Catatonia is a potentially life-threatening but treatable neuropsychiatric syndrome. The prevalence of catatonia in children and adolescents is probably underestimated since investigation on this matter is still lacking. Different studies have led to the recognition of catatonia as a separate psychiatric entity, as reflected in DSM-5, renewing interest on this subject. While in the adult population there is evidence highlighting the strong association between catatonia and affective disorders, this has been poorly reflected in child and adolescent psychiatry literature. In fact, most of the research in this population focuses on associations with organic, psychotic or developmental disorders.

We aim to illustrate the diagnostic challenges when facing an adolescent with catatonia encompassing psychiatric, neurologic and immunologic factors known as possible causes for this condition. We aim to explain the diagnostic procedure and the possible clinical results of this workup, as well as raise the discussion around treatment options.

We used a clinical case vignette of a 14-year-old adolescent, presenting with a stress-induced catatonic syndrome and depressive symptoms without any prior organic or psychiatric condition. We reviewed the most relevant literature in order to contextualize our clinical case.

Catatonia is an under-recognized condition in children and adolescents without a prior medical or psychiatric condition, especially when associated with affective disorders. The inclusion of catatonia as a specific syndrome in the psychiatric nosography may help its recognition. Case reports on this matter are therefore especially important as a way of pushing clinical investigation on this matter forward.