Catatonic features in children and adolescents with <i>N</i>-methyl-<scp>d</scp>-aspartate receptor antibody encephalitis

Eyre, Michael; Kaushik, Anya; Barrett, Elizabeth; King, Mary D.; Pollak, Thomas A; Dale, Russell C.; Byrne, Susan; Lim, Ming

doi:10.1192/bjo.2020.55

Cited by 6 publications

(12 citation statements)

References 13 publications

(24 reference statements)

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“…Only 40.5% had a positive feature, however. These two analyses support the recent concept of psychomotor “alternation” in catatonia ( 16 ) and findings in organic catatonia of coexisting excitement and stuporous features ( 35 ). The whole first episode of catatonia was reviewed to identify catatonic features, which could have contributed to the relatively high rate of co-occurrence.…”

Section: Discussionsupporting

confidence: 87%

Catatonia Psychopathology and Phenomenology in a Large Dataset

et al. 2022

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BackgroundThe external clinical manifestations (psychopathology) and internal subjective experience (phenomenology) of catatonia are of clinical importance but have received little attention. This study aimed to use a large dataset to describe the clinical signs of catatonia; to assess whether these signs are associated with underlying diagnosis and prognosis; and to describe the phenomenology of catatonia, particularly with reference to fear.MethodsA retrospective descriptive cross-sectional study was conducted using the electronic healthcare records of a large secondary mental health trust in London, United Kingdom. Patients with catatonia were identified in a previous study by screening records using natural language processing followed by manual validation. The presence of items of the Bush-Francis Catatonia Screening Instrument was coded by the investigators. The presence of psychomotor alternation was assessed by examining the frequency of stupor and excitement in the same episode. A cluster analysis and principal component analysis were conducted on catatonic signs. Principal components were tested for their associations with demographic and clinical variables. Where text was available on the phenomenology of catatonia, this was coded by two authors in an iterative process to develop a classification of the subjective experience of catatonia.ResultsSearching healthcare records provided 1,456 validated diagnoses of catatonia across a wide range of demographic groups, diagnoses and treatment settings. The median number of catatonic signs was 3 (IQR 2–5) and the most commonly reported signs were mutism, immobility/stupor and withdrawal. Stupor was present in 925 patients, of whom 105 (11.4%) also exhibited excitement. Out of 196 patients with excitement, 105 (53.6%) also had immobility/stupor. Cluster analysis produced two clusters consisting of negative and positive clinical features. From principal component analysis, three components were derived, which may be termed parakinetic, hypokinetic and withdrawal. The parakinetic component was associated with women, neurodevelopmental disorders and longer admission duration; the hypokinetic component was associated with catatonia relapse; the withdrawal component was associated with men and mood disorders. 68 patients had phenomenological data, including 49 contemporaneous and 24 retrospective accounts. 35% of these expressed fear, but a majority (72%) gave a meaningful narrative explanation for the catatonia, which consisted of hallucinations, delusions of several different types and apparently non-psychotic rationales.ConclusionThe clinical signs of catatonia can be considered as parakinetic, hypokinetic and withdrawal components. These components are associated with diagnostic and prognostic variables. Fear appears in a large minority of patients with catatonia, but narrative explanations are varied and possibly more common.

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Section: Discussionsupporting

confidence: 87%

Catatonia Psychopathology and Phenomenology in a Large Dataset

et al. 2022

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“…Since the discovery in 2005, psychiatrists are increasingly involved in the diagnosis and management of patients presenting with anti-NMDARE (9,10). The neuropsychiatric symptoms of Anti-NMDARE are complex.…”

Section: Discussionmentioning

confidence: 99%

“…Movement disorders including catatonia are a common and complex feature of the disease (13,21). Catatonic symptoms seem resistant to lorazepam, and this resistance should prompt for an evaluation of an underlying neurological disorder (10). Furthermore, catatonia is associated with more severe forms of autoimmune disorders and with more psychotic features (22).…”

