Indian Journal of Private Psychiatry

Register      Login

VOLUME 17 , ISSUE 2 ( July-December, 2023 ) > List of Articles


Catatonia in Young Male with Cerebral Palsy and Intellectual Disability: A Case Report

Ashmeet Singh, Jasleen Kaur Bhalla

Keywords : Catatonia, Cerebral palsy, Intellectual disability, Periventricular leukomalacia, Quality of life

Citation Information : Singh A, Bhalla JK. Catatonia in Young Male with Cerebral Palsy and Intellectual Disability: A Case Report. Ind J Priv Psychiatry 2023; 17 (2):95-98.

DOI: 10.5005/jp-journals-10067-0127

License: CC BY-NC 4.0

Published Online: 14-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: To consider the possibility of an organic cause vs mental health-related cause in a young patient of cerebral palsy presenting with catatonic features. Background: The catatonic symptoms in a young patient with cerebral palsy and intellectual disability can either be a sequelae of the preexisting organicity or has an independent organic or psychological cause. One of the organic causes is the white matter loss in the brain parenchyma-like periventricular leukomalacia (PVL) due to perinatal hypoxic insult that leads to cerebral palsy and consequent intellectual disability. Case description: We present the case report of a 20-year-old male who presented with acute onset of catatonic symptoms in the absence of any preexisting psychiatric disorder. His general physical examination manifested spastic diplegia, mutism, negativism, posturing, and staring gaze without any other focal neurological deficits. The routine blood investigations were within normal limits, whereas the MRI brain was suggestive of PVL with white matter loss and thinning of corpus callosum. The neurology consults suggested conservative management for the same, and the patient was managed with Lorazepam and Olanzapine, following which his catatonic symptoms started improving. During his hospital stay, intellectual quotient was assessed that revealed moderate level of intellectual disability. Conclusion: It is difficult to absolutely ascertain whether the organicity had direct influence on the patients presenting psychiatric symptoms or not. However, due to the neuropsychological changes, one cannot exclude the possibility that the sequelae of PVL or intellectual disability might have played a role in this case. Clinical significance: This raises considerable problems when it comes to choosing a therapeutic strategy for such a patient like whether the medical intervention alone or along with assistive therapies for the damaged white matter and intellectual disability would change the course, prognosis, and the outcome of the psychiatric symptoms or whether the psychopharmacological intervention would be sufficient for a better outcome and quality of life of the patient.

