About this Research Topic

Background

Catatonia is a severe syndrome gathering motor and psychiatric symptoms that may result in death. Its prevalence in inpatient youths varies from 0.6% to 17% and the mortality and morbidity rates are higher in catatonic patients than in any other psychiatric conditions. Unlike adults, psychotic symptoms and mood disorders are common in child and adolescent patients with catatonia. Catatonia largely occurs in youths with developmental disorders such as Autism Spectrum Disorder (ASD) or Intellectual Disability for whom diagnosis of catatonia can be more difficult due to the overlap in symptoms. Although, the diagnosis can be made with considerable confidence if the symptoms are either new, or include a significant worsening of baseline behaviors. Alongside the underlying psychiatric condition, traumatic factors play an important role in the onset of catatonic episodes in youths. Approximately 20% of catatonias are secondary to an underlying medical condition, including genetic, neurological, infectious and autoimmune disorders. Symptomatic treatment consists in high dosage benzodiazepines (e.g., lorazepam) at first. In case of resistance or life-threatening condition, electro-convulsive therapy (ECT) is effective and safe in youth. However etiological treatment remains the specific treatment, requiring an early introduction, especially in case of organic catatonia . Many recommend that treatment of the organic condition, if present, and the treatment of catatonia should occur simultaneously.

While clinical presentation and associated disorders are broadly comparable to that found in adults, the presence of an associated developmental disorder or an underlying organic condition should be carefully investigated in children and adolescents, in order to tailor the therapies to the patients. Recent advances in childhood and adolescent catatonia have majorly improved our understanding and may finally help to reduce the morbidity of this syndrome. A lot of work remains to be done to better understand the mechanisms behind catatonic symptoms; however, we believe that a focus on motor planning/execution provides a valuable research framework. Therefore there is a crucial need for publications tackling the following issues. We welcome different types of papers on the topic—including empirical studies, review papers, theoretical contributions, and opinion articles— which could help providing new data (epidemiology, the neurobiology, and the genetics), new physiopathological concepts and new diagnostic and therapeutic approaches, in order to answer some of the issue described below and to elucidate the complexity of the catatonic syndrome in youths.
- A better understanding of the epidemiology, the neurobiology, the physiopathology pathways and the genetics factors involved in pediatric catatonia;
- Phenotyping the specifics catatonic features depending on the etiology (organic versus psychiatric, or among different psychiatric diagnoses);
- Defining possible factors of severity in terms of clinical features, relapses, and resistance to treatment;
- Pursuing the classification of new underlying organic and psychiatric conditions associated with catatonia;
- Standardization of the symptomatic treatment with benzodiazepine and ECT, through controlled studies;
- Reporting the benefits and tolerance of new medications such as NMDA antagonist;
- Standardization of the etiological treatment with the development of diagnosis and treatment algorithms (e.g: causality assessment score, CAUS).

Keywords: Catatonia, Diagnosis, Etiology, Phenotyping, Treatment

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