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Luccarelli J, McCoy TH, York T, Baldwin I, Fricchione G, Fuchs C, Smith JR. The effectiveness of the lorazepam challenge test in pediatric catatonia: A multisite retrospective cohort study. Schizophr Res 2024; 270:410-415. [PMID: 38986388 PMCID: PMC11323129 DOI: 10.1016/j.schres.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Catatonia is a neuropsychiatric disorder associated with changes in behavior and affect. In adults, catatonia can respond rapidly to treatment with benzodiazepines as part of the "lorazepam challenge test." The acute effectiveness of benzodiazepine treatment in pediatric catatonia, however, has received less study. This study reports catatonia severity as measured by the Bush Francis Catatonia Rating Scale (BFCRS) in pediatric patients before and after treatment with lorazepam. METHODS Multicenter retrospective cohort study from 1/1/2018 to 6/1/2023 of patients aged 18 and younger with a clinical diagnosis of catatonia and assessment using the BFCRS before and after treatment with lorazepam. RESULTS Among 54 patients, median age was 16, and 26 (48.1 %) were female. Neurodevelopmental disabilities were present in 24 (44.4 %) of patients. Prior to treatment, patients had a mean BFCRS score of 16.6 ± 6.1, which significantly reduced to 9.5 ± 5.3 following treatment with lorazepam (mean paired difference 7.1; t = 9.0, df = 53, p < 0.001), representing a large effect size (Hedges's g = 1.20; 95 % CI: 0.85 to 1.55). No significant association was found between lorazepam dose or route of administration and clinical response, nor were age, sex, study site, the presence of a neurodevelopmental disorder, the presence of hyperactive catatonic features, or the time between treatment and reassessment associated with post-treatment BFCRS. CONCLUSIONS Lorazepam resulted in a rapid improvement in BFCRS score in pediatric patients, with a large effect size. Further research is needed into optimal dosing and route of administration of the lorazepam challenge test in pediatric patients.
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Affiliation(s)
- James Luccarelli
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Thomas H McCoy
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN 37212, USA
| | - Gregory Fricchione
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA; Vanderbilt Kennedy Center, Vanderbilt University, 110 Magnolia Circle, Nashville, TN 37203, USA; Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN 37212, USA
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Kristiansen K, Vernal DL, Hulgaard DR. Expanding the phenotype of NEDAMSS with a psychiatric perspective: analysis of a new case, and a systematic review of the literature. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02522-7. [PMID: 39031186 DOI: 10.1007/s00787-024-02522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
Pathogenic variants in the IRF2BPL gene are associated with neurodevelopmental disorders with varying degrees of regression, loss of speech and epilepsy. The phenotype is also known as Neurodevelopmental Disorder with regression, Abnormal Movements, loss of Speech, and Seizures (NEDAMSS). The motor symptoms of this disorder share significant phenotypical characteristics with catatonia, a severe neuropsychiatric psychomotor syndrome. The objective of this article is to expand the knowledge on the presentation of NEDAMSS with a focus on psychiatric symptoms including catatonia. A systematic review of 32 case presentations of NEDAMSS, and a novel case report of a patient with NEDAMSS, exhibiting multiple psychiatric symptoms, including catatonia are presented. Psychiatric symptoms and disorders including affective disorders, psychotic symptoms, catatonia, and developmental disorders are reported in one third of the reviewed cases. Reported effects of pharmacological treatment on motor symptoms of NEDAMSS are very limited. Our case presents improvement in motor symptoms originally attributed to NEDAMSS, after treatment with Lorazepam following diagnosis with catatonia. Patients with NEDAMSS may present with both neurological and psychiatric symptoms. The clinical presentation of NEDAMSS motor symptoms and catatonia have similarities and thus poses significant challenges to the diagnostic process, with risk of incorrect or delayed treatment. The limited experience and the complex phenotype of NEDAMSS complicates pharmacological treatment and encourages caution, especially with the use of antipsychotic drugs in the presence of possible catatonic symptoms.
