Elsevier

Schizophrenia Research

Volume 200, October 2018, Pages 56-67
Schizophrenia Research

Catatonia in children and adolescents: New perspectives

https://doi.org/10.1016/j.schres.2017.07.028Get rights and content

Abstract

Introduction

Catatonia is a rare and severe psychomotor condition in children and adolescents. In the current report, we aimed to review the recent literature.

Method

Using a PRISMA approach, we searched MEDLINE between 1982 and 2017 using the keywords ‘CATATONIA’ and ‘CHILD’ or ‘ADOLESCENT’. In total, we reviewed 130 reports (controlled study, N = 4; clinical chart, N = 23; case report, N = 54; and editorial/review, N = 42).

Results

Several aspects seem to be age specific: (1) although the clinical presentation resembles that in adults, some symptoms are important in children and adolescents (e.g., psychomotor regression). (2) Associated disorders are similar to that found in adults; however, schizophrenia is more frequently observed than mood disorder. Additionally, a history of neurodevelopmental disorders maybe encountered. (3) Morbidity and mortality are among the worst in child psychiatry. (4) Underlying organic conditions are highly prevalent (> 20% of the cases), and their search is warranted because some diagnoses may result in specific treatments (e.g., immune-suppressor therapy for autoimmune conditions). (5) Symptomatic approaches – high dose of benzodiazepines and electroconvulsive therapy (ECT) – are as efficient in children or adolescents as they are in adults, but this finding needs to be acknowledged because a resistance against the use of ECT or high-dose medication exists among child psychiatrists.

Discussion

Recent advances in child and adolescent catatonia research have offered major improvements in understanding catatonia and in new therapeutic opportunities. The syndrome is rare, but these advances need to be acknowledged in order to direct patients to centers that have developed a specific expertise.

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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