Roi Cody, Verret Luke, Peet Bradley, Conrad Erich J
Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA.
Louisiana State University School of Medicine, New Orleans, LA.
Ochsner J. 2020 Fall;20(3):307-310. doi: 10.31486/toj.19.0026.
Pediatric catatonia is a rare and poorly understood phenomenon. The majority of reported cases have a psychiatric etiology. Because of the heterogeneous presentation and treatment issues unique to the pediatric population, identification and management can be challenging. Additionally, few definitive guidelines or practice parameters are available for pediatric patients. The first-line treatment for catatonia is pharmacologic, and when treatment fails or is inadequate, electroconvulsive therapy (ECT) has been shown to be safe and effective. A previously healthy, 14-year-old male presented with acute onset of catatonia that resolved at 4 weeks after a short course of ECT with adjunctive lorazepam and risperidone. An interesting feature of this case was the resolution of autonomic symptoms and the emergence of conversion features. The resolution of the catatonia (negativism, mutism, and withdrawal) made it possible for the team to identify a thought disorder and initiate appropriate pharmacologic treatment for the precipitating etiology. ECT was a safe and effective treatment for the resolution of catatonia symptoms in this patient. Conversion and catatonia features may exist on a continuum.
儿童紧张症是一种罕见且了解甚少的现象。大多数报告病例有精神病因。由于儿童群体独特的异质性表现和治疗问题，识别和管理具有挑战性。此外，针对儿科患者的明确指南或实践参数很少。紧张症的一线治疗是药物治疗，当治疗失败或不足时，电休克疗法（ECT）已被证明是安全有效的。一名先前健康的14岁男性出现急性紧张症发作，在短期ECT联合劳拉西泮和利培酮治疗4周后症状缓解。该病例的一个有趣特征是自主神经症状的缓解和转换症状的出现。紧张症（违拗、缄默和退缩）的缓解使团队能够识别出思维障碍，并针对诱发病因启动适当的药物治疗。ECT是该患者缓解紧张症症状的安全有效治疗方法。转换症状和紧张症症状可能存在连续关系。
