Organic Causes of Catatonia in Youth
Most Common Organic Etiologies
In children and adolescents with catatonia, organic medical conditions are present in over 20% of cases, with infectious diseases, neurological conditions, toxic/drug-induced states, and genetic/metabolic disorders representing the four major categories. 1, 2
Primary Categories of Organic Causes
Infectious Diseases (most frequently reported):
- Autoimmune encephalitis, particularly anti-NMDA receptor encephalitis and systemic lupus erythematosus 1
- Viral encephalitis and meningitis 3
- HIV-related syndromes 3
Neurological Conditions:
- Seizure disorders 3, 1
- CNS lesions including brain tumors, congenital malformations, and head trauma 3
- Cerebral venous sinus thrombosis 4
Toxic and Drug-Induced States:
- Substances of abuse: amphetamines, cocaine, hallucinogens, phencyclidine, alcohol, marijuana, and solvents 3
- Medications: stimulants, corticosteroids, anticholinergic agents, and cyclosporin 3, 1
- Benzodiazepine or clozapine withdrawal 4
- Heavy metal toxicity 3
Genetic and Metabolic Disorders:
- Wilson's disease 3, 5
- Chorea (including Huntington's disease) 3, 1
- Lipid storage disorders 3, 1
- PRODH gene mutations 1
- Fatal familial insomnia 1
- Cerebrospinal fluid 5-HT deficits 1
- Velocardiofacial syndrome 3
Endocrine and Metabolic Disturbances:
Critical Clinical Implications
The high prevalence of organic causes in pediatric catatonia (22.4% in prospective studies) mandates aggressive medical workup, as six patients in one series responded only to condition-specific treatments such as plasma exchange for autoimmune encephalitis or copper chelators for Wilson's disease. 1
Mortality Risk
Three of 38 pediatric patients with organic catatonia died from their underlying condition in one comprehensive review, underscoring that delayed diagnosis of medically-related catatonia can deny patients life-saving treatment opportunities. 5, 1
Age-Specific Considerations
Neurodevelopmental disorders (present in 31% of pediatric catatonia cases) represent an important risk factor unique to youth, with autism spectrum disorder, Down syndrome, and Prader-Willi syndrome specifically documented as predisposing conditions. 1, 6
Diagnostic Pitfall
Diagnostic overshadowing occurs frequently in children with pre-existing neurodevelopmental disorders, where acute behavioral regression from catatonia is mistakenly attributed to the underlying condition rather than recognized as a new, treatable syndrome. 6