Pediatric catatonia: a case report and review of the management

Background

Catatonia is when someone does not respond to stimuli or their environment whilst awake. Catatonia can present in a variety of ways, including a change in movement, speech, and behavior. There is limited research on the causes and management of catatonia in an adult population and even more so in the pediatric population.

Case Presentation

A 13-year-old presented with a 2-week sudden onset history of distress and preoccupation regarding a child being in danger. Over the next few weeks, he was represented on multiple occasions and had a rapid weight loss due to refusing oral intake. He displayed increasing preoccupations and was admitted for intravenous fluids and commenced on nasogastric feeds. He declined rapidly, presenting with symptoms of catatonia, including stupor, catalepsy, mutism, and posturing. Physical health causes for this presentation were ruled out with imaging and bloods completed, and he was trialled on lorazepam. He responded well to the lorazepam, and after 5 days, the nasogastric tube was removed, and he commenced eating, drinking, communicating, and mobilizing. The lorazepam was reduced, and his symptoms reemerged. The lorazepam was titrated back up and reduced again at a slower rate.

Conclusion

Whilst managing this case, it was noted that there is a lack of guidance available for catatonia in both adult and pediatric populations. There is particularly a lack of guidance on how to titrate onto and off lorazepam. This case highlighted a need for further research to support the development of guidelines for the management of pediatric catatonia.