Unmasking the Enigma: A Case Report of Catatonia Unveiled As Munchausen by Proxy 2023 Takher and Cosme

Abstract

Catatonia is a behavioral syndrome characterized by a variety of symptoms such as mutism, stupor, rigidity, negativism, and verbigeration. It can be caused by various psychiatric and general medical conditions. While the diagnosis in the pediatric population is relatively uncommon, emerging literature supports a higher prevalence of catatonia in children. We present a 12-year-old girl with a complex medical and psychosocial history, including a functional neurological disorder and concerns for child abuse and Munchausen syndrome by proxy imposed by her mother. The patient was initially admitted for medical management of vomiting and refusal to eat. Child psychiatry was consulted for further assessment and noted multiple catatonic symptoms with a Busch-Francis catatonia rating scale (BFCRS) score of 22. A subsequent 1 mg IV lorazepam challenge test showed improvement in the patient's symptoms with a repeat BFCRS score of 10. This case supports emerging literature suggesting a higher prevalence of catatonia in children and the importance of recognizing this syndrome and its wide array of underlying causes.

Open access, https://www.cureus.com/articles/173...-catatonia-unveiled-as-munchausen-by-proxy#!/

 

verbigeration
n. An obsessive repetition of meaningless words and phrases, especially as a symptom of mental illness.

Hmm, that sounds familiar.

 

From the first quote in post #2 - but I've changed the bolding :

What is "medical child abuse"? Abuse carried out by medical professionals? Or abuse carried out by a family member which can be spotted by medical professionals?

 

And PANS/PANDAS is one that every so often I see trying to be flagged as existing by those who I assume there often have experiences of it not being thought of enough as a differential diagnosis, the symptoms listed made me think of that initially too but it doesn't note it being ruled out.

Agree that without being confident the purpose has been for genuine inter/multidisciplinary geting to the bottom of from a patient's best interests perspective, rather than a description of the approach of one institution or specialism I can't be confident of conclusions either. If we could be confident that both were able to be present in the literature then the contrast would surely provide stark insight as to where different 'approaches' 'rub-up' against each other?

 

This is literally just the first result in a quick google for whether PANS?PANDAS respondds to ativan, so haven't analysed methods or bias etc
PANDAS with catatonia: a case report. Therapeutic response to lorazepam and plasmapheresis, Elia et al (2005)
https://pubmed.ncbi.nlm.nih.gov/16239863/

It is mentioned in the following paper as part of individualised approaches to consider (with antimicrobials, plasmapheresis and immunomodulators and psychotherapy also there among others):
Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I—Psychiatric and Behavioral Interventions, THienneman et al (2017)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610394/

https://www.panspandasuk.org/faq-s describes: