Episode 243: Catatonia in Children and Teens

Annabel Kuhn, M.D., Joshua Ryan Smith, M.D., David Puder, M.D.

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Today, Dr. David Puder and Dr. Annabel Kuhn interviewed Dr. Joshua Ryan Smith, MD, who is an Assistant Professor of Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center and the Division Director for Child and Adolescent Psychiatry. He is also the Medical Director of the MEND Clinic and Neuromodulation.

Dr. Joshua Smith’s conflict of interests:

MEND (Medical Exploration of Neurodevelopmental Disorder) Clinic Financial Support from the following industry-sponsored clinical trials in autism: Janssen, Roche, Axial, Vanda Pharmaceuticals, and Bristol Myers Squibb.

He also receives salary support from NICHD (1P50HD103537-01) and NIMH

(1R01MH135028-01A1).

Dr. Kuhn and Dr. Puder have no conflicts of interest.

What Is Catatonia?

• Complex neuropsychiatric syndrome

• If suspected, should prompt medical or psychiatric hospitalization for initial evaluation and treatment, to monitor response to medications.

• According to an invited review in the New England Journal of Medicine, the prevalence of catatonia in pediatric and adolescent populations is not precisely established, but the prevalence of catatonia in pediatric and adolescent populations is estimated to be between 0.6% and 1.7% among general child and adolescent psychiatric inpatients (Heckers & Walther, 2023).

• A feature of another underlying diagnosis (in children, the most often psychiatric cause of catatonia is a psychotic disorder)

• Catatonia is NOT a standalone diagnosis, catatonia is included in the DSM but ONLY as a specifier for another diagnosis. 

• Underlying organic conditions are highly prevalent (> 20% of the cases)

• Medical workup is necessary because some diagnoses may result in specific treatments (e.g., immune-modulating therapy for autoimmune conditions). If present and treatable, managing the underlying medical condition is necessary to address catatonic symptoms (Consoli et al., 2012; Lahutte et al., 2008).

• Untreated Catatonia is associated with one of the highest morbidity and mortality of all psychiatric diagnoses seen in childhood and adolescence. 

• According to a prospective follow up study from 2009, “Catatonia is one of the most severe psychiatric syndromes in adolescents. It is associated with a 60-fold increased risk of premature death, including suicide, when compared to the general population of same sex and age”  (Cornic et al., 2009, Abstract).

• Catatonia is underdiagnosed in pediatric and adolescent populations. 

• In children and adolescents with neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) or intellectual disability, catatonia is frequently misattributed to baseline behavioral or motor abnormalities, leading to significant diagnostic delays—median time to diagnosis can exceed 300 days in these groups compared to about two weeks in neurotypical patients. This underdiagnosis is supported by evidence of prolonged diagnostic delays, symptom overlap with primary psychiatric or neurodevelopmental disorders, and low rates of formal diagnosis despite high-risk comorbidities (Reinfeld & Gill 2023; Zappia et al., 2024). 

How Is Catatonia Diagnosed? 

• Physical exam

• Possibly the only psychiatric syndrome for which diagnosis absolutely relies on physical exam findings more so than clinical interview.

• Constellation of specific abnormal movements, diagnosis, and severity is evaluated using Bush-Francis Catatonia Rating Scale (BFCRS). There are specific findings in children that are not seen in adults, and so, for children, in addition to BFCRS, we also use Pediatric Catatonia Rating Scale (PCRS) (Benarous et al., 2016), and the KANNER Scale (Carroll et al., 2008).

• Acrocyanosis (PCRS)

• Incontinence (PCRS)

• Nudism (KANNER)

• Note that while each individual symptom that could possibly be seen in catatonia is not pathognomonic, even though these findings might seem very specific. 

• For example, many of the physical exam findings are seen in other neurological conditions such as major neurocognitive disorders, Parkinson’s disease, autoimmune encephalitis, metabolic encephalopathies, severe delirium, and rarely, certain structural brain lesions. 

• In 2024, Dr. Smith published a paper which suggests theoretical sensitivity of telehealth assessment of BFCRS remains relatively high (98%), if a patient’s family is able to engage well in the exam (Luccarelli et al., 2024a).

