Editorial comment by Max Fink, MD on catatonia in pediatrics published in Acta Psychiatrica Scandinavica

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.