Case of paediatric catatonia precipitated by antipsychotic withdrawal in a child with autism spectrum disorder

Abstract

A 13-year-old girl with moderate intellectual disability and autism spectrum disorder (ASD) was admitted to the paediatric high-dependency unit following an 8-week history of altered mental status and motor behaviour. Her symptoms emerged followed shortly after discontinuation of risperidone, an atypical antipsychotic previously commenced to manage disruptive behaviour associated with ASD. On physical examination, the patient presented with negativism, grimacing, automatic obedience, waxy flexibility and ambitendency. Blood tests, neuroimaging and lumbar puncture failed to reveal an acute infectious or neurological precipitant. She responded immediately to a trial of intramuscular lorazepam titrated to a total daily dose of 12 mg. This case presents challenges of accurately diagnosing and managing catatonic symptoms in adolescent patients with ASD. We also discuss the potential risk of precipitating catatonia following the discontinuation of antipsychotic treatment that has been prescribed for a prolonged duration.

Revisión sistemática de la utilización de la prueba con lorazepam como evaluación diagnóstica de catatonía

“…[27][28][29] Se destaca que en muchas de estas condiciones el tratamiento de primera línea, con antipsicóticos, puede agravar la presentación clínica de los síntomas catatónicos o incluso provocar un síndrome neuroléptico. [30][31][32] Es fundamental establecer estrategias de diagnóstico precoz y adecuadas para implementar medidas eficaces y oportunas, independientemente de la búsqueda etiológica. 33 Por estas consideraciones, la prueba de lorazepam (PLz), denominada con frecuencia en la literatura en inglés como Lorazepam Challenge Test, satisface un requerimiento urgente de confirmar el diagnóstico y establecer posibilidades pronósticas al tratamiento con benzodiacepinas.…”