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Affiliation(s)
- Kimmie Kristiansen
- Mental Health Services in the Region of Southern Denmark, Child- and Adolescent Psychiatry, Esbjerg, Denmark.
| | - Ditte Lammers Vernal
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ditte Roth Hulgaard
- Mental Health Services in the Region of Southern Denmark, Child- and Adolescent Psychiatry, Esbjerg, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Children and Youth department, Lillebaelt Hospital, Kolding, Danmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Smith JR, Hopkins CE, Xiong J, Luccarelli J, Shultz E, Vandekar S. Use of ECT in Autism Spectrum Disorder and/or Intellectual Disability: A Single Site Retrospective Analysis. J Autism Dev Disord 2024; 54:963-982. [PMID: 36528758 PMCID: PMC10276173 DOI: 10.1007/s10803-022-05868-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Autism spectrum disorder (ASD) and intellectual disability (ID) are heterogenous and prevalent conditions which may occur in isolation or as a co-morbidity. Psychiatric co-morbidity is common with limited treatment options. Preliminary research into electroconvulsive therapy (ECT) for these conditions has been encouraging. Thus, further research in this patient population is warranted. We conducted a 10-year retrospective review of the electronic medical record and identified intellectually capable individuals with ASD (IC-ASD), and those with ASD+ID or ID who received at least three ECT treatments. 32 patients were identified of which 30 (94%) experienced positive clinical response, defined as a clinical global impression-improvement (CGI-I) score of 3 or less. The average retrospective CGI-I score across all groups was 1.97, and results of a t-test performed on CGI-I scores indicated improvement across all groups [t = - 16.54, df = 31, p < 0.001, 95% CI = (1.72, 2.22)]. No significant adverse events were identified based on clinical documentation. Our findings further support previous ECT research in this patient 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, 1500 21st Avenue South, Suite 2200, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, Vanderbilt University, 110 Magnolia Circle, Nashville, TN, 37203, USA.
| | - Corey E Hopkins
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN, 37212, USA
| | - Jiangmei Xiong
- Department of Biostatistics, Vanderbilt University, 2424 West End Avenue, Suite 1100, Nashville, TN, 37203, 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
| | - Elizabeth Shultz
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN, 37212, USA
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University, 2424 West End Avenue, Suite 1100, Nashville, TN, 37203, USA
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Karl S, Sartorius A, Aksay SS. Catatonia and ECT across the lifespan. Schizophr Res 2024; 263:246-251. [PMID: 37087393 DOI: 10.1016/j.schres.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/10/2023] [Accepted: 04/12/2023] [Indexed: 04/24/2023]
Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment for catatonia with high response rates. Although empirical data suggest that tolerability and efficacy are at least as good as in adults, ECT treatment of children, adolescents, and geriatric patients seems to pose a specific challenge for many practitioners. This article intends to explore and discuss reasons hindering the use of ECT in these patient groups, give an overview on the use of ECT to treat catatonia and provide practical advice on ECT in children, adolescents, and geriatric patients for the treatment of catatonia. Classification of catatonia as a subform of schizophrenia and a diagnostic overlap with other common conditions in children, adolescents, and geriatric patients might lead to underdiagnosis of catatonia. Concerns about the mechanism of action and about a lack of controlled studies as well as general concerns about the use of ECT in children and adolescents might lead to underutilization of ECT. However, studies of ECT to treat catatonia in children, adolescents, and geriatric patients consistently show its safety and effectiveness. Administration of ECT needs to consider some specific characteristics of children, adolescents, and geriatric patients. In conclusion, ECT is a safe and highly effective treatment for catatonia across the lifespan. Existing evidence does not warrant restrictions of its use in certain age groups.
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Affiliation(s)
- Sebastian Karl
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany.
