Teen Catatonia: Symptoms, Triggers, Causes, and Treatment Modalities

Teen catatonia is a complex psychomotor syndrome in teens that involves a lack of movement and communication and is accompanied by agitation, confusion, and restlessness.

Symptoms of teen catatonia range from very little to no movement to too much movement, and include disconcertment, confoundment, restlessness, repetitive, seemingly meaningless motion, mimicking someone else’s speech or movements, and holding the body in an unusual position.

Triggers and causes of teen catatonia are several psychiatric disorders, metabolic disturbances, meningoencephalitis, and toxicities. It is associated with conditions that affect body chemistry, such as kidney problems, diabetes, and thyroid conditions, as well as neurological disorders like Parkinson’s disease and encephalitis.

The treatment modalities for teenage catatonia include pharmacologic therapy and electroconvulsive therapy (ECT), including certain medications like benzodiazepines.

What Is Teen Catatonia?

Teen catatonia is a composite psychiatric condition characterized by immobility, stupor, mutism, and other motor abnormalities.

There are three types of catatonia that clinicians need to be aware of, viz: akinetic catatonia, excited catatonia, and malignant catatonia.

Catatonia manifests in teens, albeit less frequently than in adults. The pathogenesis of catatonia remains poorly elucidated, and without prompt and efficient intervention, it proves fatal. 

The diagnosis and treatment of catatonia among teens is assailed by distinctive hurdles, underscoring the necessity for additional research, particularly within the pediatric demographic.

The diagnostic criteria for catatonia in the current DSM-5 require three or more of the following symptoms: stupor, waxy flexibility, catalepsy, mutism, negativism, posturing, mannerisms, stereotypies, agitation, grimacing, echolalia, and echopraxia

Underdiagnosis of catatonia happens in adolescent and pediatric populations, which is possibly due to a lack of a universal method for diagnosing a catatonic episode in young patients.

As per findings reported in Frontiers in Psychiatry, around 20% of catatonic cases stem from an underlying medical condition, encompassing genetic, neurological, infectious, and autoimmune disorders. Initial symptomatic management typically involves high-dose benzodiazepines, such as lorazepam.

Cohen, et al., (2008) in the case report Catatonia in Adolescence, approximates that the occurrence of catatonia (across all syndrome types) among children and adolescents is around 0.16 million per year. In psychiatric settings, this rate varies widely, spanning from 0.6 to 17%. Nevertheless, these figures are notably lower than the reported frequencies in adults, which range from 7.6 to 38%. 

Reviews of literature focused on children and adolescents have uncovered only a restricted number of documented cases of catatonia, resulting in a lack of clarity in its treatment approach.

Recent progress in childhood and teen catatonia has enhanced our comprehension and holds promise for reducing the morbidity associated with this syndrome.

What Are the Types of Teen Catatonia?

Among the various manifestations of catatonia, three primary types require careful consideration: akinetic catatonia, excited catatonia, and malignant catatonia.

  • Akinetic Catatonia: This subtype of catatonia is marked by profound psychomotor retardation, with individuals exhibiting immobility, mutism, and stupor. Akinetic catatonia often presents as a state of extreme hypoactivity, where patients may remain motionless for extended periods, seemingly unresponsive to external stimuli. This form of catatonia has diagnostic difficulties due to its resemblance to other conditions, such as depression or catatonic schizophrenia.
  • Excited Catatonia: In contrast to the immobility observed in akinetic catatonia, excited catatonia is characterized by increased psychomotor activity and agitation. Individuals experiencing excited catatonia exhibit purposeless or stereotyped movements, impulsivity, and heightened arousal. This state of agitation poses significant challenges in clinical management, requiring prompt intervention to prevent self-harm or harm to others.
  • Malignant Catatonia: Malignant catatonia represents a severe and potentially life-threatening form of the syndrome, characterized by a combination of motor disturbances, autonomic instability, and altered mental status. Individuals with malignant catatonia present with hyperthermia, delirium, autonomic dysregulation, and rapid deterioration of overall clinical status. Prompt recognition and treatment are essential in malignant catatonia to prevent complications such as cardiovascular collapse and multiorgan failure.

What Are the Triggers of Teen Catatonia?

