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Indian Pediatr 2013;50: 614 |
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Childhood Catatonia
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Roshan Bhad and Rajesh Sagar
Department of Psychiatry and National Drug Dependence
Treatment Centre, All India Institute of Medical Sciences,
New Delhi 110 029, India.
Email:
[email protected]
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Catatonia is a syndrome of motor dysregulation that is
rarely recognized in pediatric age group with an estimated
incidence of 0.16 million per year [1,2]. In any patient
presenting with catatonia, neurological or other general
medical conditions, neuroleptic induced side effects,
substance intoxication or withdrawal should be ruled out
before considering psychiatric etiology [3]. We report a
rare case of childhood catatonia due to psychosis.
Master A, 11-year-old male, a fourth
standard student, presented with abrupt onset and gradually
progressive course of decreased interpersonal interaction
and decreased self care for 3 months. He was evaluated in
pediatrics, pediatric neurology and endocrinology OPD.
Personal and developmental history was uneventful. There was
no history of seizure, fever, drug use preceding onset of
illness. Apart from BMI of 28, physical examination did not
reveal any abnormality. Slit lamp examination did not reveal
K-F ring. Hemogram, renal function tests, liver function
tests, MRI brain, thyroid profile, serum insulin, fasting
blood glucose, post-prandial blood glucose and serum
cortisol did not reveal any abnormality. As no organic cause
was found, he was referred to child and adolescent
psychiatry OPD.
On mental state examination, patient
fulfilled syndromal diagnosis of catatonia and had psychotic
signs. He was not clinically depressed. He was diagnosed to
have psychosis unspecified (F 29) and treated with
risperidone (upto 4 mg/day) and lorazepam (upto 4 mg/day).
He gradually improved over 8 weeks. Lorazepam was tapered
and stopped. He was discharged on risperidone 4 mg/day. At 3
months follow up, he was mildly inactive as compared to his
usual self but was doing well otherwise.
Dysregulation of
g-aminobutyric
acid (GABA)-A, glutamate, and dopamine systems are
hypothesized to be involved in catatonia [4]. Deprivation,
abuse and trauma can precipitate catatonia in paediatric
patients without clear medical cause [5]. Acute management
of catatonia involves lorazepam challenge test, identifying
and correcting underlying medical cause, maintaining
adequate nutrition, fluid and electrolyte balance, and
avoiding postural immobility which may lead to complications
like bed sores or muscle contracture [4]. Electroconvulsive
treatment (ECT) is considered as the last choice [4]. As our
patient responded well to pharmacotherapy, ECT was not
necessitated.
Catatonia is poorly recognized in
children and adolescents due to overshadowing by medical or
neurological or pervasive developmental disorders [5].
Accurate diagnosis is important because catatonia responds
readily to benzodiazepines and electro-convulsive therapy.
References
1. Fink M. Hidden in plain sight:
catatonia in pediatrics. Acta Psychiatr Scand.
2012;125:11-2.
2. Cohen D, Flament M, Dubos PF, Basquin
M. Case Series: Catatonic syndrome in young people. J Am
Acad Child Adolesc Psychiatry. 1999;38:1040-6.
3. First MB, Frances A, Pincus HA.
DSM-IV-TR handbook of differential diagnosis. Washington:
American Psychiatric Publishing;2002.
4. Fink M, Taylor MA. Catatonia: A
Clinician’s Guide to Diagnosis and Treatment. New York:
Cambridge University Press; 2006.
5. Dhossche DM, Ross CA, Stoppelbein L. The role of
deprivation, abuse, and trauma in pediatric catatonia
without a clear medical cause. Acta Psychiatr Scand.
2012;125:25-32.
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