Background: Pediatric catatonia is an underdiagnosed and poorly understood neuropsychiatric syndrome associated with the greatest morbidity and mortality rates of any condition within the field of pediatric psychiatry. Medical and neurological etiologies of catatonia are of growing interest as they are often missed, however neurodevelopmental disorders and schizophrenia are the conditions most commonly associated with pediatric catatonia. It is rare for catatonia to be the first presenting symptom of schizophrenia in children, but should be considered as the most likely underlying cause in cases where a full neurological and medical work-up is completed and deemed noncontributory.
Methods: Report of a case and review of indicated diagnostic studies for conditions in children that may present as pediatric catatonia.
Results: A previously healthy 13-year-old female presented to the emergency department with reduced oral intake leading to 44lb weight loss, selective mutism, flat affect, impoverished thought content, and marked decrease inability to perform activities of daily living (ambulation, using the bathroom), consistent with catatonia. Brain MRI, EEG, CSF studies (including autoimmune antibody panel), thyroid stimulating hormone, ceruloplasmin, autoimmune markers, rapid plasma reagin, human immunodeficiency virus, lyme panel, genetic panel, metabolic panel, and urine drug studies were all unremarkable. Ativan challenge led to rapid but transient improvement in motor symptoms. Ativan 5mg three times daily led to drastic improvements while on inpatient psychiatry unit, yet behavior became odd and disinhibited. She was discharged home after a 3-month hospital course with an 18-month ativan taper. A year later, the patient confided to her psychiatrist that she had been experiencing auditory hallucinations since before her catatonic episode. She was diagnosed with schizophrenia and started on an atypical antipsychotic.
Conclusions: While there is increasing interest in organic etiologies of catatonia, schizophrenia must remain high on differential in children and adolescents especially after a full and unremarkable neurological and medical work-up.