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Trauma-induced Catatonia in Pediatric Patients: Case Series and Literature Review
Doreen R Elrad1, Nene Takahashi2, Maura Walsh1
1Loyola University Chicago Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153 USA.
Insights
Pediatric catatonia, a psychomotor syndrome, can be triggered by trauma. This study reports four cases and reviews trauma
Area of Science:
- Psychiatry
- Neurology
- Pediatric Medicine
Background:
- Catatonia is a complex psychomotor syndrome with diverse causes, including medical conditions, substance use, and increasingly, trauma.
- Pediatric catatonia literature is limited, necessitating further research into its specific presentations and triggers.
- Accurate diagnosis requires differentiating catatonia from other serious conditions like serotonin syndrome and neuroleptic malignant syndrome.
Purpose of the Study:
- To investigate the role of acute and chronic trauma in pediatric catatonia.
- To report on four complex cases of pediatric catatonia potentially triggered by traumatic events.
- To contribute to the expanding body of literature on pediatric catatonia.
Main Methods:
- Case series reporting four pediatric patients with catatonia.
- Literature review focusing on trauma as a substrate for catatonia.
- Utilized the Pediatric Catatonia Rating Scale (PCRS), modified from the Bush Francis Catatonia Rating Scale.
Main Results:
- Four complex cases of pediatric catatonia are presented, with trauma identified as a likely trigger in each.
- The modified PCRS includes specific symptoms like urinary incontinence and schizophasia, aiding diagnosis.
- Catatonia in pediatric patients may be misdiagnosed as Resignation Syndrome or Pervasive Refusal Syndrome.
Conclusions:
- Trauma appears to be a significant, though underrecognized, factor in the presentation of pediatric catatonia.
- Further research is crucial to understand the mechanisms linking trauma and pediatric catatonia.
- Accurate and timely diagnosis of pediatric catatonia is essential for appropriate management.
Abstract:
Catatonia is a psychomotor syndrome that can present secondary to mood and psychotic disorders, other medical conditions, antipsychotic use, and alcohol withdrawal (Rasmussen et al., World Journal of Psychiatry, 6:391-398, 2016). In addition, acute and chronic trauma are increasingly recognized as a substrate for catatonia (Dhossche et al., Acta Psychiatrica Scandinavica, 125:25-32, 2012). Catatonia is a clinical diagnosis that relies on standardized examination of the patient. The Pediatric Catatonia Rating Scale (PCRS) was modified from the Bush Francis Catatonia Rating Scale and validated in children and adolescents (Benarous et al., Schizophrenia Research, 176:378-386, 2016). Changes included the addition of urinary incontinence, schizophasia and acrocyanosis; and withdrawal was separated into refusal to eat or drink and social withdrawal (Benarous et al., Schizophrenia Research, 176:378-386, 2016). In both pediatric and adult patients, catatonia must be differentiated from other movement disorder emergencies such as serotonin syndrome and neuroleptic malignant syndrome, which can also present with altered mental status and autonomic dysfunction (Rajan et al., Seminars in Neurology, 39:125-136, 2019). In pediatric patients, catatonia may be the genuine diagnosis in cases of Resignation Syndrome and Pervasive Refusal Syndrome (Sallin et al., Frontiers in Behavioral Neuroscience, 10(7), 2016; Ngo and Hodes, Clinical Child Psychology and Psychiatry, 25:227-241, 2019). The literature on pediatric catatonia is scarce but nevertheless expanding. Herein, we contribute to the literature by reporting four complex cases of pediatric catatonia that appear to have been triggered by a traumatic event and further reviewing the role of acute and chronic trauma in the presentation of pediatric catatonia.