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Suna Su Aksay
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
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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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Palffy A, Ghaziuddin N. Letter to the Editor regarding "Unexplained regression in Down syndrome: Management of 51 patients in an international patient database" by Santoro et al. Am J Med Genet A 2023; 191:1474-1475. [PMID: 36598151 DOI: 10.1002/ajmg.a.63117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Alexander Palffy
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Neera Ghaziuddin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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Smith JR, York T, Warn S, Borodge D, Pierce DL, Fuchs DC. Another Option for Aggression and Self-Injury, Alternative Benzodiazepines for Catatonia in Profound Autism. J Child Adolesc Psychopharmacol 2023; 33:109-117. [PMID: 37023406 DOI: 10.1089/cap.2022.0067] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Introduction: Individuals with profound autism often present for inpatient care due to aggression. Diagnostic and treatment options are limited. Agitated catatonia is a treatable comorbidity in autism, which should be considered in cases of aggression. Preliminary data report high clinical response rates of catatonia in autism when treated with electroconvulsive therapy (ECT), with poor response to lorazepam. However, access to ECT is often limited, especially in pediatric populations. Methods: We conducted a retrospective chart review to identify cases of hyperactive catatonia with partial response to lorazepam in profoundly autistic children presenting to the pediatric medical hospital. Five cases were identified, all of whom were followed by the child and adolescent psychiatry consult-liaison service during admission and treated without the use of ECT. Data from the medical record were obtained after institutional review board (IRB) approval including the following: (1) treatment course, (2) Bush-Francis Catatonia Rating Scale (BFCRS) scores, and (3) Kanner Catatonia Rating Scale (KCRS) severity scores. The Clinical Global Impressions-Improvement (CGI-I) Scale was applied retrospectively to each case. Results: All five patients demonstrated clinically significant improvements. The average CGI-I score was 1.2. The average percentage reduction in the BFCRS and KCRS severity scores was 63% and 59%, respectively. Two of five patients were first stabilized with infusions midazolam and dexmedetomidine due to the symptom severity and then transitioned to long-acting oral benzodiazepines. Overall, four of five patients were stabilized with oral clonazepam and one of five with oral diazepam. Notably, four of five patients experienced an acute worsening of aggression, self-injury, and other catatonic symptoms with escalating dosages of antipsychotic treatment, which occurred before inpatient admission. All patients experienced resolution of physical aggression toward self and/or others, experienced improvement in their communicative abilities, and were able to return home or enter residential level of care upon discharge. Conclusions: Given the limited availability of ECT and the unclear utility of lorazepam for hyperactive catatonia in autism, the use of long-acting benzodiazepines and/or midazolam infusion may offer a safe and readily available treatment alternative.
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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, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Nashville, Tennessee, USA
| | - Tasia York
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samuel Warn
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Darara Borodge
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Donald L Pierce
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - D Catherine Fuchs
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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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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Karl S, Schönfeldt-Lecuona C, Hirjak D, Sartorius A. [Acute catatonia]. DER NERVENARZT 2023; 94:106-112. [PMID: 36416934 DOI: 10.1007/s00115-022-01407-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Catatonia is an underdiagnosed psychomotor syndrome that can occur in the context of various mental and somatic diseases. Malignant catatonia is particularly relevant in the context of intensive medical care. Clear recommendations in guidelines are missing. OBJECTIVE To present the current state of the diagnosis and treatment of catatonia, especially malignant catatonia. MATERIAL AND METHODS The literature was evaluated with respect to acute catatonic conditions, with a special focus on the differential diagnosis, relevance to intensive medical care and treatment of catatonia. RESULTS In psychiatric inpatients, catatonic syndromes are relatively frequent with a prevalence between 9% and 17%, and in neurological patients somewhat less frequent with a prevalence of 3.3%. There is a clear recommendation for pharmacological treatment with lorazepam. Additional electroconvulsive therapy (ECT) should be considered as early as possible, especially in cases not responding to benzodiazepines. Response rates to ECT have been shown to be 80-100%. In malignant catatonia, ECT should be performed immediately as an emergency indication. CONCLUSION Several factors lead to the underdiagnosis of catatonia. It is problematic that even life-threatening malignant catatonia is often not recognized as such, although there is a mortality of about 50% if untreated. The best treatment outcome is achieved with a combination of benzodiazepines and ECT. The treatment of severe malignant catatonia represents an emergency indication for ECT.