  1. Lahutte B, Cornic F, Bonnot O, et al. Multidisciplinary approach of organic catatonia in children and adolescents may improve treatment decision making. Prog Neuropsychopharmacol Biol Psychiatry 2008;32(6):1393–1398. DOI: 10.1016/j.pnpbp.2008.02.015.
  2. Grover S, Sahoo S, Chakravarty R, et al. Comparative study of symptom profile of catatonia in patients with psychotic disorders, affective disorders and organic disorders. Asian J Psychiatr 2019;43:170–176. DOI:10.1016/j.ajp.2019.05.024s.
  3. Hamlin DW, Hussain N, Pathare A. Storms and silence: A case report of catatonia and paroxysmal sympathetic hyperactivity following cerebral hypoxia. BMC Psychiatry 2020;20(1):473. DOI: 10.1186/s12888-020-02878-5S.
  4. Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral palsy: Current opinions on definition, epidemiology, risk factors, classification and treatment options. Neurcvopsychiatr Dis Treat 2020;16:1505–1518. DOI: 10.2147/NDT.S235165S.
  5. CDC. The mental health of people with disabilities. Centers for Disease Control and Prevention 2021. Available from:
  6. McMahon J, Harvey A, Reid SM, et al. Anxiety in children and adolescents with cerebral palsy. J Paediatr Child Health 2020;56(8): 1194–1200. DOI: 10.1111/jpc.14879.
  7. Richards CF, Gurr DE. Psychosis. Emerg Med Clin North Am 2000;18(2):253–262. DOI: 10.1016/s0733-8627(05)70122-x.
  8. Whitney DG, Warschausky SA, Ng S, et al. Prevalence of mental health disorders among adults with cerebral palsy: A cross-sectional analysis. Ann Intern Med 2019;171(5):328–333. DOI: 10.7326/M18-3420s.
  9. Smith KJ, Peterson MD, O'Connell NE, et al. Risk of depression and anxiety in adults with cerebral palsy. JAMA Neurol 2019;76(3): 294–300. DOI: 10.1001/jamaneurol.2018.4147.
  10. Blackshaw S, Bowen RC. A case of atypical psychosis associated with alexithymia and a left fronto-temporal lesion: Possible correlations. Can J Psychiatry 1987;32(8):688–692. DOI: 10.1177/070674378703200809.
  11. Frame DS, Kercher EE. Acute psychosis. Functional versus organic. Emerg Med Clin North Am 1991;9(1):123–136. PMID: 2001662.
  12. Price T. Neuropsychiatric aspects of brain tumours. Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Benjamin J. Sadock VAS; Philadelphia: Lippincott Williams & Wilkins; 2005.
  13. Sorg EM, Chaney-Catchpole M, Hazen EP. Pediatric catatonia: A case series-based review of presentation, evaluation, and management. Psychosomatics 2018;59(6):531–538. DOI: 10.1016/j.psym.2018.05.012s.
  14. Grover S, Suman A, Shouan A. Catatonia in a young woman with intellectual disability and vitamin D deficiency managed with electroconvulsive therapy. J Ment Health Hum Behav 2020;25(1): 60–62. DOI: 10.4103/jmhhb.jmhhb_22_20.
  15. Bush G, Fink M, Petrides G, et al. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand 1996;93(2):129–136. DOI: 10.1111/j.1600-0447.1996.tb09814.x.
  16. Shorter E, Wachtel LE. Childhood catatonia, autism and psychosis past and present: Is there an “iron triangle”? Acta Psychiatr Scand 2013;128(1):21–33. DOI: 10.1111/acps.12082.
  17. Rosebush PI, Hildebrand AM, Furlong BG, et al. Catatonic syndrome in a general psychiatric inpatient population: Frequency, clinical presentation, and response to lorazepam. J Clin Psychiatry 1990;51(9):357–362. PMID: 2211547.
  18. Peralta V, Cuesta MJ. Motor features in psychotic disorders. II. Schizophr Res 2001;47(2–3):117–126. DOI: 10.1016/s0920-9964(00)00035-9.
  19. Peralta V, Campos MS, de Jalon EG, et al. DSM-IV catatonia signs and criteria in first-episode, drug-naive, psychotic patients: Psychometric validity and response to antipsychotic medication. Schizophr Res 2010;118(1–3):168–175. DOI: 10.1016/j.schres.2009.12.023.
  20. Morrison JR. Catatonia. Retarded and excited types. Arch Gen Psychiatry 1973;28(1):39–41. DOI: 10.1001/archpsyc.1973.01750 310023005.
  21. Thakur A, Jagadsen K, Dutta S, et al. Incidence of catatonia in children and adolescents in a pediatric psychiatric clinic. Aust N Z J Psychiatry 2003;37(2):200–203. DOI: 10.1046/j.1440-1614.2003.01125.x.
  22. Dhossche DM, Ross CA, Stoppelbein L. The role of deprivation, abuse, and trauma in pediatric catatonia without a clear medical cause: The role of deprivation, abuse, and trauma in pediatric catatonia without a cslear medical cause. Acta Psychiatr Scand 2012;125(1):25–32. DOI: 10.1111/j.1600-0447.2011.01779.x.
  23. Sienaert P, Dhossche DM, Vancampfort D, et al. A clinical review of the treatment of catatonia. Front Psychiatry 2014;5:181. DOI: 10.3389/fpsyt.2014.00181.
  24. Dhossche DM, Stoppelbein L, Rout UK. Etiopathogenesis of catatonia: Generalizations and working hypothesess. J ECT 2010;26(4):253–258. DOI: 10.1097/YCT.0b013e3181fbf96d.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.