title: Catatonia in Down syndrome; a treatable cause of regression.
abstract: OBJECTIVE
  The main aim of this case series report is to alert physicians to the occurrence of catatonia in Down syndrome (DS). A second aim is to stimulate the study of regression in DS and of catatonia. A subset of individuals with DS is noted to experience unexplained regression in behavior, mood, activities of daily living, motor activities, and intellectual functioning during adolescence or young adulthood. Depression, early onset Alzheimer's, or just "the Down syndrome" are often blamed after general medical causes have been ruled out. Clinicians are generally unaware that catatonia, which can cause these symptoms, may occur in DS.
  
  
  METHODS
  Four DS adolescents who experienced regression are reported. Laboratory tests intended to rule out causes of motor and cognitive regression were within normal limits. Based on the presence of multiple motor disturbances (slowing and/or increased motor activity, grimacing, posturing), the individuals were diagnosed with unspecified catatonia and treated with anti-catatonic treatments (benzodiazepines and electroconvulsive therapy [ECT]).
  
  
  RESULTS
  All four cases were treated with a benzodiazepine combined with ECT and recovered their baseline functioning.
  
  
  CONCLUSIONS
  We suspect catatonia is a common cause of unexplained deterioration in adolescents and young adults with DS. Moreover, pediatricians and others who care for individuals with DS are generally unfamiliar with the catatonia diagnosis outside schizophrenia, resulting in misdiagnosis and years of morbidity. Alerting physicians to catatonia in DS is essential to prompt diagnosis, appropriate treatment, and identification of the frequency and course of this disorder.
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Neera
authors.initials: N
authors.lastname: Ghaziuddin
authors.affiliation: Community Psychiatry, San Jose, California, University of Missouri, Columbia, Missouri, USA.
authors.forename: Armin
authors.initials: A
authors.lastname: Nassiri
authors.affiliation: Thompson Center for Autism and Neurodevelopmental Disorders and Department of Child Health, University of Missouri, Columbia, Missouri, USA.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Miles
keywords: adolescence; benzodiazepines; electroconvulsive therapy; young adulthood