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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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Saidinejad M, Foster AA, Santillanes G, Li J, Wallin D, Barata IA, Joseph M, Rose E, Cheng T, Waseem M, Berg K, Hooley G, Ruttan T, Shahid S, Lam SHF, Amanullah S, Lin S, Heniff MS, Brown K, Gausche‐Hill M. Strategies for optimal management of pediatric acute agitation in emergency settings. J Am Coll Emerg Physicians Open 2024; 5:e13255. [PMID: 39183940 PMCID: PMC11342465 DOI: 10.1002/emp2.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/11/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
Acute agitation in youth is a challenging presentation to the emergency department. In many cases, however, youth can be behaviorally de-escalated using a combination of environmental modification and verbal de-escalation. In cases where additional strategies such as pharmacologic de-escalation or physical restraint are needed, using the least restrictive means possible, including the youth in the decision-making process, and providing options are important. This paper reviews specific considerations on the approach to a youth with acute agitation and strategies and techniques to successfully de-escalate agitated youth who pose a danger to themselves and/or others.
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Affiliation(s)
- Mohsen Saidinejad
- David Geffen School of Medicine at UCLAThe Lundquist Institute for Biomedical Innovation at Harbor UCLADepartment of Emergency Medicine, Harbor UCLA Medical CenterTorranceCaliforniaUSA
| | - Ashley A. Foster
- Department of Emergency MedicineBenioff Children's HospitalUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Genevieve Santillanes
- Department of PediatricsLos Angeles General Medical CenterKeck School of Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Joyce Li
- Department of PediatricsBoston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Dina Wallin
- Department of Emergency MedicineBenioff Children's HospitalUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Isabel A. Barata
- Departments of Emergency Medicine and PediatricsDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellManhassetNew YorkUSA
| | - Madeline Joseph
- Department of Emergency MedicineUniversity of Florida, College of MedicineJacksonvilleFloridaUSA
| | - Emily Rose
- Department of Emergency MedicineLos Angeles General Medical CenterKeck School of Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Tabitha Cheng
- David Geffen School of Medicine at UCLAThe Lundquist Institute for Biomedical Innovation at Harbor UCLADepartment of Emergency Medicine, Harbor UCLA Medical CenterTorranceCaliforniaUSA
| | - Muhammad Waseem
- Department of PediatricsLincoln Medical CenterBronxNew YorkUSA
| | - Kathleen Berg
- Department of PediatricsUniversity of Texas at Austin—Dell Medical SchoolAustinTexasUSA
| | - Gwendolyn Hooley
- Department of Emergency MedicineChildren's Hospital, Keck School of Medicine at University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Timothy Ruttan
- Department of PediatricsUniversity of Texas at Austin—Dell Medical SchoolAustinTexasUSA
- US Acute Care SolutionsCantonOhioUSA
| | - Sam Shahid
- American College of Emergency PhysiciansIrvingTexasUSA
| | - Samuel H. F. Lam
- Department of PediatricsChildren's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Siraj Amanullah
- Department of Emergency MedicineBrown University School of MedicineProvidenceRhode IslandUSA
| | - Sophia Lin
- Department of Emergency MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Melanie S. Heniff
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Kathleen Brown
- Department of PediatricsGeorge Washington University School of MedicineWashingtonDistrict of ColumbiaUSA
| | - Marianne Gausche‐Hill
- David Geffen School of Medicine at UCLAThe Lundquist Institute for Biomedical Innovation at Harbor UCLADepartment of Emergency Medicine, Harbor UCLA Medical CenterTorranceCaliforniaUSA
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Cozzi G, Zago A, Poropat F, Rabach I, Barbi E, Amaddeo A. Continuous Infusion of Dexmedetomidine for Maintenance of Sedation in an Aggressive Adolescent with Autism Spectrum Disorder in the Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2024; 11:833. [PMID: 39062282 PMCID: PMC11276318 DOI: 10.3390/children11070833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/29/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND The treatment of aggressive behavior and agitation in pediatric patients with autism spectrum disorder (ASD) in the emergency department is topical and challenging. CASE PRESENTATION We described an adolescent with autism spectrum disorder treated ten times in the pediatric emergency department for severe episodes of aggressiveness and agitation. After resolving the acute phase of these behavioural crises, sedation was maintained with a continuous infusion of dexmedetomidine to prevent the resurgence of agitation and to organize discharge properly, considering the family's needs. The continuous infusion of dexmedetomidine allowed the patient to remain asleep most of the time during his stay at the emergency department. No adverse events were recorded. CONCLUSIONS The continuous infusion of dexmedetomidine could represent a safe and valuable tool to facilitate the permanence of the patient in the PED.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
| | - Alessandro Zago
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Federico Poropat
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
| | - Ingrid Rabach
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
| | - Egidio Barbi
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
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Smolko NA, Valiev RI, Kabdesh IM, Fayzullina RA, Mukhamedshina YO. Eating disorder in children: Impact on quality of life, with a spotlight on autism spectrum disorder. Nutr Res 2024; 123:38-52. [PMID: 38241984 DOI: 10.1016/j.nutres.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
Eating behavior, which includes eating habits and preferences, frequency of eating, and other features related to diet, is a major characteristic not only of a person's nutritional status, but also of health in general. In recent years, the prevalence of eating disorders in children has tended to increase; they also require cross-system approaches in diagnosis by a variety of specialists and correction requires appropriate selection of optimal methods. Maladaptive eating attitudes formed at an early age can contribute to the formation of eating disorders, which can lead to or worsen various neuropsychiatric diseases, digestive diseases, and other related conditions. In children with autism spectrum disorder (ASD), eating disorders often appear earlier than other major symptoms of the condition. However, the clinical manifestations of eating disorders in children with ASD are varied and differ in severity and duration, whereas these disorders in neurotypical children might present as short-lived and may not lead to serious consequences. Nevertheless, cases of progressive eating disorders accompanied by a child presenting as under- or overweight and/or with macronutrient and micronutrient deficiencies cannot be excluded. Given the high prevalence of eating disorders in children, many researchers have highlighted the lack of a valid and universally accepted instruments to assess atypical eating behaviors in this population. Therefore, in this review, we wanted to highlight the problems and causes of eating disorders in children, and also to analyze the existing approaches to the validation of these problems, taking into account the existing behavioral features in children with ASD.