Section: Discussionmentioning

confidence: 99%

“…Anti NMDA-R encephalitis (anti-NMDARE), the most common form of autoimmune encephalitis in children (6,7) is an autoimmune disorder mediated by autoantibodies against the GluN1 subunit of the receptor, presenting with prominent neuropsychiatric manifestations, including catatonia (8,9). Eyre et.al., reported that 86% of children and adolescents with Anti-NMDARE had symptoms consistent with catatonia, with 69% of affected patients manifesting both positive (hyperkinetic) and negative (hypokinetic) features (10). About 80% of patients presenting with anti Anti-NMDARE are women and the detection of an underlying tumor varies with age, with younger people being less likely to have an underlying tumor (11).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure

et al. 2022

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IntroductionCatatonia is a severe syndrome associated with a high proportion of underlying organic conditions including autoimmune encephalitis. The link between catatonia and psychiatric conditions such as mood disorders and schizophrenia spectrum disorders is well established while the causative effect of Post-Traumatic Stress Disorders and stress related disorders remains speculative.Case ReportHere we describe the clinical case of a 14-year-old female patient presenting to the Emergency Department of a Pediatric University Hospital with acute changes in behavior five days after a sexual abuse. Acute stress reaction was suspected. Afterwards she developed catatonic symptoms alternating from stupor to excitement, resistant to the usual treatment with benzodiazepines. The first line examinations (PE, MRI, EEG) were inconclusive. The final diagnosis of anti-NMDARE was made 22 days after her admission in a University Department of Child and Adolescent Psychiatry. Her state improved after first- and second-line immunotherapy, with no signs of relapse at this day (8 months of clinical follow-up).DiscussionThe diagnosis of anti-NMDARE is challenging, involving a multidisciplinary approach. The neuropsychiatric features are complex, with no specific psychiatric phenotype. Several hypotheses are discussed to determine the role of an acute environmental stressors in the emergence of such complex neuropsychiatric clinical presentation (i.e., shared vulnerability, precipitators, consequences of preexisting psychiatric symptoms).ConclusionChild and adolescent psychiatrists and pediatricians should be aware of the overlap between neurological and psychiatric features in the setting of anti-NMDARE. Catatonia should not be dismissed as a primary psychiatric disorder even in the context of recent traumatic exposure.

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“…Across all age groups (from 8 months to 84 years) severe agitation, psychotic features, speech abnormalities and catatonia were common reported psychiatric features in anti-NMDAR encephalitis and the association with neurological symptoms aided illness identification, but data analysis was not specific to paediatric population [ 13 ]. In paediatric populations, catatonia has been specifically analysed and the majority of patients manifested both hyperkinetic and hypokinetic features in the course of anti-NMDAR encephalitis [ 14 ]. Less is well known of the psychiatric symptoms of children presenting with AE, where no antibodies are identified [ 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis

Roselló

Serrano

Gómez

et al. 2021

Eur Arch Psychiatry Clin Neurosci

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Autoimmune encephalitis (AE) can present like a psychiatric disorder. We aimed to illustrate the psychiatric manifestations, course and management of AE in a paediatric cohort. Neuropsychiatric symptoms, investigations and treatment were retrospectively retrieved in 16 patients (mean age 11.31, SD 2.98) with an AE diagnosis at the liaison psychiatry services in two UK tertiary paediatric centres. Psychiatric presentation was characterised by an acute polysymptomatic (predominantly agitation, anger outbursts/aggressiveness, hallucinations, and emotional lability) onset. Antipsychotics produced side effects and significant worsening of symptoms in four cases, and benzodiazepines were commonly used. This psychiatric phenotype should make clinicians suspect the diagnosis of AE and carefully consider use of treatments.

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Catatonic features in children and adolescents with N-methyl-d-aspartate receptor antibody encephalitis

Cited by 6 publications

References 13 publications

Catatonia Psychopathology and Phenomenology in a Large Dataset

Catatonia Psychopathology and Phenomenology in a Large Dataset

Case Report: Anti-NMDAR Encephalitis Presenting With Catatonic Symptoms in an Adolescent Female Patient With a History of Traumatic Exposure

Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis

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