Bush Francis Catatonia Rating Scale

Excitement (video) (URMC Dept. of Psychiatry, 2022f)

Extreme hyperactivity, constant motor unrest which is apparently non-purposeful. Not to be attributed to akathisia or goal-directed agitation.

0 = Absent
1 = Excessive motion, intermittent
2 = Constant motion, hyperkinetic without rest periods
3 = Full-blown catatonic excitement, endless frenzied motor activity

Immobility/Stupor (video) (URMC Dept. of Psychiatry, 2022j)

Extreme hypoactivity, immobile, minimally responsive to stimuli.

1 = Sits abnormally still, may interact briefly
2 = Virtually no interaction with external world
3 = Stuporous, non-reactive to painful stimuli

Mutism (video) (URMC, Dept. of Psychiatry, 2022n)

Verbally unresponsive or minimally responsive.

0 = Absent

1 = Verbally unresponsive to majority of questions; incomprehensible whisper

2 = Speaks less than 20 words/5 minutes

3 = No speech

Staring (video) (URMC, Dept. of Psychiatry, 2022s)

Fixed gaze, little or no visual scanning of environment, decreased blinking.

0 = Absent
1 = Poor eye contact, repeatedly gazes less than 20 sec between shifting of attention; decreased blinking
2 = Gaze held longer than 20 sec, occasionally shifts attention
3 = Fixed gaze, non-reactive

Posturing/catalepsy (video) (URMC, Dept. of Psychiatry, 2022q)

Spontaneous maintenance of posture(s), including mundane (e.g., sitting/standing for long periods without reacting).

0 = Absent
1 = Less than one minute
2 = Greater than one minute, less than 15 minutes
3 = Bizarre posture, or mundane maintained more than 15 min

Grimacing (video) (URMC, Dept. of Psychiatry, 2022i)

Maintenance of odd facial expressions.

0 = Absent
1 = Less than 10 sec
2 = Less than 1 min
3 = Bizarre expression(s) or maintained more than 1 min

Echopraxia/Echolalia  (video) (URMC, Dept. of Psychiatry, 2022e)

Mimicking of examiner's movements/ speech.

0 = Absent
1 = Occasional
2 = Frequent
3 = Constant

Stereotypy  (video) (URMC, Dept. of Psychiatry, 2022t)

Repetitive, non-goal-directed motor activity (e.g. finger-play; repeatedly touching, patting or rubbing self); abnormality not inherent in act but in its frequency.

0 = Absent
1 = Occasional
2 = Frequent
3 = Constant

Mannerisms  (video) (URMC, Dept. of Psychiatry, 2022l)

Odd, purposeful movements (hopping or walking tiptoe, saluting passersby or exaggerated caricatures of mundane movements); abnormality inherent in act itself.

0 = Absent
1 = Occasional
2 = Frequent
3 = Constant

Verbigeration  (video) (URMC, Dept. of Psychiatry, 2022u)

Repetition of phrases or sentences (like a scratched record).

0 = Absent
1 = Occasional
2 = Frequent, difficult to interrupt
3 = Constant

Rigidity  (video) (URMC, Dept. of Psychiatry, 2022r)

Maintenance of a rigid position despite efforts to be moved, exclude if cog-wheeling or tremor present.

0 = Absent
1 = Mild resistance
2 = Moderate
3 = Severe, cannot be repostured

Negativism  (video) (URMC, Dept. of Psychiatry, 2022)

Apparently motiveless resistance to instructions or attempts to move/examine patient. Contrary behavior, does exact opposite of instruction.

0 = Absent
1 = Mild resistance and/or occasionally contrary
2 = Moderate resistance and/or frequently contrary
3 = Severe resistance and/or continually contrary

Waxy Flexibility  (video) (URMC, Dept. of Psychiatry, 2022o)

During reposturing of patient, patient offers initial resistance before allowing himself to be repositioned, similar to that of a bending candle.

0 = Absent
3 = Present

Withdrawal  (video) (URMC, Dept. of Psychiatry, 2022w)

Refusal to eat, drink and/or make eye contact.