Triggers of teen catatonia are associated with various psychiatric and medical conditions, including:

  1. Trauma or Stress: Emotional trauma or overwhelming stressors precipitate catatonic episodes in susceptible individuals.
  2. Psychiatric Disorders: Underlying psychiatric conditions such as schizophrenia, bipolar disorder, or major depression predispose teens to develop catatonia.
  3. Medical Conditions: Certain medical conditions, including neurological disorders, autoimmune diseases, and metabolic imbalances, contribute to the onset of catatonic symptoms.
  4. Substance Abuse: The use of drugs or alcohol, particularly psychoactive substances, triggers catatonic episodes in teens with a predisposition to the condition.
  5. Medications: Certain medications, such as antipsychotics or antidepressants, induce catatonic symptoms as a side effect in some individuals. Withdrawal from medications like clozapine (Clozaril) causes catatonia.

Catatonia also manifests as a symptom in other conditions, including acute psychosis, encephalitis, and neuroleptic malignant syndrome, thereby complicating the diagnostic process.

What Are the Causes of Teen Catatonia?

The precise cause of catatonia in teens is not fully understood, but it is believed to result from a combination of genetic, neurological, and environmental factors. Some potential causes and contributing factors include:

  • Abnormal Brain Function: Alterations in neurotransmitter levels or dysfunction in brain regions involved in motor control and regulation play a role in the development of catatonia.
  • Genetic Predisposition: There is a genetic component to catatonia, with certain individuals being more genetically susceptible to developing the condition.
  • Neurological Abnormalities: Structural or functional abnormalities in the brain, including lesions, tumors, or abnormalities in neurotransmitter systems, contribute to catatonic symptoms.
  • Environmental Stressors: High levels of stress, trauma, or adverse life events trigger catatonic episodes in vulnerable teens, particularly those with underlying psychiatric conditions.
  • Medical Conditions: Certain medical conditions, such as encephalitis, epilepsy, or autoimmune disorders, lead to catatonic symptoms as a secondary manifestation of the underlying disease process.

What Are the Treatment Modalities for Teen Catatonia?

Treatment modalities for catatonia include benzodiazepines, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS). Effective management of teen catatonia typically involves a multidisciplinary approach that addresses both the underlying cause of the condition and the associated symptoms. Treatment modalities include:

  1. Medication: Pharmacological interventions, such as benzodiazepines, antipsychotics, or mood stabilizers, are prescribed to alleviate catatonic symptoms and stabilize mood.
  2. Psychotherapy: Individual or family therapy helps teens with catatonia address underlying psychological issues, develop coping strategies, and improve social functioning.
  3. Hospitalization: In severe cases of catatonia where the teen is at risk of harm to themselves or others, hospitalization is necessary to provide intensive medical and psychiatric care.
  4. Electroconvulsive Therapy (ECT): ECT is considered for teens with severe, treatment-resistant catatonia, particularly when other interventions have been ineffective. The use of ECT is extremely rare in pediatric populations and is largely reserved for patients with life-threatening catatonia.
  5. Supportive Care: Providing a supportive and nurturing environment, ensuring the teen’s basic needs are met, and offering encouragement and reassurance are beneficial in managing catatonic symptoms.

If you notice any signs of catatonia in your teenager, it’s crucial to seek professional help immediately. Early intervention makes a substantial difference in managing symptoms and improving outcomes. Don’t hesitate to reach out to a healthcare provider or mental health specialist for guidance and support. Your teen’s well-being is paramount, and taking action promptly is better for treatment and recovery.

Is catatonia in adolescents effectively treated?

With timely diagnosis and intervention, catatonia in adolescents is often effectively managed, although the treatment approach varies depending on the severity of symptoms and underlying causes.

What should parents and caregivers do if they suspect their teenager has catatonia?

If parents or caregivers suspect catatonia in a teenager, they should seek prompt medical attention from a qualified healthcare provider or mental health professional for a thorough evaluation and appropriate management.

Author: Shantel Sullivan Ed.D., LCSW
Dr. Shantel Sullivan, Ed.D., LCSW, serves as the CEO of Bright Path with a rich background in residential adolescent treatment, adult outpatient services, and academia, leveraging over a decade of licensed social work experience in New York and North Carolina. Her academic credentials include a BA in Sociology, an MSW and a graduate certificate in addictions counseling from the University of New England, culminating in a doctoral degree in Educational Leadership focused on transformational leadership. Beyond her clinical expertise, Dr. Sullivan contributes to the field as a national speaker, educator, and editor of the Bright Path Teen Mental Health Blog, committed to enhancing access to evidence-based mental health care for adolescents and their families.
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