(033) COVID-19 and Pediatric Catatonia

Abstract:

Background: The COVID-19 pandemic altered the landscape of healthcare, with psychiatric disorders being no exception. There is an increasing number of reports of catatonia in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Catatonia is underdiagnosed in the pediatric population despite how its presenting symptoms are thought to be similar across etiologies and ages [Hauptman, 2016]. This predisposes children to significant morbidity and mortality [Sorg, 2018]. Despite this, there are currently no reports considering the management of pediatric catatonia associated with COVID-19 infection. This case series examines the clinical courses and treatment regimens of COVID-19-associated catatonia in two pediatric patients, with discussion of how the neurobiological and psychosocial impacts of COVID-19 may have contributed to their symptom development. Given the widespread shortage of child and adolescent psychiatrists, consultation-liaison (C-L) psychiatrists are often called to evaluate and guide treatments for these pediatric patients [Sorg, 2018].


Case Summary: We present two mid-adolescent females who developed catatonic syndrome in the setting of a recent COVID-19 infection. The first case is a 15-year-old Hispanic female with no significant medical or psychiatric history who presented with six weeks of behavioral and sleep disturbances accompanied by akinetic mutism, poor oral intake and both hallucinatory and suspicious behavior. The second case is a 16-year-old White female with pre-morbid moderate depression, anxiety, no significant medical history, and no vaccination against COVID-19 who presented with behavioral changes, fatigue, lethargy and akinetic mutism. Collaborative workup by the C-L psychiatry team, Neuromodulation division and the Pediatrics team at Cooper University Hospital (CUH) revealed different etiologies of catatonia: psychotic etiology in the former and depressive etiology in the latter. Both responded well to medications, family interventions and supportive therapy.



Discussion: This case series highlights special considerations when evaluating pediatric catatonia. We will examine the etiological origins of catatonia in the context of neurobiology, the possible role of cultural factors and COVID-19-associated psychosocial stressors, and the ECT-sparing role of low dose aripiprazole in treating these patients. This case series highlights the importance of early diagnosis and collaborative treatment of adolescent-onset catatonia given its significant predisposition to high mortality and morbidity rates [Cornic, 2009]. Considering the persistence of COVID-19, psychoeducation and enhanced communication will make early diagnosis and interventions possible so that outcomes can be favorable.



References:



Cornic, F., et al., Association of adolescent catatonia with increased mortality and morbidity: Evidence from a prospective follow-up study. Schizophrenia Research, 2009. 113(2): p. 233-240.



Hauptman, A.J. and S. Benjamin, The Differential Diagnosis and Treatment of Catatonia in Children and Adolescents. Harvard Review of Psychiatry, 2016. 24(6).



Sorg, E.M., M. Chaney-Catchpole, and E.P. Hazen, Pediatric Catatonia: A Case Series-Based Review of Presentation, Evaluation, and Management. Psychosomatics, 2018. 59(6): p. 531-538.