary of international guidelines regarding the use of ECT in children and adolescents. We evaluated the overall quality of evidence by using Grading of Recommendations, Assessment, Development and Evaluations and found the overall level of evidence to be of low quality. There are no absolute contra indications for ECT in children and adolescents. Fears regarding cognitive dysfunction have not been reproduced in studies. Electroconvulsive therapy should be considered in severe, treatment-resistant mood disorders, catatonia, and schizophrenia, especially in older adolescents. High-quality studies are warranted to assess the efficacy of ECT, especially in these potentially life-threatening diseases.
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Affiliation(s)
- Erik Døssing
- From the Child and Adolescent Mental Health Centre, Mental Health Services, Zealand Region, Roskilde
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Pediatric Malignant Catatonia Associated With Vaporized Cannabis Use: A Case Series. J Acad Consult Liaison Psychiatry 2021; 62:445-448. [PMID: 34210403 DOI: 10.1016/j.jaclp.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 11/23/2022]
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Pereira Herrera M, Zimmerman AM. Case of refractory delirious mania responsive to lithium. BJPsych Open 2021; 7:e119. [PMID: 34184627 PMCID: PMC8269925 DOI: 10.1192/bjo.2021.957] [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] [Indexed: 11/23/2022] Open
Abstract
Delirious mania is an uncommon condition that is challenging to diagnose and treat. More often seen in patients with a history of bipolar disorder, it frequently presents with prominent catatonic features and overlaps with other diseases in the catatonic spectrum, such as neuroleptic malignant syndrome, serotonin syndrome and malignant catatonia. We present a case of delirious mania refractory to high doses of lorazepam, several antipsychotics and valproic acid, which responded dramatically to therapy with lithium after 26 days of minimal improvement with the other medications. The pathophysiology of delirious mania is reviewed, and the unique actions of lithium are discussed, highlighting possible reasons as to why lithium might offer advantages in the treatment of this disease.
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Hořínková J, Bartečků E, Kališová L. The Practice of Electroconvulsive Therapy in Children and Adolescents in the Czech Republic. J ECT 2021; 37:112-118. [PMID: 33093400 DOI: 10.1097/yct.0000000000000726] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study was to describe the practice of electroconvulsive therapy (ECT) in child and adolescent patients in the Czech Republic. METHODS We conducted a mail questionnaire survey among Czech facilities associated with the Association of Child and Adolescent Psychiatry, and university hospitals with inpatient psychiatric wards, focused on the practice of ECT between 2013 and 2017 in patients younger than 18 years. RESULTS Of 18 approached facilities, 13 had access to ECT, and only 6 used ECT on 16 patients. The most common diagnosis was schizophrenia or related disorders (68.75% of patients), and the most common reason for ECT was catatonic symptoms (37.5%). The most common ECT methodology was bitemporal electrode placement with brief-pulse current (62.5%). In 2 patients, ECT was terminated because of ineffectiveness and in 1 patient because of adverse reaction. In other patients, ECT ended after achieving a clinical effect. The most common adverse effect was transient memory impairment in a quarter of the patients. The number of pharmacological treatment attempts before ECT significantly correlated with hospitalization length. CONCLUSIONS The utilization of ECT among children and adolescents was low. It was usually used in severe conditions after several pharmacological treatment attempts, which may indicate reluctance among providers to use this modality. A number of pharmacological attempts were associated with longer hospitalizations. In the majority of patients, ECT was effective and safe. On the other hand, the monitoring of cognitive adverse effects was insufficient and could be improved.
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Affiliation(s)
- Jana Hořínková
- From the Department of Psychiatry, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno
| | - Elis Bartečků
- From the Department of Psychiatry, Faculty of Medicine of Masaryk University and University Hospital Brno, Brno
| | - Lucie Kališová
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, Prague, Czech Republic
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Giggie MA. Catatonia in a 10-year-old boy with early childhood neglect and disruptive behaviours in psychiatric residential treatment. BMJ Case Rep 2021; 14:14/2/e239596. [PMID: 33602769 PMCID: PMC7896594 DOI: 10.1136/bcr-2020-239596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Catatonia is a rare medical condition that can be fatal in paediatric patients if left untreated. It is often misdiagnosed or underdiagnosed. There are no published cases of catatonia in traumatised children living in long-term psychiatric care. However, there is some evidence that childhood maltreatment in its variant forms may be a risk for the development of catatonia in children and adolescents. In this case, a 10-year-old boy with intrauterine exposure to alcohol and multiple drugs and early childhood deprivation, developed neuroleptic-induced catatonia in an intensive psychiatric residential treatment centre approximately 24 hours after receiving a first-time intramuscular injection of haloperidol 5 mg for acute agitation. He had no known predisposing factors for catatonia such as psychosis, autism, neurological or general medical problems. This 10-year-old child's early childhood trauma should be considered as a predisposing factor for catatonia.
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Affiliation(s)
- Marisa A Giggie
- Psychiatry and Behavioral Medicine, The University of Alabama at Birmingham School of Medicine Tuscaloosa, Tuscaloosa, Alabama, USA
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41
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Clermont A, Loubriel D, Li E, Mitera D, Samuels S. Electroconvulsive therapy in an adolescent patient with catatonia: a case report. Neurocase 2021; 27:18-21. [PMID: 33297838 DOI: 10.1080/13554794.2020.1859545] [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] [Indexed: 10/22/2022]
Abstract
Catatonia is characterized by motor and behavioral symptoms and can arise in a wide variety of medical and psychiatric conditions. We describe the case of a 16-year-old female with a history of anxiety and depression who presented with prominent symptoms of negativism, initially diagnosed as conversion disorder. She failed to respond to increasing doses of benzodiazepines; after over six weeks of hospitalization, she received electroconvulsive therapy (ECT), resulting in significant remission of symptoms. This case demonstrates the importance of prompt diagnosis and treatment of catatonia in adolescent patients, as well as the safety and efficacy of ECT in this population.Abbreviations: AACAP: American Academy of Child and Adolescent Psychiatry; BPAD: Bipolar affective disorder; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; ECT: Electroconvulsive therapy; NMDA: N-methyl-D-aspartate.
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Affiliation(s)
| | - Daphne Loubriel
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Erin Li
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Darlene Mitera
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Susan Samuels
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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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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Guetta M, Kas A, Aouidad A, Soret M, Allenbach Y, Bordonné M, Oppetit A, Raffin M, Psimaras D, Cohen D, Consoli A. Relevance of Brain 18F-FDG PET Imaging in Probable Seronegative Encephalitis With Catatonia: A Case Report. Front Psychiatry 2021; 12:685711. [PMID: 34177668 PMCID: PMC8219867 DOI: 10.3389/fpsyt.2021.685711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Autoimmune encephalitis (AIE) is a rare, severe, and rapidly progressive encephalopathy, and its diagnosis is challenging, especially in adolescent populations when the presentation is mainly psychiatric. Currently, cerebral 18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) imaging is not included in the diagnosis algorithm. We describe a 16-year-old patient with probable seronegative encephalitis with catatonia for which several cerebral PET scans were relevant and helpful for diagnosis, treatment decision making, and follow-up monitoring. The patient recovered after 2 years of treatment with etiologic treatment of AIE and treatment of catatonia. This case suggests a more systematic assessment of the clinical relevance of 18F-FDG-PET imaging in probable seronegative AIE.
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Affiliation(s)
- Michaël Guetta
- Department of Child and Adolescent Psychiatry, APHP. SU, Pitié-Salpêtrière Hospital, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, APHP. SU, Pitié-Salpêtrière Hospital, LIB, INSERM U1146, Paris, France
| | - Aveline Aouidad
- Department of Child and Adolescent Psychiatry, APHP. SU, Pitié-Salpêtrière Hospital, Paris, France
| | - Marine Soret
- Department of Nuclear Medicine, APHP. SU, Pitié-Salpêtrière Hospital, LIB, INSERM U1146, Paris, France
| | - Yves Allenbach
- Sorbonne-University, Internal Medecine and Clinical Immunlogy Departement, Paris, France
| | - Manon Bordonné
- University of Lorraine, Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy, Nancy, France
| | - Alice Oppetit
- Department of Child and Adolescent Psychiatry, APHP. SU, Pitié-Salpêtrière Hospital, Paris, France
| | - Marie Raffin
- Department of Child and Adolescent Psychiatry, APHP. SU, Pitié-Salpêtrière Hospital, Paris, France
| | - Dimitri Psimaras
- Department of Neurology, APHP. SU, Pitié-Salpêtrière Hospital, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, APHP. SU, Pitié-Salpêtrière Hospital, Paris, France.,CNRS UMR 7222, Institute for Intelligent Systems and Robotics, Sorbonne University, Paris, France.,National Center for Rare Psychiatric Diseases, APHP. SU, Pitié-Salpêtrière Hospital, Paris, France
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, APHP. SU, Pitié-Salpêtrière Hospital, Paris, France.,National Center for Rare Psychiatric Diseases, APHP. SU, Pitié-Salpêtrière Hospital, Paris, France
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44
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Traverso A, Ancora C, Zanato S, Raffagnato A, Gatta M. Diagnostic and Therapeutic Challenges of Catatonia in an Adolescent With High Functioning Autism Spectrum Disorder: A Case Report. Front Psychiatry 2021; 12:644727. [PMID: 34149473 PMCID: PMC8211461 DOI: 10.3389/fpsyt.2021.644727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/04/2021] [Indexed: 12/27/2022] Open
Abstract
Catatonia is a psychomotor syndrome with specific clusters of speech, behavioral and motor features. Although potentially life-threatening, especially in its malignant form accompanied with autonomic dysregulation and medical complications, it is a treatable condition, when promptly identified. For a long time catatonia was considered a marker of schizophrenia, thus limiting the possibility of diagnosis and treatment. Due to growing awareness and studies on the subject, it is now known that catatonia can occur in the context of a number of diseases, including psychotic, affective and neurodevelopmental disorders. In recent years, there's been a renewed interest in the recognition and definition of catatonia in neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD), where the differential diagnosis poses great challenges, given the considerable overlapping of signs and symptoms between the conditions. We present the case of a 15 year old boy with High Functioning ASD with a sudden onset of severe catatonic symptoms and the co-existence of psychotic symptoms, whose complex clinical course raises many questions on the differentiation and relation of said disorders.
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Affiliation(s)
- Annalisa Traverso
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Caterina Ancora
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Silvia Zanato
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Michela Gatta
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
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Ghaziuddin N, Yaqub T, Shamseddeen W, Reddy P, Reynard H, Maixner D. Maintenance Electroconvulsive Therapy Is an Essential Medical Treatment for Patients With Catatonia: A COVID-19 Related Experience. Front Psychiatry 2021; 12:670476. [PMID: 34335326 PMCID: PMC8319714 DOI: 10.3389/fpsyt.2021.670476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/10/2021] [Indexed: 12/02/2022] Open
Abstract
Aim: Describe naturalistic clinical course over 14 weeks in a mixed adolescent and a young-adult patient group diagnosed with developmental delays and catatonia, when the frequency of maintenance electroconvulsive therapy (M-ECT) was reduced secondary to 2020 COVID-19 pandemic restrictions. Methods: Participants were diagnosed with catatonia, and were receiving care in a specialized clinic. They (n = 9), F = 5, and M = 4, ranged in age from 16 to 21 years; ECT frequency was reduced at end of March 2020 due to institutional restrictions. Two parents/caregivers elected to discontinue ECT due to concern for COVID-19 transmission. Majority (n = 8) were developmentally delayed with some degree of intellectual disability (ID). Observable symptoms were rated on a three point scale during virtual visits. Results: All cases experienced clinically significant decline. Worsening of motor symptoms (agitation, aggression, slowness, repetitive self-injury, stereotypies, speech deficits) emerged within the first 3 weeks, persisted over the 14 week observation period and were more frequent than neurovegetative symptoms (appetite, incontinence, sleep). Four participants deteriorated requiring rehospitalization, and 2 among these 4 needed a gastrostomy feeding tube. Conclusion: Moderate and severe symptoms became apparent in all 9 cases during the observation period; medication adjustments were ineffective; resuming M-ECT at each participant's baseline schedule, usually by week 7, resulted in progressive improvement in some cases but the improvement was insufficient to prevent re-hospitalization in 4 cases. In summary, rapid deterioration was noted when M-ECT was acutely reduced in the setting of COVID-19 related restrictions.
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Affiliation(s)
- Neera Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Tareq Yaqub
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | | | - Priyanka Reddy
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Hannah Reynard
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Maixner
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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46
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Mooneyham GC, Ferrafiat V, Stolte E, Fuchs DC, Cohen D. Developing Consensus in the Assessment and Treatment Pathways for Autoimmune Encephalitis in Child and Adolescent Psychiatry. Front Psychiatry 2021; 12:638901. [PMID: 33854451 PMCID: PMC8039450 DOI: 10.3389/fpsyt.2021.638901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/16/2021] [Indexed: 12/17/2022] Open
Abstract
Children with a diagnosis of Autoimmune Encephalitis (AE) frequently require multi-disciplinary care in order to mobilize the assessment and treatment necessary for recovery. Institutional and provider practice differences often influence the diagnostic workup and treatment pathways made available to patients. There are a variety of provider coalitions in pediatric rheumatology, internal medicine, and neurology that have been making meaningful progress toward the development of consensus in assessment and treatment approaches to patient care. However, child psychiatry is currently underrepresented in this work in spite of the high psychiatric symptom burden seen in some young patients. The need for consensus is often made visible only with inter-institutional dialogue regarding patient care trajectories. We aim to review key updates in the assessment and treatment of children and adolescents with autoimmune encephalitis during the acute phase, with or without catatonia, and to outline provider perspectives by comparing current treatment models in the United States, Canada, and Europe.
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Affiliation(s)
- GenaLynne C Mooneyham
- National Institutes of Health, National Institute of Mental Health, Bethesda, MD, United States
| | - Vladimir Ferrafiat
- Child and Adolescent Psychiatric Unit, URHEA, CHSR Sotteville les Rouen, Rouen, France.,Department of Child and Adolescent Psychiatry, CHU Charles Nicolle, Rouen, France
| | - Erin Stolte
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - D Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France.,CNRS UMR 7222, Hôpital Pitié-Salpêtrière, AP-HP, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France
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47
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Ridgeway L, Okoye A, McClelland I, Dhossche D, Kutay D, Loureiro M. Case Report: A Case of Pediatric Catatonia: Role of the Lorazepam Challenge Test. Front Psychiatry 2021; 12:637886. [PMID: 33841207 PMCID: PMC8024572 DOI: 10.3389/fpsyt.2021.637886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/03/2021] [Indexed: 11/30/2022] Open
Abstract
A case of a 12-year-old boy who developed catatonia is presented. He had no previous psychiatric history but has a family history of affective disorder. An extensive medical workup was negative. Despite a negative lorazepam challenge test, lorazepam was titrated up to 24 mg/day, with resolution of most catatonic symptoms. The case highlights an important point in the management of catatonia that may be a source of confusion, i.e., a positive lorazepam challenge test corroborates the diagnosis of catatonia; however, a negative lorazepam challenge test does not negate the diagnosis of catatonia, and subsequent focused benzodiazepine treatment may still be effective.
