Smith Joshua R, Baldwin Isaac, York Tasia, Anderson Carina, McGonigle Trey, Vandekar Simon, Wachtel Lee, Luccarelli James
Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, TN, United States.
Vanderbilt Kennedy Center, Vanderbilt University, Nashville, TN, United States.
Front Child Adolesc Psychiatry. 2023;2. doi: 10.3389/frcha.2023.1208926. Epub 2023 Jun 20.
Pediatric 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.
The 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.
102 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 ( = 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 [ = 11.2, df = 30, std = 6.3, < 0.001, 95% CI = (7.8, 15.1)], KCS [ = 4.6, df = 38, < 0.001, 95% CI = (12.0, 31.0)], and KCE [ = 7.8, df = 30, std = 1.8, < 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, < 0.001, 95% CI = (0.931,0.992)], indicating the average subject is expected to experience some improvement.
In 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.
儿童紧张症是一种共病率很高的疾病，其治疗选择通常限于电休克疗法（ECT）或劳拉西泮。然而，劳拉西泮可能不易获得，且ECT的使用受到严格立法和污名化的限制。本研究旨在为儿童紧张症提供替代治疗方案。
该研究对美国南部一家私立大学医院进行了单中心回顾性分析。研究纳入了18岁以下患有紧张症且接受了除劳拉西泮以外药物的心理药物治疗的患者。在初始评估时和病情稳定时，使用布什-弗朗西斯紧张症评定量表（BFCRS）、坎纳紧张症严重程度量表（KCS）和坎纳紧张症检查（KCE）对患者进行评估。四位作者给出了回顾性临床总体印象改善（CGI-I）评分。
确定了102例诊断为紧张症的儿科患者，其中31例符合研究标准。20例（65%）为白人，6例（19%）为黑人，4例（13%）为西班牙裔，1例（3%）为印第安人。大多数患者（n = 18；58%）由医疗补助计划承保。紧张症诊断时的平均年龄为13.5岁。所有患者均使用氯硝西泮或地西泮稳定病情，其中21例（68%）需要加用抗癫痫药、N-甲基-D-天冬氨酸（NMDA）受体拮抗剂、阿立哌唑或氯氮平中的一种药物进行治疗。BFCRS[M = 11.2，df = 30，std = 6.3，p < 0.001，95%CI =（7.8，15.1）]、KCS[M = 4.6，df = 38，p < 0.001，95%CI =（12.0，31.0）]和KCE[M = 7.8，df = 30，std = 1.8，p < 0.001，95%CI =（1.9，3.2）]在统计学上有显著降低。对于CGI-I，结果显示观察到评分优于无变化（>4）的估计概率为0.976[t.s. = 43.2，p < 0.001，95%CI =（0.931，0.992）]，表明平均受试者预计会有一定改善。
总之，所有患者对这些治疗均有反应，紧张症症状得到改善。用于紧张症的替代药物干预措施，包括除劳拉西泮以外的苯二氮䓬类药物、丙戊酸、NMDA受体拮抗剂和非典型抗精神病药物，在治疗该人群紧张症方面是安全有效的。