0 = Absent
1 = Minimal PO intake/ interaction for less than one day
2 = Minimal PO intake/ interaction for more than one day
3 = No PO intake/interaction for one day or more

Impulsivity  (video) (URMC, Dept. of Psychiatry, 2022k)

Patient suddenly engages in inappropriate behavior (e.g. runs down hallway, starts screaming or takes off clothes) without provocation.  Afterwards can give no, or only a facile explanation.

0 = Absent
1 = Occasional
2 = Frequent
3 = Constant or not redirectable

Automatic Obedience  (video) (URMC, Dept. of Psychiatry, 2022b)

Exaggerated cooperation with examiner's request or spontaneous continuation of movement requested.

0= Absent
1= Occasional
2= Frequent
3= Constant

Mitgehen  (video) (URMC, Dept. of Psychiatry, 2022m)

"Anglepoise lamp" arm raising in response to light pressure of finger, despite instructions to the contrary.

0 = Absent
3 = Present

Gegenhalten  (video) (URMC, Dept. of Psychiatry, 2022g)

Resistance to passive movement which is proportional to strength of the stimulus, appears automatic rather than willful.

0 = Absent
3 = Present

Ambitendency  (video) (URMC, Dept. of Psychiatry, 2022a)

Patient appears motorically "stuck" in indecisive, hesitant movement.

0 = Absent
3 = Present

Grasp Reflex  (video) (URMC, Dept. of Psychiatry, 2022h)

Per neurological exam.

0 = Absent
3 = Present

Perseveration  (video) (URMC, Dept. of Psychiatry, 2022p)

Repeatedly returns to same topic or persists with movement.

0 = Absent
3 = Present

Combativeness  (video) (URMC, Dept. of Psychiatry, 2022d)

Usually in an undirected manner, with no, or only a facile explanation (ie simple explanation while not acknowledging the complexities of what just occurred) afterwards.

0 = Absent
1 = Occasionally strikes out, low potential for injury
2 = Frequently strikes out, moderate potential for injury
3 = Serious danger to others

Autonomic Abnormality  (video) (URMC, Dept. of Psychiatry, 2022b)

Abnormality of temperature, BP, pulse, respiratory rate, diaphoresis.

0 = Absent
1 = Abnormality of one parameter [exclude pre-existing hypertension]
2 = Abnormality of 2 parameters
3 = Abnormality of 3 or greater parameter

Causes Of Catatonia In Children

• Catatonia is never a standalone diagnosis. If you see catatonia, ask yourself, “What underlying diagnosis may be present and is causing catatonic symptoms?”

• There is extremely limited research surrounding causes of catatonia in children. The most common cause appears to be schizophrenia, followed by an underlying medical diagnosis, but there is no clear consensus about exactly how frequently it is associated with each diagnosis. 

• Among children and adolescents with catatonia:

• 30-40% of pediatric and adolescent catatonia cases are thought to be related to schizophrenia (Benarous et al., 2018; Consoli et al., 2012)

• Schizophrenia is exceedingly rare in children and adolescents, particularly in prepubertal children, with an estimated prevalence of childhood-onset schizophrenia of approximately 1 in 10,000 and only a handful of cases identified in large national datasets over many years. (Leslie & O’Sullivan, 2023)

• 20–22% of pediatric and adolescent catatonia cases are thought to be related to underlying medical conditions (Benarous et al., 2018; Consoli et al., 2012).

• The remainder of cases are due to mood disorders, developmental disorders, and other psychiatric conditions (Benarous et al., 2018; Consoli et al., 2012).

• Underlying medical condition 

• Brain cancer or brain mass

• Autoimmune encephalitis 

• Anti NMDA receptor encephalitis (Consoli et al., 2012)

• Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS) (Elia et al., 2005)

• Lupus (Lanham et al., 1985)

• Epilepsy (Consoli et al., 2012)

• Metabolic conditions 

• Wilson disease, homocystinurias, adrenoleukodystrophy and some lysosomal disorders (Sedel et al., 2007).

• Underlying psychiatric conditions

• Schizophrenia (most common cause of catatonia in children and adolescents, as stated above) (Cornic et al., 2007)

• Mood disorders (i.e., bipolar disorder, major depressive disorder) (Benarous et al., 2018)

• Developmental disorders (Benarous et al., 2018)

• Trauma history (Benarous et al., 2018)

• Autism

• “Our meta-analysis showed that 10.4% (5.8–18.0 95%CI) of individuals with ASD have catatonia” (Vaquerizo-Serrano et al., 2022, Results).