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Affiliation(s)
- Natalia A Smolko
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Department of Propaedeutics of Pediatric Diseases and Faculty Pediatrics, Kazan State Medical University, Kazan, Russia
| | - Rushan I Valiev
- Department of General Hygiene, Kazan State Medical University, Kazan, Russia
| | - Ilyas M Kabdesh
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.
| | - Rezeda A Fayzullina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Department of Propaedeutics of Pediatric Diseases and Faculty Pediatrics, Kazan State Medical University, Kazan, Russia
| | - Yana O Mukhamedshina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Department of Histology, Cytology and Embryology, Kazan State Medical University, Kazan, Russia
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Abstract
ABSTRACT The emergency department can be a particularly challenging environment for the care of pediatric patients presenting with acute agitation. Agitation is a behavioral emergency requiring prompt intervention. Timely recognition of agitation and proactive implementation of de-escalation strategies are critical for safe and effective management of agitation, as well as prevention of recurrent episodes. This article reviews the definition of agitation, explores the domains of verbal de-escalation, and considers multidisciplinary management strategies for children with acute agitation.
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Affiliation(s)
| | - Carl R Baum
- Professor, Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, CT
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Foster AA, Saidinejad M, Duffy S, Hoffmann JA, Goodman R, Monuteaux MC, Li J. Pediatric Agitation in the Emergency Department: A Survey of Pediatric Emergency Care Coordinators. Acad Pediatr 2023; 23:988-992. [PMID: 36948291 DOI: 10.1016/j.acap.2023.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Acute agitation episodes in the emergency department (ED) can be distressing for patients, families, and staff and may lead to injuries. We aim to understand availability of ED resources to care for children with acute agitation, perceived staff confidence with agitation management, barriers to use of de-escalation techniques, and desired resources to enhance care. METHODS We conducted a survey of pediatric emergency care coordinators (PECCs) in EDs in Massachusetts, Rhode Island, and Los Angeles County, California. RESULTS PECCs from 63 of 102 (61.8%) EDs responded. PECCs reported that ED staff feel least confident managing agitation due to developmental delay (DD) or autism spectrum disorder (ASD) (52.4%). Few EDs had a separate space to care for children with mental health conditions (22.5%), a standardized agitation scale (9.6%), an agitation management guideline (12.9%), or agitation management training (24.2%). Modification of the environment was not perceived possible for 42% of EDs. Participants reported that a barrier to the use of the de-escalation techniques distraction and verbal de-escalation was perceived lack of effectiveness (22.6% and 22.6%, respectively). Desired resources to manage agitation included guidelines for medications (82.5%) and sample care pathways (57.1%). CONCLUSIONS ED PECCs report low confidence in managing agitation due to DD or ASD and limited pediatric resources to address acute agitation. Additional pediatric-specific resources and training, especially for children with DD or ASD, are needed to increase clinician confidence in agitation management and to promote high-quality, patient-centered care. Training programs can focus on the early identification of agitation and the effective use of non-invasive de-escalation strategies.
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Affiliation(s)
- Ashley A Foster
- Department of Emergency Medicine (AA Foster), University of California San Francisco, Calif.
| | - Mohsen Saidinejad
- The Lundquist Institute for Biomedical Innovation at Harbor UCLA (M Saidinejad and R Goodman), Torrance, Calif; David Geffen School of Medicine at UCLA (M Saidinejad), Los Angeles, Calif; Department of Emergency Medicine (M Saidinejad), Harbor UCLA Medical Center, Torrance, Calif.
| | - Susan Duffy
- Department of Emergency Medicine (S Duffy), The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
| | - Jennifer A Hoffmann
- Division of Emergency Medicine (JA Hoffmann), Ann & Robert H. Lurie Children...s Hospital of Chicago, Ill; Feinberg School of Medicine (JA Hoffmann), Northwestern University, Chicago, Ill.
| | - Robin Goodman
- The Lundquist Institute for Biomedical Innovation at Harbor UCLA (M Saidinejad and R Goodman), Torrance, Calif.
| | - Michael C Monuteaux
- Division of Emergency Medicine (MC Monuteaux and J Li), Boston Children...s Hospital, Mass.
| | - Joyce Li
- Division of Emergency Medicine (MC Monuteaux and J Li), Boston Children...s Hospital, Mass; Department of Emergency Medicine (J Li), Harvard Medical School, Boston, Mass; Department of Pediatrics (J Li), Harvard Medical School, Boston, Mass.
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