Kansas Journal of Medicine | 2021
A Case of Pediatric Catatonia
Abstract
INTRODUCTION Karl Ludwig Kahlbaum was the first to describe catatonia in 1868.1 Although it has been described as an adult condition, Kahlbaum observed that the majority of the adults had their first symptoms of catatonia in childhood, and described catatonia as a syndrome of abnormal motor function.2 Catatonic symptoms can be divided into motor (e.g., posturing, catalepsy, waxy flexibility), behavioral (e.g., negativism, mutism), affective (e.g., uncontrollable emotional reactions, withdrawal), and regressive (e.g., enuresis). Pediatric catatonia usually presents acutely, but its onset can be insidious.2 Duration can be brief or chronic for weeks or months. Though schizophrenia was believed, for a long time, to be the major cause of catatonia, the syndrome is now known to occur in a wide range of psychiatric and medical conditions.3 Catatonia in children and adolescents occur most commonly in the context of the schizophrenia spectrum followed by affective disorders. Trauma also plays an important role in the onset of catatonic presentations in youths.2 In addition to psychiatric diagnoses, in more than 20% of cases of pediatric catatonia, an underlying medical condition could be identified.2 Systemic autoimmune disorders, such as systemic lupus erythematosus and autoimmune encephalitis, are the two common classes of autoimmune disorders associated with catatonia. The most common autoimmune encephalitis underlying catatonia are anti-NMDA-receptor (anti-NMDAR) encephalitis and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS).2 Various drugs or toxic compounds can cause catatonia in youths, including steroids, lithium, phencyclidine, and cannabis abuse. Furthermore, catatonia can be associated with metabolic and genetic conditions such as Wilson s disease and porphyria. Regarding treatment, benzodiazepines and, in particular, lorazepam, are the first line treatment for pediatric catatonia.2 At times, dosing in the range of 15 mg daily is necessary for resolution of symptoms. Lorazepam treatment needs to be maintained until the underlying cause of catatonia is found and appropriately treated. Antipsychotic medications, specifically first-generation, worsen catatonia especially in the acute phase.2 However, neuroleptics can be used with caution to treat the underlying psychiatric disorders when catatonia symptoms are stabilized. Electroconvulsive therapy should be considered when catatonia does not respond to benzodiazepine treatment.2