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Affiliation(s)
- Sebastian Karl
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.
| | | | - Dusan Hirjak
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Alexander Sartorius
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
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Goodman D, Pletch A, Paul P, Anderson E, Kverno K. Nonsuicidal Self-Injury: A Nurse-Led Quality Improvement Project to Address Self-Harm. J Psychosoc Nurs Ment Health Serv 2022; 60:7-10. [PMID: 35244492 DOI: 10.3928/02793695-20220208-02] [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: 11/20/2022]
Abstract
Nonsuicidal self-injury (NSSI) behaviors, such as cutting, scratching, or more severe injuries, are frequently comorbid with neurodevelopmental, intellectual, trauma, personality, and major depressive disorders, complicating treatment and placing added care burdens on hospital nursing staff and advanced practice nurses. Although specific psychopharmacological treatment guidelines and approved medications for NSSI are non-existent, patients are treated with medications approved for co-morbid disorders and behavioral interventions targeting intrapersonal (poor emotional self-regulation) and interpersonal (communication of distress) functions. The current article describes a nurse-led quality improvement project, using the Plan-Do-Study-Act cycle, in a case example. Outcomes include improved staff competencies and policies, yet we remain challenged in implementing planned actions that add additional time burdens to already stretched care providers. [Journal of Psychosocial Nursing and Mental Health Services, 60(3), 7-10.].
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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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12
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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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Abstract
The mechanism of action of electroconvulsive therapy (ECT) is not fully elucidated, with prevailing theories ranging from neuroendocrinological to neuroplasticity effects of ECT or epileptiform brain plasticity. Youth with autism can present with catatonia. ECT is a treatment that can safely and rapidly resolve catatonia in autism and should be considered promptly. The literature available for ECT use in youth with autism is consistently growing. Under-recognition of the catatonic syndrome and delayed diagnosis and implementation of the anticatatonic treatment paradigms, including ECT, as well as stigma and lack of knowledge of ECT remain clinical stumbling blocks.
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Affiliation(s)
- Sa Eun Park
- Kennedy Krieger Institute, 1741 Ashland Avenue, Baltimore, MD 21205, USA.
| | - Marco Grados
- Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Lee Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, 707 North Broadway Street, Baltimore, MD 21209, USA
| | - Sanjay Kaji
- Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA
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14
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Electroconvulsive Therapy for Catatonia with mTOR Mutation. J Autism Dev Disord 2021; 51:3782-3783. [PMID: 33394247 DOI: 10.1007/s10803-020-04815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
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15
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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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16
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Abstract
Catatonia was buried within the confines of schizophrenia for over a century- deterring study, appropriate diagnosis and treatment for many years. With revised changes in the classification of this distinct neuropsychiatric syndrome, it is becoming more recognized clinically and in ongoing research. Catatonia occurs among various psychiatric, metabolic or neurologic conditions. It may present in many forms, including neuroleptic malignant syndrome. Treatment with benzodiazepines or electroconvulsive therapy usually produces dramatic and rapid response, although systematic, randomized trials are lacking. The role of antipsychotic agents in treatment is controversial as they may worsen the syndrome. An important unresolved clinical question is the diagnosis and treatment of catatonia in the setting of delirium.
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Affiliation(s)
- Charles Mormando
- Department of Psychiatry, Penn State Medical School, Hershey, PA, USA
| | - Andrew Francis
- Department of Psychiatry, Penn State Medical School, Hershey, PA, USA
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17
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Abstract
The mechanism of action of electroconvulsive therapy (ECT) is not fully elucidated, with prevailing theories ranging from neuroendocrinological to neuroplasticity effects of ECT or epileptiform brain plasticity. Youth with autism can present with catatonia. ECT is a treatment that can safely and rapidly resolve catatonia in autism and should be considered promptly. The literature available for ECT use in youth with autism is consistently growing. Under-recognition of the catatonic syndrome and delayed diagnosis and implementation of the anticatatonic treatment paradigms, including ECT, as well as stigma and lack of knowledge of ECT remain clinical stumbling blocks.
