Prepubertal Catatonic Schizophrenia

Abstract

FEA Abdul Rahim, Prepubertal Catatonic Schizophrenia. 1990; 10(2): 207-210 The syndrome of catatonia was first described by Karl Kahlbaum in 1874, 1 and included the symptoms of catalepsy, negativism, mutism, stereotypy, posturing, muscular rigidity, and verbigeration. Emil Kraepelin 2 regarded catatonia as a subtype of the dementia praecox he described, and Bleuler later called this disorder schizophrenia. Schizophrenia continued to be considered the main cause of catatonia, but since Gelenberg's 1976 paper, 3 there have been several reports that have emphasized the organic and affective etiology of catatonia and catatonia-like symptomatology. [4][5][6] The validity of catatonic schizophrenia has been increasingly questioned, with greater emphasis now placed on the nonschizophrenic aspect.Though decreasing in incidence, 6 functional catatonia is relatively common in adults, but has been reported rarely in children. Bemporad and Dunton,7 in a survey of the international literature, found only 22 cases of catatonia in childhood and noted that seizure disorders were related to the appearance of the catatonic episodes in many. They believed the catatonia in two of their patients was psychogenic and suggested an oppositional mechanism. Feinberg 8 reported the case of a 14-year-old girl with fever of unknown origin that was diagnosed as acute catatonic schizophrenia after a lengthy medical evaluation showed no organic mechanism. However, her disorder was complicated by sepsis, thrombocytopenia, convulsions, and abnormal electroencephalogram (EEG), with death occurring three months after admission, raising the possibility of a lethal form of catatonia.Belfer and d'Autremont 9 described catatonia-like symptoms in a 16-year-old and attributed them to an arteriovenous malformation in the left frontal lobe. Shah and Kaplan 10 reported catatonic symptoms in a 10-year-old girl with abnormal EEG tracings who exhibited a dramatic response to intravenously administered Phenytoin. They emphasized the organic etiology of catatonic symptoms in childhood. A case of steroid-induced catatonia was reported by Sullivan and Dickerman 11 in an 11-year-old boy with dermatomyositis. Among 12 patients with catatonia secondary to typhoid fever reported by Breakey and Kala, 12 one was a 7-yearold boy who showed gradual improvement when treated with chlorpromazine.Recently, five case reports have been published concerning adolescents with depressive stupor and other catatonic features followed by manic-like symptoms, suggesting the diagnosis of bipolar affective psychosis. [13][14][15][16] The conclusion was that catatonic signs in young adolescents should raise the suspicion of an underlying affective disorder rather than schizophrenia.The case of an 11-year-old schizophrenic boy presenting with catatonia is reported. In a search of the recent literature, I failed to find a similar case. The case reported emphasizes the possible schizophrenic etiology of the disorder. Case ReportAn 11-year-old Muslim boy of bedouin background was admitted...