Crossing State Lines: Ethical and Clinical Considerations in Treating a Child With Catatonia

Miller, Jeremy; Sowar, Kristina; Abbott, Christopher; Christie, William A; Carubia, Beau; Geppert, Cynthia M. A.

doi:10.1016/j.jaac.2022.02.004

Cited by 10 publications

(6 citation statements)

References 17 publications

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“…[29][30][31][32] Restricted and delayed access to ECT in younger patients, however, further highlights the need for quickly identifying catatonia in children and adolescents, because they face barriers to accessing ECT in cases where it may be required. [33][34][35][36] Strengths of this study include a large sample size, making it the largest single sample of paediatric patients diagnosed with catatonia that has been reported. Additionally, the multicentre nature of the study and the inclusion of medical and psychiatric in-patients and out-patients enhances the generalisability of the findings.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic features of paediatric catatonia: multisite retrospective cohort study

Smith,

York,

Baldwin

et al. 2024

BJPsych open

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Background Catatonia is a neuropsychiatric disorder characterised by psychomotor changes that can affect individuals across the lifespan. Although features of catatonia have been described in adults, the most common clinical symptoms among paediatric patients with catatonia are not well characterised. Aims The goal of this study was to characterise the symptoms of catatonia demonstrated by paediatric patients, and to explore demographic and diagnostic factors associated with greater catatonia severity. Method We conducted a multicentre retrospective cohort study, from 1 January 2018 to 6 January 2023, of patients aged 18 and younger with a clinical diagnosis of catatonia and symptom assessment using the Bush Francis Catatonia Rating Scale (BFCRS). Results A total of 143 patients met inclusion criteria. The median age was 15 (interquartile range: 13–16) years and 66 (46.2%) patients were female. Neurodevelopmental disabilities were present in 55 (38.5%) patients. Patients demonstrated a mean of 6.0 ± 2.1 signs of catatonia on the Bush Francis Catatonia Screening Item, with a mean BFCRS score of 15.0 ± 5.9. Among the 23 items of the BFCRS, six were present in >50% of patients (staring, mutism, immobility/stupor, withdrawal, posturing/catalepsy, rigidity), and four were present in <20% of cases (waxy flexibility, mitgehen, gegenhalten, grasp reflex). In an adjusted model, patients with neurodevelopmental disorders demonstrated greater BFCRS severity than those with other diagnoses. Conclusions Catatonia was diagnosed in a range of mental health conditions. Further research is needed to define optimal diagnostic criteria for catatonia in paediatric patients, and clarify the clinical course of the disorder.

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Section: Discussionmentioning

confidence: 99%

“… 29 – 32 Restricted and delayed access to ECT in younger patients, however, further highlights the need for quickly identifying catatonia in children and adolescents, because they face barriers to accessing ECT in cases where it may be required. 33 – 36 …”

Section: Discussionmentioning

confidence: 99%

Diagnostic features of paediatric catatonia: multisite retrospective cohort study

Smith,

York,

Baldwin

et al. 2024

BJPsych open

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“…It is noteworthy that states vary considerably in regulations pertaining to patient age, provider qualifications, and informed consent. 19,20 Future surveys should consider listing this as a response option.…”

Section: Ect Practice Over Timementioning

confidence: 99%

Electroconvulsive Therapy in the United States

Noorani,

Rohde,

Feuer

et al. 2024

J ECT

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Objectives This study aimed to describe current US electroconvulsive therapy (ECT) practice, identify practice changes over time, and inform discussion of practice. Method Our anonymous survey was open on SurveyMonkey.com from January to June 2022. We sent invitations to providers identified using a Medicare provider database, an advanced PubMed search function, and professional group listservs. Participants were instructed to submit 1 survey per ECT site. We examined frequency of responses, tabulated individual comments, and grouped data for comparison. Results We received responses from 74 US practice sites encompassing 283 providers. Forty-nine percent (n = 36) of respondents practiced at general academic medical centers, 23% (n = 17) at general medical centers, 16% (n = 12) at freestanding psychiatric hospitals, and 7% (n = 5) at Veterans Affairs medical centers. Proportions of female (29%) and Black or African American (AA) (1%) ECT providers were markedly lower than proportions of female (60%) and Black or African American ECT patients (10%). The median number of treatments for a major depressive episode was 10. The preferred electrode placement was right unilateral (66%, n = 45). The favored dosing strategy was seizure threshold titration. Quantitative outcome measures were used by 89% (n = 66) of sites for depressive symptoms and 84% (n = 62) for cognitive adverse effects. Conclusions This survey is the first nationwide survey of ECT practice in nearly 40 years. Our results describe changes in practice over time and highlight the need to increase the number of female and Black or African American ECT providers. A comprehensive network of ECT sites could facilitate more frequent nationwide surveys.

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“…Administration in pediatric populations is likely limited by stigma, minimal education in psychiatric training programs, provider comfort, and access 36 . Pediatric ECT is also subject to state regulations with limitations regarding age, consent, and medical necessity 37-40 …”

Section: Questions To the Consultantsmentioning

confidence: 99%

“…36 Pediatric ECT is also subject to state regulations with limitations regarding age, consent, and medical necessity. [37][38][39][40] Though there is international consensus that high-dose lorazepam and ECT are first-line in the management of pediatric catatonia, significant and heterogenous restrictions often limit their use. In addition, little is known regarding specific neural underpinnings or etiologies of pediatric catatonia.…”

Section: Questions To the Consultantsmentioning

confidence: 99%

Use of First-Generation Antipsychotics in an Adolescent Male with Catatonic Schizophrenia

Patterson,

Lim,

Fuchs

et al. 2023

Harv Rev Psychiatry

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Crossing State Lines: Ethical and Clinical Considerations in Treating a Child With Catatonia

Cited by 10 publications

References 17 publications

Diagnostic features of paediatric catatonia: multisite retrospective cohort study

Diagnostic features of paediatric catatonia: multisite retrospective cohort study

Electroconvulsive Therapy in the United States

Use of First-Generation Antipsychotics in an Adolescent Male with Catatonic Schizophrenia

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