Treatment use in a prospective naturalistic cohort of children and adolescents with catatonia

• Published in: European child & adolescent psychiatry 2015-04, Vol.24 (4), p.441-449
• Main Authors: Raffin, Marie, Zugaj-Bensaou, Laetitia, Bodeau, Nicolas, Milhiet, Vanessa, Laurent, Claudine, Cohen, David, Consoli, Angèle
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Antipsychotics; Autism; Behavior disorders; Benzodiazepines; Benzodiazepines - therapeutic use; Catatonia; Catatonia - diagnosis; Catatonia - therapy; Child; Child & adolescent psychiatry; Child and Adolescent Psychiatry; Child development; Children; Children & youth; Clinical trials; Conditions; Critical incidents; Curie, Marie (1867-1934); Drug dosages; Efficacy; Electroconvulsive therapy; Electroconvulsive Therapy - methods; Female; Hospitalization; Humans; Inpatients; Lupus; Male; Medicine; Medicine & Public Health; Original Contribution; Patients; Pediatrics; Prospective Studies; Psychiatry; Psychopharmacology; Psychotropic drugs; Referrals; Schizophrenia; Sociodemographics; Socioeconomic Factors; Syndrome; Teenagers; Treatment Outcome; Young Adult
• ISSN: 1018-8827; 1435-165X
• DOI: 10.1007/s00787-014-0595-y

We aimed to (1) describe the treatment used in a large sample of young inpatients with catatonia, (2) determine which factors were associated with improvement and (3) benzodiazepine (BZD) efficacy. From 1993 to 2011, 66 patients between the ages of 9 and 19 years were consecutively hospitalized for a catatonic syndrome. We prospectively collected sociodemographic, clinical and treatment data. In total, 51 (77 %) patients underwent a BZD trial. BZDs were effective in 33 (65 %) patients, who were associated with significantly fewer severe adverse events ( p  = 0.013) and resulted in fewer referrals for electroconvulsive therapy (ECT) ( p  = 0.037). Other treatments included ECT ( N  = 12, 18 %); antipsychotic medications, mostly in combination; and treatment of an underlying medical condition, when possible. For 10 patients, four different trials were needed to achieve clinical improvement. When all treatments were combined, there was a better clinical response in acute-onset catatonia ( p  = 0.032). In contrast, the response was lower in boys ( p  = 0.044) and when posturing ( p  = 0.04) and mannerisms ( p  = 0.008) were present as catatonic symptoms. The treatment response was independent of the underlying psychiatric or systemic medical condition. As in adults, BZDs should be the first-line symptomatic treatment for catatonia in young patients, and ECT should be a second option. Additionally, the absence of an association between the response to treatment and the underlying psychiatric condition suggests that catatonia should be considered as a syndrome.