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Affiliation(s)
- Laura Ridgeway
- Department of Child and Adolescent Psychiatry, University Hospital Waterford, Waterford, Ireland
| | - Albert Okoye
- Department of Child and Adolescent Psychiatry, University Hospital Waterford, Waterford, Ireland
| | - Ian McClelland
- Department of Liaison Psychiatry, Children's University Hospital, Dublin, Ireland
| | - Dirk Dhossche
- Department of Psychiatry and Human Behaviour, University of Mississippi Medical Center, Jackson, MS, United States
| | - Deniz Kutay
- Department of Child and Adolescent Psychiatry, University Hospital Waterford, Waterford, Ireland
| | - Mario Loureiro
- Department of Child and Adolescent Psychiatry, University Hospital Waterford, Waterford, Ireland
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48
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Treatment of a Complex Case of Catatonia and Conversion Features With Electroconvulsive Therapy in a 14-Year-Old Male. Ochsner J 2020; 20:307-310. [PMID: 33071665 PMCID: PMC7529127 DOI: 10.31486/toj.19.0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Pediatric catatonia is a rare and poorly understood phenomenon. The majority of reported cases have a psychiatric etiology. Because of the heterogeneous presentation and treatment issues unique to the pediatric population, identification and management can be challenging. Additionally, few definitive guidelines or practice parameters are available for pediatric patients. The first-line treatment for catatonia is pharmacologic, and when treatment fails or is inadequate, electroconvulsive therapy (ECT) has been shown to be safe and effective. Case Report: A previously healthy, 14-year-old male presented with acute onset of catatonia that resolved at 4 weeks after a short course of ECT with adjunctive lorazepam and risperidone. An interesting feature of this case was the resolution of autonomic symptoms and the emergence of conversion features. The resolution of the catatonia (negativism, mutism, and withdrawal) made it possible for the team to identify a thought disorder and initiate appropriate pharmacologic treatment for the precipitating etiology. Conclusion: ECT was a safe and effective treatment for the resolution of catatonia symptoms in this patient. Conversion and catatonia features may exist on a continuum.
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Geng F, Jiang F, Rakofsky J, Liu T, Liu Y, Liu H, Tang YL. Psychiatric inpatient beds for youths in China: data from a nation-wide survey. BMC Psychiatry 2020; 20:398. [PMID: 32762744 PMCID: PMC7412828 DOI: 10.1186/s12888-020-02802-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/30/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The development of child psychiatric services in China has been slow and very limited resources have been allocated to support its growth. This study set out to investigate the child and adolescent inpatient psychiatric resources currently available in top-tier psychiatric hospitals in China and the characteristics of youth patients hospitalized on an adult unit. METHODS As part of an official national survey, 29 provincial tertiary psychiatric hospitals in China were selected. Data from 1975 inpatients discharged from these hospitals from March 19 to 31, 2019 were retrieved and analyzed. RESULTS The mean number of youth psychiatric beds was 27.7 ± 22.9 in these hospitals and 6/29 hospitals had no youth beds. There were significantly more youth beds in developed regions than in less developed regions (P < 0.05). Most of the discharged youth patients were teenagers with severe mental illnesses, including schizophrenia, depressive disorder and bipolar disorder. 7.5% (149) of the 1975 discharged patients were children or adolescents, however youth beds only accounted for 3.2% (804/25,136) of all psychiatric beds. 45.6% (68) of youth patients were discharged from adult psychiatric units. CONCLUSION Our findings highlight the lack of adequate youth psychiatric inpatient services for children and adolescents living in China, especially in less developed regions. There is an urgent need to build more child and adolescent psychiatric units in provinces where there are none, and to increase the number of beds within the units that exist presently.
