title: Treatment use in a prospective naturalistic cohort of children and adolescents with catatonia.
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.
authors.affiliation: 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@psl.aphp.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Raffin
authors.forename: Laetitia
authors.initials: L
authors.lastname: Zugaj-Bensaou
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bodeau
authors.forename: Vanessa
authors.initials: V
authors.lastname: Milhiet
authors.forename: Claudine
authors.initials: C
authors.lastname: Laurent
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: Angèle
authors.initials: A
authors.lastname: Consoli
mesh_terms: D000293:Adolescent; D001569:Benzodiazepines / Q000627:therapeutic use*; D002389:Catatonia / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013577:Syndrome; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001569:Benzodiazepines