Catatonia in children and adolescents: New perspectives
Introduction
While catatonia has been described as an adult condition, catatonic symptoms have been reported in children or adolescents since the nineteenth century. In a series of 26 adults with catatonia, Kahlbaum noted that the majority had their first symptoms in childhood (Kahlbaum, 1874). Raecke (1909), who presented the first clinical series in youths (n = 10), observed that the presentation was comparable between children and adults. The first attempt to separate catatonia from other mental conditions in children was made by Karl Leonhard (1979), who listed the differences between “infant catatonia”, autism and the “state of feeblemindedness” (Leonhard, 1979).
Leonhard's research on youths with neuro-developmental disorders helped distinguish catatonia from motor dysfunctions associated with autism (Ohta et al., 2006, Wachtel and Dhossche, 2010, Wing and Shah, 2000). In the same vein, the observations made by Cohen et al. (1999) and Dhossche et al. (2006) in cohorts of inpatient youths promoted a syndromic view of the condition. This perspective, which has progressively been internationally endorsed (American Psychiatric Association, 2000, American Psychiatric Association, 2013), has also contributed to the acceleration of evidence-based research development and helped in the recognition of catatonia in children and adolescents.
In this article, we provide a review on catatonia in children and adolescents. Section 3 presents the epidemiology and the phenomenology of the syndrome, including the differential diagnoses. Section 4 summarizes the etiological factors and disorders associated with catatonia in children and adolescents. Section 5 attempts to propose a comprehensive model for catatonia. Finally, Section 6 provides an overview of therapeutic approaches.
Section snippets
Methods
The systematic review was conducted following the recommendations outlined in the PRISMA guide (Moher et al., 2009). To take into account relevant papers that were written in English, MEDLINE databases between 1982 and 2017 were searched using key terms that included ‘CATATONIA’ and ‘CHILD’ or ‘ADOLESCENT’ in addition to manual searches. Titles and abstracts were scanned for relevance. Full texts were ordered in case of uncertainty to maximize sensitivity. Reference lists of retrieved
Epidemiology
A prevalence rate for the general population is not available, which indicates that catatonia is a rare clinical syndrome in children and adolescents. The prevalence of catatonia in inpatient youths varies from 0.6% to 17% (Cohen et al., 2005, Takaoka and Takata, 2003, Thakur et al., 2003, Wing and Shah, 2000). In the overwhelming majority of cases, catatonic episodes occur in patients at pubertal ages (Consoli et al., 2012) and exceptionally at pre-pubertal ages (e.g., Wachtel et al., 2008).
Psychiatric disorders associated with catatonia
Unlike adults, the most common underlying psychiatric disorders of catatonia in children and adolescents are schizophrenic disorders (Cohen et al., 2005, Takaoka and Takata, 2003). In our clinical cohort, 43 out of 89 youths (48.3%) presented schizophrenia spectrum disorders (i.e., schizophrenia, schizoaffective disorder, or a brief psychotic episode). The prevalence of catatonia among patients with early-onset schizophrenia is not known. Green et al. (1992) examined 38 children with
Subjective experiences of catatonic patients
The subjective feelings experienced by catatonic patients can be examined through retrospective investigations with patients in remission from an acute form of catatonia (Cohen et al., 1999). Northoff et al. (1998) and Rosebush and Mazurek (1999) have largely improved in adult patients our understanding of the specific experience associated with catatonia by comparing them with those reported by patients with neurological symptoms. Unlike patients with motor neurological disorder (e.g.,
Benzodiazepines
Lorazepam represents the first line of treatment for pediatric catatonia (Sharma et al., 2014). In most cases, symptoms are drastically reduced within three hours after receiving 1 to 3 mg of lorazepam. When a positive response is observed, a titration should be completed to maintain the dose that achieves a complete resolution of symptoms. This symptomatic treatment should be maintained until the underlying cause of catatonia is found and appropriately treated. In a naturalistic study of 66
Conclusion
Catatonia is an infrequent but potentially lethal condition in children and adolescents. While clinical presentation and associated disorders are broadly comparable to that found in adults, the presence of an associated developmental disorder or an underlying organic condition should be carefully investigated in children and adolescents in order to tailor the therapies to the patients. Recent advances in childhood and adolescent catatonia have majorly improved our understanding and may finally
Funding/support
No grants supported this research.
Contributors
Study concept and design: DC, XB, and VF.
Acquisition of data: DC, AC, MR, XB, and VF.
Interpretation of data: DC, AC, MR, XB, and VF.
Drafting the manuscript: DC, XB, and VF.
Critical revision of the manuscript for important intellectual content: DC, AC, and MR.
Final draft: All authors.
Conflict of interest
We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.
Acknowledgements
We thank the medical secretaries for their expert technical assistance.
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