• Diagnosis is challenging due to overlapping symptoms.

• Suspect catatonia when there is a sudden and sustained increase in motor symptoms, or onset of new symptoms (food refusal).

• Substances (Benarous et al., 2018)

• Synthetic marijuana

• Ecstasy/MDMA

• Bath salts

• Medications (evidence mostly limited to case reports)

• Corticosteroid

• According to a case report (Sullivan & Dickerman, 1979)

• Insulin

• Case report involving a patient with  symptoms of catatonia in setting of post-insulin coma encephalopathy following a suicide attempt via intentional insulin overdose (Consoli et al., 2012)

•  Antiretroviral agents

• According to a case report (Lingeswaran, 2014) 

• Antipsychotics

• According to a systematic review by Virolle et al., from 2023:

• Any antipsychotic medication, even second generation monotherapy prescribed at recommended doses, pose a risk of inducing catatonia.

• First generation antipsychotics and polypharmacy seem to pose a higher risk of antipsychotic-induced catatonia.

Treatment

We will discuss the role of lorazepam in treating catatonia symptoms. It is imperative to treat the underlying condition. Note that schizophrenia is the most common cause of catatonia in children and adolescents. However, antipsychotics can worsen and even cause catatonia. Management requires close monitoring and a delicate balance of medications. 

Lorazepam challenge

Among 54 patients (median age 16 years, 48.1% female, 44.4% with neurodevelopmental disabilities), treatment with lorazepam significantly reduced mean BFCRS scores from 16.6 ± 6.1 to 9.5 ± 5.3 (mean difference 7.1; t=9.0, df=53, p<0.001; Hedges's g=1.20, 95% CI: 0.85–1.55), with no significant associations between clinical response and lorazepam dose, route of administration, age, sex, study site, presence of neurodevelopmental disorders, hyperactive catatonic features, or treatment-to-reassessment interval (Luccarelli et al., 2024).

“In most cases, symptoms are drastically reduced within three hours after receiving 1 to 3 mg of lorazepam. When a positive response is observed, a titration should be completed to maintain the dose that achieves a complete resolution of symptoms. This symptomatic treatment should be maintained until the underlying cause of catatonia is found and appropriately treated” (Benarous et al., 2018, Benzodiazepines). 

• Lorazepam

• BFCRS (Bush Francis Catatonia Rating Scale) immediately before first dose and 30 min after.

• If there is any improvement at all, diagnosis is confirmed.

• Continue at 2 mg IV Q6h, may have to increase dose until symptom improvement.

• There is no maximum dose of lorazepam when treating catatonia. The dose should be increased as needed and as tolerated, with the most common side effect being sedation. If a child is severely catatonic, there will be very little sedation from lorazepam.

• A child might begin to appear more sedated if the dose is too high, or if the syndrome is beginning to improve and the lorazepam is no longer “working on” the catatonia, and is “spilling over” and leading to sedation. Would decrease dose.

• In a naturalistic study of 66 children and adolescents with catatonia, the response rate for benzodiazepines was approximately 65%.The mean daily dose of lorazepam was 5.35 ± 3.64 mg/day and reached 15 mg/day in some patients (Raffin et al., 2015). 

• Among 165 patients hospitalized for catatonia (median age 15, 50.3% with neurodevelopmental disorders), 164 received benzodiazepines (median maximum 24-hour dose: 6 mg lorazepam-equivalents, 14.5% underwent electroconvulsive therapy (ECT), and an ordinal regression model indicated an 88.3% probability of achieving at least "much improvement" (CGI < 3). (Luccarelli et al., 2025).

• Challenges

• Lorazepam is not FDA approved to treat catatonia. It is not approved to treat catatonia in either children or adults.

• The lack of FDA approval for this indication may be due to the absence of large-scale, randomized controlled trials submitted to the FDA for this specific use. Nonetheless, the off-label use of lorazepam for catatonia is supported by clinical evidence and is a common practice among healthcare providers.

• Potential for initial worsening of score due to “waking up” out of stuporous catatonic state, may see more symptoms initially. Providers may think the patient failed the lorazepam challenge and start seeking other diagnoses.

