Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis
IntroductionPediatric catatonia is a highly co-morbid condition with treatment options often limited to electroconvulsive therapy (ECT) or lorazepam. However, lorazepam may not be readily available, and access to ECT is limited by restrictive legislation and stigma. This study aims to provide altern...
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Child and Adolescent Psychiatry |
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| author | Joshua R. Smith Joshua R. Smith Isaac Baldwin Tasia York Carina Anderson Trey McGonigle Simon Vandekar Lee Wachtel James Luccarelli James Luccarelli |
| author_facet | Joshua R. Smith Joshua R. Smith Isaac Baldwin Tasia York Carina Anderson Trey McGonigle Simon Vandekar Lee Wachtel James Luccarelli James Luccarelli |
| author_sort | Joshua R. Smith |
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| description | IntroductionPediatric catatonia is a highly co-morbid condition with treatment options often limited to electroconvulsive therapy (ECT) or lorazepam. However, lorazepam may not be readily available, and access to ECT is limited by restrictive legislation and stigma. This study aims to provide alternative treatment options for pediatric catatonia.MethodsThe study involved a single-site retrospective analysis of a private university hospital in the southern United States. The study included patients under eighteen with catatonia who received psychopharmacologic treatment with an agent other than lorazepam. The patients were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), and Kanner Catatonia Examination (KCE) at the time of initial evaluation and upon stabilization. A retrospective clinical global impressions-improvement (CGI-I) score was assigned by four authors.Results102 pediatric patients diagnosed with catatonia were identified, and 31 met criteria for the study. 20 (65%) were white, 6 (19%) were Black, 4 (13%) were Hispanic, and 1 (3%) were Indian. Most patients (N = 18; 58%) were insured by Medicaid. The mean age at the time of catatonia diagnosis was 13.5 years. All patients were stabilized on either clonazepam or diazepam, with 21 (68%) requiring treatment with an additional medication of either an anti-epileptic, N-methyl-D-aspartate (NMDA) receptor antagonist, and aripiprazole or clozapine. Statistically significant reductions in the BFCRS [t = 11.2, df = 30, std = 6.3, p < 0.001, 95% CI = (7.8, 15.1)], KCS [t = 4.6, df = 38, p < 0.001, 95% CI = (12.0, 31.0)], and KCE [t = 7.8, df = 30, std = 1.8, p < 0.001, 95% CI = (1.9, 3.2)] were observed. For CGI-I the results showed that the estimated probability of observing a score better than no change (>4) is 0.976 [t.s. = 43.2, p < 0.001, 95% CI = (0.931,0.992)], indicating the average subject is expected to experience some improvement.DiscussionIn conclusion, all patients responded to these treatments with improvement in their catatonic symptoms. Alternative pharmacologic interventions for catatonia, including benzodiazepines other than lorazepam, valproic acid, NMDA receptor antagonists, and atypical antipsychotics were safe and effective in treating catatonia in this population. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2023-06-01 |
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| spelling | doaj-art-7bb28f8d136c4368b17b8aed05d1889c2025-01-20T10:23:22ZengFrontiers Media S.A.Frontiers in Child and Adolescent Psychiatry2813-45402023-06-01210.3389/frcha.2023.12089261208926Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysisJoshua R. Smith0Joshua R. Smith1Isaac Baldwin2Tasia York3Carina Anderson4Trey McGonigle5Simon Vandekar6Lee Wachtel7James Luccarelli8James Luccarelli9Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United StatesVanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, United StatesDivision of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United StatesDivision of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United StatesDivision of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United StatesDepartment of Biostatistics, Vanderbilt University, Nashville, TNDepartment of Biostatistics, Vanderbilt University, Nashville, TNKennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, United StatesDivision of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United StatesDepartment of Psychiatry, Harvard Medical School, Boston, MA, United StatesIntroductionPediatric catatonia is a highly co-morbid condition with treatment options often limited to electroconvulsive therapy (ECT) or lorazepam. However, lorazepam may not be readily available, and access to ECT is limited by restrictive legislation and stigma. This study aims to provide alternative treatment options for pediatric catatonia.MethodsThe study involved a single-site retrospective analysis of a private university hospital in the southern United States. The study included patients under eighteen with catatonia who received psychopharmacologic treatment with an agent other than lorazepam. The patients were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), and Kanner Catatonia Examination (KCE) at the time of initial evaluation and upon stabilization. A retrospective clinical global impressions-improvement (CGI-I) score was assigned by four authors.Results102 pediatric patients diagnosed with catatonia were identified, and 31 met criteria for the study. 20 (65%) were white, 6 (19%) were Black, 4 (13%) were Hispanic, and 1 (3%) were Indian. Most patients (N = 18; 58%) were insured by Medicaid. The mean age at the time of catatonia diagnosis was 13.5 years. All patients were stabilized on either clonazepam or diazepam, with 21 (68%) requiring treatment with an additional medication of either an anti-epileptic, N-methyl-D-aspartate (NMDA) receptor antagonist, and aripiprazole or clozapine. Statistically significant reductions in the BFCRS [t = 11.2, df = 30, std = 6.3, p < 0.001, 95% CI = (7.8, 15.1)], KCS [t = 4.6, df = 38, p < 0.001, 95% CI = (12.0, 31.0)], and KCE [t = 7.8, df = 30, std = 1.8, p < 0.001, 95% CI = (1.9, 3.2)] were observed. For CGI-I the results showed that the estimated probability of observing a score better than no change (>4) is 0.976 [t.s. = 43.2, p < 0.001, 95% CI = (0.931,0.992)], indicating the average subject is expected to experience some improvement.DiscussionIn conclusion, all patients responded to these treatments with improvement in their catatonic symptoms. Alternative pharmacologic interventions for catatonia, including benzodiazepines other than lorazepam, valproic acid, NMDA receptor antagonists, and atypical antipsychotics were safe and effective in treating catatonia in this population.https://www.frontiersin.org/articles/10.3389/frcha.2023.1208926/fullpediatric catatoniaelectroconvulsive therapybenzodiazepinespediatric psychopharmacologyconsult liaison |
| spellingShingle | Joshua R. Smith Joshua R. Smith Isaac Baldwin Tasia York Carina Anderson Trey McGonigle Simon Vandekar Lee Wachtel James Luccarelli James Luccarelli Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis Frontiers in Child and Adolescent Psychiatry pediatric catatonia electroconvulsive therapy benzodiazepines pediatric psychopharmacology consult liaison |
| title | Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis |
| title_full | Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis |
| title_fullStr | Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis |
| title_full_unstemmed | Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis |
| title_short | Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis |
| title_sort | alternative psychopharmacologic treatments for pediatric catatonia a retrospective analysis |
| topic | pediatric catatonia electroconvulsive therapy benzodiazepines pediatric psychopharmacology consult liaison |
| url | https://www.frontiersin.org/articles/10.3389/frcha.2023.1208926/full |
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