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Affiliation(s)
- Sa Eun Park
- Kennedy Krieger Institute, 1741 Ashland Avenue, Baltimore, MD 21205, USA.
| | - Marco Grados
- Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Lee Wachtel
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, 707 North Broadway Street, Baltimore, MD 21209, USA
| | - Sanjay Kaji
- Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA
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18
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Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT). Acta Psychiatr Scand 2020; 141:304-315. [PMID: 31774547 DOI: 10.1111/acps.13134] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To familiarize the reader with the role of electroconvulsive therapy (ECT) in current psychiatric medicine. METHOD We review clinical indications for ECT, patient selection, contemporary ECT practice, maintenance treatment and ECT in major treatment guidelines. RESULTS ECT is underutilized largely due to persisting stigma and lack of knowledge about modern ECT technique. CONCLUSION ECT remains a vital treatment for patients with severe mood disorders, psychotic illness and catatonia.
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Affiliation(s)
- C H Kellner
- New York Community Hospital, Brooklyn, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center, KU Leuven (Catholic University of Leuven), Kortenberg, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center, KU Leuven (Catholic University of Leuven), Kortenberg, Belgium
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González-Romero MF, Avina-Galindo AM, Elbe D, Friedlander R, Vila-Rodriguez F. Lifesaving Electroconvulsive Therapy for a Child With Autism Spectrum Disorder, Severe Self-Injurious Behavior, and Neuroleptic Malignant Syndrome. J ECT 2019; 35:e55-e56. [PMID: 31764456 DOI: 10.1097/yct.0000000000000598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of a preteen with autism spectrum disorder and severe self-injurious behavior who developed neuroleptic malignant syndrome on antipsychotics and required urgent electroconvulsive therapy and continued maintenance electroconvulsive therapy for ongoing clinical stability.
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Affiliation(s)
| | | | - Dean Elbe
- Department of Psychiatry, University of British Columbia
- Child and Adolescent Mental Health Programs, BC Children's Hospital
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia
| | - Robin Friedlander
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia
| | - Fidel Vila-Rodriguez
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Machado AF, de Marigny LR, Schlittler LX. Satisfactory response to electroconvulsive therapy in an autistic patient with severe self-injurious behavior. REVISTA BRASILEIRA DE PSIQUIATRIA 2019; 41:458-459. [PMID: 31644779 PMCID: PMC6796821 DOI: 10.1590/1516-4446-2019-0534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/01/2019] [Indexed: 11/21/2022]
Affiliation(s)
- Ana F Machado
- Departamento de Psicologia Médica e Psiquiatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Loran R de Marigny
- Departamento de Psicologia Médica e Psiquiatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Leandro X Schlittler
- Departamento de Psicologia Médica e Psiquiatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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21
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Wachtel LE. The multiple faces of catatonia in autism spectrum disorders: descriptive clinical experience of 22 patients over 12 years. Eur Child Adolesc Psychiatry 2019; 28:471-480. [PMID: 30069655 DOI: 10.1007/s00787-018-1210-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/24/2018] [Indexed: 01/25/2023]
Abstract
A retrospective review was conducted from the inpatient and outpatient records of twenty-two autistic youth presenting to a neurobehavioral service over a twelve-year period for combined psychiatric and behavioral pathology who also met DSM5 criteria for catatonia. Six autistic girls and 16 autistic boys ranging from ages eight to 26 years old were identified, and their variegated symptoms evaluated. Stereotypy, posturing, negativism, mutism and stupor were the most common catatonic symptoms, each present in more than half of the study patients. One patient had abnormal vital signs indicative of malignant catatonia. Twenty patients had concomitant repetitive self-injurious behaviors that had led to significant tissue injury and were refractory to psychotropic and behavioral interventions. The sample was weighted towards patients with severe self-injurious behavior, which often was the reason for admission. The many "faces" of catatonia in autism spectrum disorders are seen in this sample, and the novel recognition of repetitive self-injury as an under-recognized motor symptom of catatonia is highlighted. The preliminary findings in this study open many important future vistas for ongoing research regarding catatonia in ASDs.
