An editorial comment on catatonia in pediatrics by Professor Emeritus of
Psychiatry and Neurology, Max Fink, MD has been published in the
January 2012 edition of Acta Psychiatrica Scandinavica. As a
member of the Editorial Advisory Board he had invited and vetted three
articles by pediatric catatonia scholars from the Universities of
Michigan, Toronto and Mississippi.
The articles find catatonia is
more common in children and adolescents than appreciated. A review of
101 medical records at University of Michigan by Dr. Ghaziuddin found
the signs of catatonia in 18. The diagnosis was properly recognized by
only two providers. Dr. Shorter of the University of Toronto pointed
out that catatonia has been recognized under a variety of names
throughout the history of psychiatry, mainly as schizophrenia, hysteria,
and most recently as autism. Dr. Dhossche of the University of
Mississippi, a graduate of the Stony Brook Department of Psychiatry
residency program in 1993, found that treatments for catatonia were
effective in treating children and adolescents who have experienced
deprivation, trauma and abuse.
Although catatonia is becoming
increasingly recognized among adult patients, it is seldom mentioned in
the pediatric literature. The syndrome was first described by Karl
Kahlbaum in 1874 but has remained largely hidden as a subtype of
schizophrenia for the past 100 years. Although benzodiazepines and ECT
are the effective treatments for catatonia, its submersion under the
rubric of schizophrenia mistakenly suggests treatment with neuroleptic
drugs, which are not effective and often riskful.
Dr. Fink’s
editorial comment is titled “Hidden in plain sight: catatonia in
pediatrics.” He contends that the American Psychiatric Associations’
Diagnostic and Statistical Manual and the World Health Organization’s
International Classification of Diseases should recognize catatonia in
children and adults as a distinct and independent syndrome.
