Drug-related catatonia in youths: real-world insights from the WHO Safety Database

Abstract

Catatonia is characterized by psychomotor alterations and reduced contact with the environment. Initially linked to schizophrenia, it also occurs in mood disorders or organic conditions. In children, catatonia remains poorly delineated, despite dramatically increasing the risk of premature death. As data on pediatric drug-induced catatonia bears many uncertainties, we aimed to characterize its age-dependent patterns, using real-world data from the WHO safety database (VigiBase®).VigiBase® was queried for all reports of catatonia registered up to December 8th 2022. Reports involving patients <18 years were classified into 3 groups: ≤23 months, 2–11 years, and 12–17 years. Disproportionality analyses relied on the Reporting Odds Ratio (ROR), and the positivity of the lower end of the 95% confidence interval of the Information Component (IC) was required to suspect a signal. Catatonia was evoked in 421 pediatric reports. In infants, vaccines were leading. In children, the main signals involved haloperidol (ROR 104.3; 95% CI 45.6–238.5), ondansetron (ROR 40.5; 95% CI 16.5–99.5), and ciclosporin (ROR 27.4; 95% CI 13.8–54.1). In adolescents, chlorpromazine (ROR 199.1; 95% CI 134.8–294.1), benzatropine (ROR 193; 95% CI 104.1–361.6), and olanzapine (ROR 135.7; 95% CI 104.6–175.9) reached the highest RORs. In infants, catatonia was related to vaccines, it was ascribed to multiple drugs in children, and mainly to psychotropic drugs in adolescents. Less suspected drugs, such as ondansetron, were highlighted. Despite limitations inherent in spontaneous reporting systems, this study supports that a careful anamnesis is warranted to separate catatonia associated with medical conditions from drug-induced catatonia in pediatric patients.

Delayed drug-induced catatonia in an adolescent girl – clinical implications: A case report

“…As antipsychotics have sometimes been used for catatonia, subsequent risperidone, and aripiprazol were tested to ameliorate the psychotic symptoms, with a recurrent obvious dose dependent deterioration in catatonic symptoms. In adolescents with catatonia exacerbated by psychotropic drugs, about half of the patients had a previous psychiatric medical history [3] and catatonia is sometimes the rst recognized presentation of bipolar disorder. This could possibly explain why the other individuals taking the same drugs did not develop catatonia.…”

“…In pediatric patients, catatonia is associated with increased mortality and with psychiatric illnesses such as schizophrenia, major depression, encephalitis, and bipolar disorder [2]. Catatonia may also appear without any prior psychiatric comorbidity in the presence of medical and neurological illness, or as a result of prior intake of drugs, both prescribed [3] and illicit [1]. The incidence in adolescent patients admitted to psychiatric in-patient clinics has been estimated to 0.6% [4].…”