Catatonic syndrome preceded by symptoms of anorexia nervosa in a 14-year-old boy with arachnoid cyst

Wernicke's encephalopathy in adolescents with anorexia nervosa

Anorexia Nervosa (AN) has always been prevalent in adolescents. During the COVID-19 pandemic, the eating disorder community across the world has noted a sharp increase in adolescent patients with AN and the severity of medical compromise. Rarely seen sequelae have become increasingly more common. This case report describes two previously healthy female adolescents with severe malnutrition due to AN admitted for nutritional stabilization who exhibited paranoid delusions responsive to thiamine and olanzapine. Though neither exhibit the full triad or all the Caine criteria for Wernicke's Encephalopathy (WE), the triad will not present completely in most patients with WE, especially in the pediatric population. Having one symptom of the triad is indicative of WE. Due to the decreased number of clinical criteria for Wernicke's encephalopathy coupled with the lack of typical brain MRI findings found in these patients, we recommend a high index of suspicion for WE and investigation with thiamine. Thiamine supplementation should be standard care in AN with oral supplementation in stable conditions. In the case of refeeding syndromes, preventative parenteral thiamine 100 mg IV qd, and in the case of thiamine deficiency, thiamine 500 mg IV TID.

Symptom profile of catatonia in children and adolescents admitted to psychiatry inpatient unit

AIM

To study the symptom profile of catatonia in children and adolescents.

METHODOLOGY

Treatment records of all the inpatients aged (≤19 years) were reviewed for the period January 2005 to January 2017. Patients with catatonia (diagnosed as having at least two symptoms as per the Bush Francis Catatonia Rating scale) were included.

RESULTS

During the study period, data was available for 52 children and adolescent. The mean age of the sample was 16.8 years (SD=2.0; range 9-19). Males (N=28; 53.8%) outnumbered females. The most common primary psychiatric diagnostic category was that of psychotic disorders (N=26; 78.8%). One-sixth (N=8; 15.4%) were diagnosed with organic illnesses like epilepsy and systemic lupus erythematosus. Affective disorders accounted for only one-tenth (N=5; 9.6%) of cases, with mania being more common presentation than depression. Very few patients were diagnosed with pervasive developmental disorder (N=2). The common signs and symptoms noted were mutism (90.4%) followed by immobility/stupor (75%), staring (71.2%), negativism (57.7%), rigidity (55.8%) and posturing (53.8%). The mean BFCRS score was 13.73 (SD - 7.6; range 3-20). Overall there was no significant difference in the prevalence of various signs and symptoms of catatonia between those with psychotic disorders, affective disorders and those with catatonia due to organic causes. In only half of the patients catatonia responded to lorazepam and other half required electroconvulsive therapy.

CONCLUSION

The most common symptoms of catatonia in children and adolescent are mutism, immobility/stupor, staring, posturing, negativism and rigidity. The most common underlying psychiatric diagnosis is that of schizophrenia.

Brain lesions and eating disorders

OBJECTIVE

To evaluate the relation between lesions of various brain structures and the development of eating disorders and thus inform the neurobiological research on the aetiology of these mental illnesses.

METHOD

We systematically reviewed 54 previously published case reports of eating disorders with brain damage. Lesion location, presence of typical psychopathology, and evidence suggestive of causal association were recorded.

RESULTS

Although simple changes in appetite and eating behaviour occur with hypothalamic and brain stem lesions, more complex syndromes, including characteristic psychopathology of eating disorders, are associated with right frontal and temporal lobe damage.

CONCLUSIONS

These findings challenge the traditional view that eating disorders are linked to hypothalamic disturbance and suggest a major role of frontotemporal circuits with right hemispheric predominance in the pathogenesis.

Case series: catatonic syndrome in young people

This article reviews all recent (1977-1997) reports on catatonic adolescents and summarizes the 9 consecutive cases seen at the authors' institution during the past 6 years. Catatonia occurs infrequently in adolescents (0.6% of the inpatient population), but it appears to be a severe syndrome in adolescents of both sexes. Diagnoses associated with catatonia are diverse, including in this series: schizophrenia (n = 6), psychotic depression (n = 1), mania (n = 1), and schizophreniform disorder (n = 1). Two patients had a previous history of pervasive developmental disorder. In the literature, catatonia was also reported in children with organic condition (e.g., epilepsy, encephalitis). Therapeutic management depends on the specific causes, but several points need to be stressed: (1) the frequency of neuroleptic-induced adverse effects; (2) the potential efficacy of sedative drugs on motor signs; (3) the possible use of electroconvulsive therapy; and (4) the necessity to manage family reactions and fears, which are frequent causes of noncooperation. It is concluded that catatonia is an infrequent but severe condition in young people. While symptomatology, etiologies, complications, and treatment are similar to those reported in the adult literature, findings differ with regard to the female-male ratio and the relative frequencies of associated mental disorders.