• It’s crucial to monitor the patient closely after administering the dose, as there may be a brief period of improvement prior to the patient falling asleep that can be easily missed. If you are not present to observe, it may appear as though the patient simply fell asleep, potentially leading to the incorrect assumption that there was no catatonia to begin with. 

• This is where parent observations become especially valuable. They may note that the child seemed a bit more like themselves before falling asleep. If so, this supports the diagnosis of catatonia and suggests the dose was too high. In this case, the dose should be adjusted downward based on the response.

• Paradoxical reaction

• Paradoxical reactions to benzodiazepines in children with autism spectrum disorder (ASD) are uncommon, but the precise prevalence is not well established. In the general pediatric population, paradoxical reactions—characterized by agitation, disinhibition, aggression, or hyperactivity—occur in less than 1% of children exposed to benzodiazepines such as midazolam. However, there is evidence suggesting that children with ASD may be at increased risk for such reactions, likely due to underlying differences in GABAergic neurotransmission associated with ASD (Hanamoto et al., 2023).

• If history of paradoxical reaction, consider risks/benefits, may consider ECT sooner if unable to safely use a benzodiazepine. 

• Outpatient providers do not commonly prescribe high dose lorazepam

• The most common dose and frequency for outpatient lorazepam prescriptions is 2 to 3 mg per day, administered orally, in two or three divided doses. This regimen is typically used for the management of anxiety disorders or for short-term relief of anxiety symptoms (Lorazepam FDA drug label).

• On average, children with catatonia require 6 mg/day (Luccarelli et al., 2025), some cases requiring escalation to higher daily doses (e.g., up to 16–24 mg/day in refractory or severe presentations) (Ridgeway et al., 2021).

• Withdrawal if discontinued suddenly

• “At discharge, most patients continued benzodiazepines, though at reduced doses (median: 3 mg lorazepam equivalents per day). No prospective data currently guide benzodiazepine tapering strategies for this population” (Luccarelli et al., 2024c, Discussion).

• Rapid withdrawal of benzodiazepines can result in resurgence of catatonic symptoms, and can result in seizure and death (Lorazepam FDA drug label).

• A gradual reduction of approximately 0.5 mg per month may be reasonable, with careful monitoring for recurrence of catatonia.

• Oversedation (must be seen for frequent visits) 

• Dependence

• Diversion

• If lorazepam doesn't work

• ECT (which, unlike lorazepam, IS FDA approved to treat catatonia in individuals ages 13 and up) (USDA, 2018)

• Balance lorazepam dosing/seizure threshold, involve ECT psychiatrist in medication management.

• Avoid rapid discontinuation of lorazepam for the sake of ECT due to risk of worsening catatonia symptoms, risk of seizure and death from benzodiazepine withdrawal.

• Another benzodiazepine (clonazepam or diazepam)

• Among patients treated with benzodiazepines, 21.5% required sequential trials with more than one benzodiazepine, commonly involving longer-acting agents such as clonazepam and diazepam (Luccarelli et al., 2024c, Discussion).

• Memantine (FDA approved to treat Alzheimer’s Disease) 

• Case reports have supported safety and potential efficacy (Chaffkin et al., 2022)

• Anti-seizure medications

• There are several reports describing the use of carbamazepine, valproic acid, topiramate, levetiracetam and zonisamide in adult catatonia (Beach et al., 2017). There is currently no published evidence to support the use of anti-seizure medications in children with catatonia. 

Conclusion:

Pediatric catatonia is a rare but underdiagnosed condition that is always secondary to an underlying cause. In children, it is most commonly associated with schizophrenia (30–40%) and medical conditions (20%), and is also frequently seen in the context of neurodevelopmental disorders such as autism spectrum disorder. Diagnosis in both pediatric and adult populations is typically made using the Bush-Francis Catatonia Rating Scale (BFCRS); however, in younger patients, clinicians may consider using the KANNER Scale or the Pediatric Catatonia Rating Scale (PCRS), which highlight symptoms more specific to pediatric presentations, such as nudism, acrocyanosis, and incontinence. First-line treatment is lorazepam, which is effective in over 60% of cases. A positive response to the initial dose should prompt scheduled dosing at regular intervals. For patients 13 and older who do not respond to benzodiazepines, electroconvulsive therapy (ECT)—an FDA-approved treatment for catatonia in adolescents—should be considered as a second-line intervention.