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Affiliation(s)
- Feng Geng
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, No.64 Chaohu North Road, Hefei, 238000 Chaohu District China ,Hefei Fourth People’s Hospital, No.316 Huangshan Road, Hefei, 230022 China
| | - Feng Jiang
- grid.506261.60000 0001 0706 7839School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Beijing, 100730 Dongcheng District China ,grid.12527.330000 0001 0662 3178Research Center for Public Health, Tsinghua University, Beijing, 100730 Haidian District China
| | - Jeffrey Rakofsky
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30329 USA
| | - Tingfang Liu
- grid.12527.330000 0001 0662 3178Institute for Hospital Management of Tsinghua University, Beijing, 100730 Haidian District China
| | - Yuanli Liu
- grid.506261.60000 0001 0706 7839School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.3 Dong Dan San Tiao, Beijing, 100730 Dongcheng District China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, No.64 Chaohu North Road, Hefei, 238000, Chaohu District, China.
| | - Yi-lang Tang
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30329 USA ,grid.414026.50000 0004 0419 4084Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA 30033 USA
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Ayrolles A, Ellul P, Renaldo F, Boespflug-Tanguy O, Delorme R, Drunat S, Elmaleh-Bergès M, Kwon T, Rozenberg F, Bondet V, Duffy D, Crow YJ, Melki I. Catatonia in a patient with Aicardi-Goutières syndrome efficiently treated with immunoadsorption. Schizophr Res 2020; 222:484-486. [PMID: 32571621 DOI: 10.1016/j.schres.2020.05.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/31/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Anaël Ayrolles
- Service de psychiatrie de l'enfant et l'adolescent, APHP Robert Debré, Paris, France; Génétique Humaine et Fonctions Cognitives, Institut Pasteur, Paris, France.
| | - Pierre Ellul
- Service de psychiatrie de l'enfant et l'adolescent, APHP Robert Debré, Paris, France
| | - Florence Renaldo
- Service de Neurologie Pédiatrique, Centre de reference leucodystrophies et leucoencephalopathies de cause rare (LEUKOFRANCE), APHP Robert-Debré, Paris, France
| | - Odile Boespflug-Tanguy
- Service de Neurologie Pédiatrique, Centre de reference leucodystrophies et leucoencephalopathies de cause rare (LEUKOFRANCE), APHP Robert-Debré, Paris, France; INSERM UMR 1141 NeuroDiderot, Université de Paris, Paris, France
| | - Richard Delorme
- Service de psychiatrie de l'enfant et l'adolescent, APHP Robert Debré, Paris, France; Génétique Humaine et Fonctions Cognitives, Institut Pasteur, Paris, France
| | - Séverine Drunat
- Service de génétique, APHP Robert Debré, Paris, France; INSERM UMR 1141 NeuroDiderot, Université de Paris, Paris, France
| | | | - Theresa Kwon
- Service de néphrologie pédiatrique, APHP Robert Debré, Paris, France
| | - Flore Rozenberg
- Service de virologie, Université Paris Descartes, Université Sorbonne Paris Cité, APHP Groupe Hospitalier Universitaire Paris Centre, Paris, France
| | - Vincent Bondet
- Immunobiologie des cellules dendritiques, Institut Pasteur, Paris, France; Inserm U1223, Institut Pasteur, Paris, France
| | - Darragh Duffy
- Immunobiologie des cellules dendritiques, Institut Pasteur, Paris, France; Inserm U1223, Institut Pasteur, Paris, France
| | - Yanick J Crow
- Université Paris Descartes, Sorbonne-Paris-Cité, Institut Imagine, Paris, France; Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; INSERM UMR 1163, Laboratoire de Neurogénétique et Neuroinflammation, Paris, France
| | - Isabelle Melki
- INSERM UMR 1163, Laboratoire de Neurogénétique et Neuroinflammation, Paris, France; Service de Pédiatrie Générale, Maladies Infectieuses et Médecine Interne, Centre de référence des rhumatismes inflammatoires et maladies autoimmunes systémiques rares de l'enfant (RAISE), APHP Robert Debré, Paris, France; Service d'Immunologie-Hématologie et Rhumatologie Pédiatriques, APHP Necker-Enfants Malades, Paris, France
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