Treatment of Catatonia in Children and Adolescents

Initial Assessment and Recognition

The American Academy of Child and Adolescent Psychiatry recommends identifying key clinical features to confirm the diagnosis of catatonia, including life-threatening presentations such as refusal to eat or drink, severe malnutrition, extreme suicidality, or florid psychosis 1, 3, 2
Autonomic instability, such as fever, tachycardia, and blood pressure changes, can be a sign of malignant catatonia 4

The American Academy of Child and Adolescent Psychiatry recommends lorazepam as the preferred benzodiazepine for treating pediatric catatonia 2
Monitoring of vital signs, airway patency, and level of consciousness is necessary during and after benzodiazepine administration 2

The American Academy of Child and Adolescent Psychiatry recommends initiating ECT when benzodiazepines fail or in life-threatening situations, such as severe malnutrition, extreme suicidality, or florid psychosis 1, 2
ECT is indicated for treatment-resistant catatonia, malignant catatonia with autonomic instability, neuroleptic malignant syndrome, and catatonia associated with mood disorders or schizophrenia 1, 3, 5
Bilateral electrode placement may be used initially for critically ill patients, and treatment begins at two to three times weekly 2
Monitoring during and after ECT is necessary to observe seizure duration, airway patency, vital signs, and adverse effects 2

ECT is considered the treatment of choice for catatonia during pregnancy 5
Catatonia associated with schizophrenia may require earlier progression to ECT due to inadequate benzodiazepine response, and certain atypical antipsychotics such as clozapine or quetiapine may be efficient as adjunctive treatment 3

Untreated catatonia can cause severe medical complications, including rhabdomyolysis, renal failure, and death 4