References:

Ativan [lorazepam] tablets. (2023, January 13). In DailyMed (Label ID 89057c93‑8155‑4040‑acec‑64e877bd2b4c). U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=89057c93-8155-4040-acec-64e877bd2b4c

Beach, S. R., Gomez-Bernal, F., Huffman, J. C., & Fricchione, G. L. (2017). Alternative treatment strategies for catatonia: A systematic review. General hospital psychiatry, 48, 1–19. https://doi.org/10.1016/j.genhosppsych.2017.06.011 

Benarous, X., Consoli, A., Raffin, M., Bodeau, N., Giannitelli, M., Cohen, D., & Olliac, B. (2016). Pediatric Catatonia Rating Scale (PCRS) [Database record]. APA PsycTests.

https://doi.org/10.1037/t57203-000 

Benarous, X., Raffin, M., Ferrafiat, V., Consoli, A., & Cohen, D. (2018). Catatonia in children and adolescents: New perspectives. Schizophrenia research, 200, 56–67. https://doi.org/10.1016/j.schres.2017.07.028 

Carroll, B. T., Kirkhart, R., Ahuja, N., Soovere, I., Lauterbach, E. C., Dhossche, D., & Talbert, R. (2008). Katatonia: A new conceptual understanding of catatonia and a new rating scale. Psychiatry (Edgmont), 5(12), 42–50. https://pubmed.ncbi.nlm.nih.gov/19724775/ 

Chaffkin, J., Josephs, I. A., & Katz, E. R. (2022). Safe Use of Memantine in a Pediatric Patient With Catatonia. Journal of the American Academy of Child and Adolescent Psychiatry, 61(12), 1401–1403. https://doi.org/10.1016/j.jaac.2022.05.007 

Consoli, A., Raffin, M., Laurent, C., Bodeau, N., Campion, D., Amoura, Z., Sedel, F., An-Gourfinkel, I., Bonnot, O., & Cohen, D. (2012). Medical and developmental risk factors of catatonia in children and adolescents: a prospective case-control study. Schizophrenia research, 137(1-3), 151–158. https://doi.org/10.1016/j.schres.2012.02.012 

Cornic, F., Consoli, A., & Cohen, D. (2007). Catatonia in children and adolescents. Psychiatric Annals, 37(1), 19–26. https://doi.org/10.3928/00485713-20070101-05 

Cornic, F., Consoli, A., Tanguy, M. L., Bonnot, O., Périsse, D., Tordjman, S., Laurent, C., & Cohen, D. (2009). Association of adolescent catatonia with increased mortality and morbidity: evidence from a prospective follow-up study. Schizophrenia research, 113(2-3), 233–240. https://doi.org/10.1016/j.schres.2009.04.021 

Elia, J., Dell, M. L., Friedman, D. F., Zimmerman, R. A., Balamuth, N., Ahmed, A. A., & Pati, S. (2005). PANDAS with catatonia: A case report. Therapeutic response to lorazepam and plasmapheresis. Journal of the American Academy of Child & Adolescent Psychiatry, 44(11), 1145–1150. https://doi.org/10.1097/01.chi.0000179056.54419.5e 

Hanamoto, H., Hirose, Y., Toyama, M., Yokoe, C., Oyamaguchi, A., & Niwa, H. (2023). Effect of midazolam in autism spectrum disorder: A retrospective observational analysis. Acta anaesthesiologica Scandinavica, 67(5), 606–612. https://doi.org/10.1111/aas.14211 

Heckers, S., & Walther, S. (2023). Catatonia. New England Journal of Medicine, 389(19), 1797-1802. https://doi.org/10.1056/NEJMra2116304 

Lahutte, B., Cornic, F., Bonnot, O., Consoli, A., An-Gourfinkel, I., Amoura, Z., Sedel, F., & Cohen, D. (2008). Multidisciplinary approach of organic catatonia in children and adolescents may improve treatment decision making. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 32(6), 1393–1398. https://doi.org/10.1016/j.pnpbp.2008.02.015