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22
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Kakko K, Bjelogrlic-Laakso N, Pihlakoski L, Lehtimäki K, Järventausta K. Tardive Dyskinesia Should Not Be Overlooked. J Child Adolesc Psychopharmacol 2019; 29:72-74. [PMID: 30388034 DOI: 10.1089/cap.2018.0084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kirsi Kakko
- 1 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,2 Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland
| | | | - Leena Pihlakoski
- 2 Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Kai Lehtimäki
- 4 Department of Neurosciences, Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Kaija Järventausta
- 1 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,5 Department of Psychiatry, Tampere University Hospital, Tampere, Finland
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Sartorius A, Demirakca T, Böhringer A, Clemm von Hohenberg C, Aksay SS, Bumb JM, Kranaster L, Nickl-Jockschat T, Grözinger M, Thomann PA, Wolf RC, Zwanzger P, Dannlowski U, Redlich R, Zavorotnyy M, Zöllner R, Methfessel I, Besse M, Zilles D, Ende G. Electroconvulsive therapy induced gray matter increase is not necessarily correlated with clinical data in depressed patients. Brain Stimul 2018; 12:335-343. [PMID: 30554869 DOI: 10.1016/j.brs.2018.11.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/08/2018] [Accepted: 11/29/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) and depression have been associated with brain volume changes, especially in the hippocampus and the amygdala. METHODS In this retrospective study we collected data from individual pre-post ECT whole brain magnetic resonance imaging scans of depressed patients from six German university hospitals. Gray matter volume (GMV) changes were quantified via voxel-based morphometry in a total sample of 92 patients with major depressive episodes (MDE). Additionally, 43 healthy controls were scanned twice within a similar time interval. RESULTS Most prominently longitudinal GMV increases occurred in temporal lobe regions. Within specific region of interests we detected significant increases of GMV in the hippocampus and the amygdala. These results were more pronounced in the right hemisphere. Decreases in GMV were not observed. GMV changes did not correlate with psychopathology, age, gender or number of ECT sessions. We ruled out white matter reductions as a possible indirect cause of the detected GMV increase. CONCLUSION The present findings support the notion of hippocampus and amygdala modulation following an acute ECT series in patients with MDE. These results corroborate the hypothesis that ECT enables primarily unspecific and regionally dependent neuroplasticity effects to the brain.
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Affiliation(s)
- Alexander Sartorius
- Research Group Translational Imaging, Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany.
| | - Traute Demirakca
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Andreas Böhringer
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Christian Clemm von Hohenberg
- Research Group Translational Imaging, Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany; Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Suna Su Aksay
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Jan Malte Bumb
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany; Department of Psychiatry, Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael Grözinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Philipp A Thomann
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany; Center for Mental Health, Odenwald District Healthcare Center, Uniklinik RWTH, Aachen, Germany
| | - Robert Christian Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Peter Zwanzger
- kbo-Inn-Salzach-Hospital, Gabersee 7, 83512, Wasserburg am Inn, Germany; Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University of Munich, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Germany
| | - Ronny Redlich
- Department of Psychiatry and Psychotherapy, Albert-Schweitzer-Campus 1, University of Muenster, Germany
| | - Maxim Zavorotnyy
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany; Marburg Center for Mind, Brain and Behavior - MCMBB, University of Marburg, Germany
| | - Rebecca Zöllner
- Department of Psychiatry and Psychotherapy, University of Marburg, Germany
| | - Isabel Methfessel
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Matthias Besse
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - David Zilles
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
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Controversies and clarifications in the classification of disorders of intellectual development, new genetic findings, epilepsy, bullying, and innovative developmental neuropsychiatric treatments (deep-brain stimulation, electroconvulsive therapy, and oxytocin). Curr Opin Psychiatry 2018; 31:75-78. [PMID: 29278530 DOI: 10.1097/yco.0000000000000398] [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: 11/26/2022]
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