An intricate connection between the mind and body: A case study of a 12-yearold girl with behavioural changes for 1 ½ years presenting with catatonic symptoms from Dehiwala

Abstract

This case study focuses on a 12-year-old girl from Dehiwala, Sri Lanka who presented with behavioural changes for 1 ½ years and who became mute for 3 days prior to hospital admission. The development of a few other catatonic symptoms was more in favour of an organic aetiology. Even though the supportive evidence by investigations was not conclusive for an organic aetiology the child’s symptoms started to respond for IV immunoglobulin. However, the remaining negative psychotic symptoms slowly started responding to Amisulpiride. An additional challenge on managing this child was her sensitivity to antipsychotics which left only a minute array of medications for her symptom relief. This case study included a thorough assessment of clinical evaluation including history taking, physical and mental state examination findings, in depth investigations including blood investigations, neuroimaging and use of assessment tools for her psychopathology and catatonic symptoms. Detailed history evaluation was done through previous clinical notes and parental interviews initially as the child was mute. Later on, when her catatonic symptoms started responding, the child’s interviews shed light to fill in the gaps on some details. Extensive liaison with several medical areas was mandatory to find a customized management plan for her. Standardised assessment tools like PANSS and Bush-Francis Catatonia rating scale was used to evaluate her progress and the response of medications. This study underscores the challenges in teasing out evolving symptomatology of psychiatry which may actually be a part of an organic pathology vs. dual pathology. Child’s gradual change of behaviour affected her parent’s prompt search for any medical causes complicating the matter further. This also emphasizes the importance of good observation skills when there are barriers for detailed history taking. In order to address these issues optimally, multidisciplinary approach with quality nursing care, liaison services and timely interventions are required. Social support with healthy family interactions and continued medical care will help her to reintegrate with society and pursue her academic career which was markedly hindered due to illness presentation.