Lanham, J. G., Brown, M. M., & Hughes, G. R. V. (1985). Cerebral systemic lupus erythematosus presenting with catatonia. Postgraduate Medical Journal, 61(714), 329–330. https://doi.org/10.1136/pgmj.61.714.329 

Leslie, A. C., & O'Sullivan, M. (2023). The Triad of Childhood-Onset Schizophrenia, Autism Spectrum Disorder, and Catatonia: A Case Report. Schizophrenia bulletin, 49(2), 239–243. https://doi.org/10.1093/schbul/sbac200 

Lingeswaran, A. (2014). Antiretroviral treatment induced catatonia in a 16-year-old boy. Journal of Pediatric Neurosciences, 9(3), 283–285. https://doi.org/10.4103/1817-1745.147598 

Luccarelli, J., Smith, J. R., Heckers, S., Fricchione, G., & Wilson, J. E. (2024a). The theoretical sensitivity of virtual assessment of catatonia. Schizophrenia Research, 274, 486-488. https://doi.org/10.1016/j.schres.2024.10.020

Luccarelli, J., McCoy, T. H., York, T., Baldwin, I., Fricchione, G., Fuchs, C., & Smith, J. R. (2024b). The effectiveness of the lorazepam challenge test in pediatric catatonia: A multisite retrospective cohort study. Schizophrenia Research, 270, 410–415. https://doi.org/10.1016/j.schres.2024.07.004

Luccarelli, J., Clauss, J. A., York, T., Baldwin, I., Vandekar, S., McGonigle, T., Fricchione, G., Fuchs, C., & Smith, J. R. (2024c). Exploring the Trajectory of Catatonia in Neurodiverse and Neurotypical Pediatric Hospitalizations: A Multicenter Longitudinal Analysis. medRxiv : the preprint server for health sciences, 2024.06.06.24308554. https://doi.org/10.1101/2024.06.06.24308554 

Luccarelli, J., Clauss, J. A., York, T., Baldwin, I., Vandekar, S., McGonigle, T., Fricchione, G., Fuchs, C., & Smith, J. R. (2025). Hospitalizations for pediatric catatonia in neurodivergent and neurotypical patients. General hospital psychiatry, 95, 133–139. https://doi.org/10.1016/j.genhosppsych.2025.05.003 

Raffin, M., Zugaj-Bensaou, L., Bodeau, N., Milhiet, V., Laurent, C., Cohen, D., & Consoli, A. (2015). Treatment use in a prospective naturalistic cohort of children and adolescents with catatonia. European Child & Adolescent Psychiatry, 24(4), 441–449. https://doi.org/10.1007/s00787-014-0595-y 

Reinfeld, S., & Gill, P. (2023). Diagnostic overshadowing clouding the efficient recognition of pediatric catatonia: a case series. CNS spectrums, 28(5), 587–591. https://doi.org/10.1017/S1092852922001158 

Ridgeway, L., Okoye, A., McClelland, I., Dhossche, D., Kutay, D., & Loureiro, M. (2021). Case Report: A Case of Pediatric Catatonia: Role of the Lorazepam Challenge Test. Frontiers in psychiatry, 12, 637886. https://doi.org/10.3389/fpsyt.2021.637886 

Sedel, F., Baumann, N., Turpin, J. C., Lyon‐Caen, O., Saudubray, J. M., & Cohen, D. (2007). Psychiatric manifestations revealing inborn errors of metabolism in adolescents and adults. Journal of Inherited Metabolic Disease: Officialhttps://www.youtube.com/watch?v=8mvcg8lYbCUJournal of the Society for the Study of Inborn Errors of Metabolism, 30(5), 631-641. https://doi.org/10.1007/s10545-007-0661-4

Sullivan, B. J., & Dickerman, J. D. (1979). Steroid-associated catatonia: Report of a case. Pediatrics, 63(4), 677–679. https://doi.org/10.1542/peds.63.4.677 

U.S. Food and Drug Administration (USDA). (2018, December 21). FDA takes action to ensure regulation of electroconvulsive therapy devices better protects patients, reflects current understanding of safety and effectiveness [Press release]. https://www.fda.gov/news-events/fda-brief/fda-takes-action-ensure-regulation-electroconvulsive-therapy-devices-better-protects 

