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

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Abstract

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.

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Acknowledgments

This work was supported by a grant from the Fondation Pfiz;, the French ministry of health (Programme Hospitalier de Recherche Clinique); the University Pierre et Marie Curie and the Assistance Publique Hôpitaux de Paris. None of these funding organizations had any role in the design or conduct of the study, preparation, review or approval of the manuscript. NB had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The authors thank Max Fink, MD, for his expertise on catatonia and for giving feedback regarding a first version of the manuscript.

conflict of interest

During the last two years, Dr. Cohen reported past consultation for or the receipt of honoraria from Bristol-Myers Squibb, Otsuka, Shire, Lundbeck and IntegraGen. Dr Consoli reported receiving travel support from BMS. No other authors reported financial disclosure or conflict of interest.

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l’Hôpital, 75013, Paris, France

    Marie Raffin, Laetitia Zugaj-Bensaou, Nicolas Bodeau, Vanessa Milhiet, Claudine Laurent, David Cohen & Angèle Consoli

  2. CRICM-CNRS, Institut du Cerveau et de la Moelle, Paris, France

    Claudine Laurent

  3. CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l’Hôpital, 75013, Paris, France

    David Cohen

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  1. Marie Raffin
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  2. Laetitia Zugaj-Bensaou
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Correspondence to Marie Raffin.

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Raffin, M., Zugaj-Bensaou, L., Bodeau, N. et al. Treatment use in a prospective naturalistic cohort of children and adolescents with catatonia. Eur Child Adolesc Psychiatry 24, 441–449 (2015). https://doi.org/10.1007/s00787-014-0595-y

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