Rising Incidence of Pediatric Catatonia and Medical Etiology: Multiyear Trends

OBJECTIVES Pediatric catatonia is a neuropsychiatric syndrome due to a medical diagnosis and/or psychiatric disorder and is often underrecognized and undertreated, with significant morbidity and mortality. Given limited published data, we examine its presentation, assessment, and treatment by etiology. We hypothesized increased incidence over time. METHODS Retrospective medical record review of patients younger than age 19 years diagnosed with catatonia at a quaternary care pediatric hospital from 2018 to 2023 admitted to the hospital’s emergency department and/or hospital. Sociodemographic and clinical data, including laboratory tests, imaging, and treatment, were reported and subcategorized and compared by catatonia etiology and presence or absence of a neurodevelopmental disorder. RESULTS Fifty-two patients met inclusion criteria. There was a statistically significant increase in catatonia over the study period, particularly among catatonia associated with a medical diagnosis (P = .002), with more than double the number of catatonia cases from 2021 to 2023 (9.7 per 1000 psychiatry consults) compared with cases identified from 2018 to 2020 (3.9 per 1000 psychiatry consults; P = .002). Diagnostic work up was generally similar regardless of etiology. Most patients with medical etiology alone had autoimmune encephalitis (70%) and abnormal electroencephalograms (P = .006). Higher average lorazepam doses were used to treat catatonia associated with a medical etiology (P = .007). CONCLUSIONS Our study identified significantly increased pediatric catatonia incidence and frequency of medical etiology over the study period. There were also differences in the presentation, diagnostic results, and treatment by catatonia etiology. Protocols accounting for these differences and more comprehensive etiologic surveillance in pediatric patients could be valuable.