URMC Dept. of Psychiatry. (2022a, June 6). Ambitendency: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/F4iu7X2_EFs

URMC Dept. of Psychiatry. (2022b, June 6). Autonomic Abnormality: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/A7l6eB3Kwf0

URMC Dept. of Psychiatry. (2022c, June 6). Automatic obedience: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/dW5gYLWINyA

URMC Dept. of Psychiatry. (2022d, June 6). Combativeness: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/Nr7Rp_V1nZ4

URMC Dept. of Psychiatry. (2022e, June 6). Echopraxia / Echolalia: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://www.youtube.com/watch?v=8mvcg8lYbCU

URMC Dept. of Psychiatry. (2022f, June 6). Excitement: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://www.youtube.com/watch?v=mIbI-v6Q-jU

URMC Dept. of Psychiatry. (2022g, June 6). Gegenhalten: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/2eez4EXPPT4

URMC Dept. of Psychiatry. (2022h, June 6). Grasp Reflex: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/ks7_HZ8mgwM

URMC Dept. of Psychiatry. (2022i, June 6). Grimacing: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://www.youtube.com/watch?v=hxdJoqmvLos

URMC Dept. of Psychiatry. (2022j, June 6). Immobility/Stupor: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://www.youtube.com/watch?v=-jcW3wlmOEo

URMC Dept. of Psychiatry. (2022k, June 6). Impulsivity: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/cmA1JoJxjGQ

URMC Dept. of Psychiatry. (2022l, June 6). Mannerisms: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/gNC7DGa95jo

URMC Dept. of Psychiatry. (2022m, June 6). Mitgehen: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/xtjMxbjJ8yU

URMC Dept. of Psychiatry. (2022n, June 6). Mutism: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://www.youtube.com/watch?v=h8cLSRkp2Io

URMC Dept. of Psychiatry. (2022o, June 6). Negativism: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/dOlXxBmhwdg

URMC Dept. of Psychiatry. (2022p, June 6). Perseveration: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/RV1JjOXzA5U

URMC Dept. of Psychiatry. (2022q, June 6). Posturing/Catalepsy: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://www.youtube.com/watch?v=SPJslTt4Rgc

URMC Dept. of Psychiatry. (2022r, June 6). Rigidity: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/12BfJSzYuw0

URMC Dept. of Psychiatry. (2022s, June 6). Staring: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://www.youtube.com/watch?v=26bAY75JvXk

URMC Dept. of Psychiatry. (2022t, June 6). Stereotypy: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://www.youtube.com/watch?v=fxN_SvcnzYQ

URMC Dept. of Psychiatry. (2022u, June 6). Verbigeration: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/vKzDO-aBD2I

URMC Dept. of Psychiatry. (2022v, June 6). Waxy flexibility: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/DdTR8QzA7No

URMC Dept. of Psychiatry. (2022w, June 6). Withdrawal: Bush‑Francis Catatonia Rating Scale [Video]. YouTube. https://youtu.be/6eG7KL-IB3A

Vaquerizo-Serrano, J., Salazar De Pablo, G., Singh, J., & Santosh, P. (2022). Catatonia in autism spectrum disorders: A systematic review and meta-analysis. European Psychiatry, 65(1), e4. DOI: https://doi.org/10.1192/j.eurpsy.2021.2259 

Virolle, J., Redon, M., Montastruc, F., Taïb, S., Revet, A., Zivkovic, V., Da Costa, J., & Very, E. (2023). What clinical analysis of antipsychotic-induced catatonia and neuroleptic malignant syndrome tells us about the links between these two syndromes: A systematic review. Schizophrenia research, 262, 184–200. https://doi.org/10.1016/j.schres.2023.08.003 

Zappia, K. J., Shillington, A., Fosdick, C., Erickson, C. A., Lamy, M., & Dominick, K. C. (2024). Neurodevelopmental Disorders Including Autism Spectrum Disorder and Intellectual Disability as a Risk Factor for Delayed Diagnosis of Catatonia. Journal of developmental and behavioral pediatrics : JDBP, 45(2), e137–e142. https://doi.org/10.1097/DBP.0000000000001252