Diagnostic trajectories of pediatric catatonia – A unicentric study

Background: Catatonia is a severe neuropsychiatric syndrome characterized by marked psychomotor retardation. Catatonia is associated with high morbidity and mortality in children; however, much of the understanding comes from the adult subset of the population. The diagnosis and management of pediatric catatonia pose unique challenges. This study looks into an exclusive cohort of catatonia in the pediatric age range. The profiling of this cohort and tracking their diagnostic trajectories will add to the current evidence pool to help establish a consensus guideline for early evaluation and management of pediatric catatonia in a low-resource setting. Methodology: The 2-year clinical data were gathered retrospectively using purposive sampling from the database of the child and adolescent psychiatry outpatient registry of a tertiary care center based in South India. Results: A total of 15 pediatric presenters were included in the sample. The average age was 14.6 (2.26) years. There were 8 (53%) male patients. The diagnostic trajectories in pediatric catatonia were heterogeneous. Seven patients retained their initial diagnosis. Among ten cases presenting with melancholic depressive features, six retained a depressive disorder diagnosis, while others evolved to bipolar disorder, obsessive–compulsive disorder, and neurodegeneration with brain iron accumulation. Of two psychosis cases, one evolved to schizophrenia, and one was diagnosed with NMDAR encephalitis. Three had organic etiologies: B-cell acute lymphoblastic leukemia with steroid-induced mood disorder, seronegative autoimmune encephalitis, and one of unknown cause. The average time to reach a final diagnosis in evolving cases was 9 months (standard deviation = 11.6), highlighting diagnostic complexity. There were 9 (60%) patients with a comorbid diagnosis of neurodevelopmental disorder (intellectual disability and autism spectrum disorder). There was a significantly elevated risk of catatonia in the sample with neurodevelopmental disorders ( P < 0.0001). Conclusions: It is essential that the clinical and investigative markers be defined separately for neurotypical and neurodiverse populations, especially with profound intellectual delay and autism. The diagnostic trajectories of presenters vary, but initial clinical assessment and investigation protocols need to be unified for the acute management of catatonia.