Out on PubMed from child psychiatrist and pediatric catatonia expert Dirk Dhossche, myself, and Michael Goetz is this letter-to-the-editor in European Child and Adolescent Psychiatry:
Definitive treatment options for pediatric catatonia should include electroconvulsive therapy.
Dhossche D, Kellner CH, Goetz M.
Eur Child Adolesc Psychiatry. 2020 Jun 13. doi: 10.1007/s00787-020-01576-7. Online ahead of print.PMID: 32535657
Our letter was in response to:
Asylum-seeking children with resignation syndrome: catatonia or traumaticwithdrawal syndrome?
von Knorring AL, Hultcrantz E.Eur Child Adolesc Psychiatry. 2019 Nov 1. doi: 10.1007/s00787-019-01427-0. Online ahead of print.PMID: 31676913
The pdf is here.
These authors wrote:
In the beginning of the 2000s, an increasing number of asylum-seeking children in Sweden fell into a stuporous condition. In the present study, we report 46 consecutive children with the most severe form of this illness where the children were unable to give any response at all, did not react to pain, cold or touching, could not be supported to sit or stand on their feet, could not do anything when requested, and in most cases had enuresis/encopresis.
Our responsive LTE make the point that "resignation syndrome" (also referred to as "pervasive refusal syndrome") is actually catatonia in these children and adolescents. As such, when benzodiazepines are inadequately helpful, ECT needs to be considered. These are very ill patients and prolonged stupor can lead to serious medical complications, so definitive treatment, sooner rather than later, is indicated.
Two issues make this use of ECT a challenge:
1) the idea that a psychological trauma could lead to a neuropsychiatric illness, that is, an "organic" brain illness requiring medical treatment, rather than psychological treatment, is hard for some to accept.
2) ECT for children/adolescents is so stigmatized, and most child psychiatrists are, at best, unaware of the use of modern ECT in the pediatric population; at worst, they are opposed to the use of ECT in children and adolescents, based on prejudice and ignorance.
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ReplyDeleteThe below comment is from Max Fink:
ReplyDeleteThe Expanding Tent of Catatonia
Recognizing the Swedish resignation syndrome as a form of catatonia, thereby offering an effective treatment, is an example of the broadening tent that has, in the past four decades, included the neuroleptic malignant syndrome, delirious mania, self-injurious behaviors in autism, and limbic encephalitis (NMDAR encephalitis) as treatable examples. When catatonia was first described in 1874 by the German psychiatrist Karl Kahlbaum, he described persistent fears as the basic mechanism. In the century since, other examples of fear as the basis for the syndrome have dotted the literature.
Alas, after Kahlbaum's description, Emil Kraepelin buried catatonia within his concept of dementia praecox. As Bleuler's schizophrenia, it was treated with neuroleptic drugs, neither effective nor safe for catatonia. In the 1930s, intravenous barbiturates and ECT were recognized as treatments for catatonia, not for schizophrenia. Since the 1980s, catatonia has been liberated from schizophrenia, finally dissociated in 2013 in DSM-5 as "catatonia secondary to a medical condition." and the discard of the catatonia type of schizophrenia.
The remarkable feature of catatonia is that it is a recognizable (2 or more positive signs from a Catatonia Rating Scale), verifiable by the lorazepam relief test, and 70% eminently treatable by high doses benzodiazepines (lorazepam, diazepam) and the remainder by ECT. Its liberation from a century of burial in schizophrenia has permitted the rapid expansion of its tent to include numerous treatable syndromes.
The remarkable history is told by the medical historian Edward Shorter and myself in "The Madness of Fear: A History of Catatonia" published by Oxford University Press in 2018.
Max Fink