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Catatonic conundrum
  1. Lucy Paterson-Brown1,
  2. Niamh Scally2,
  3. Dorrie Imeson3,
  4. Alexandra Jones1,
  5. Vinay Shivamurthy1
  1. 1 Paediatric Rheumatology Department, Evelina London Children's Hospital Paediatrics, London, UK
  2. 2 General Paediatric Department, Croydon University Hospital, Croydon, UK
  3. 3 Liaison Child and Adolescent Psychiatry, Evelina London Children's Hospital, London, UK
  1. Correspondence to Dr Lucy Paterson-Brown, Paediatric Rheumatology, Evelina London Children's Hospital Paediatrics, London, UK; l.paterson-brown{at}


Differentiating between physical and psychological causes of confusion and psychosis poses a significant challenge to clinicians across all disciplines of medicine. This case report explores the clinical presentation and diagnostic journey of an adolescent girl. She presented to the emergency department with acutely altered behaviour and went on to re-present on multiple occasions over the following months with symptoms suggestive of psychosis. The team faced diagnostic difficulty differentiating between organic and non-organic causes of altered behaviour and mental state. This article explores the challenge faced by the team during the assessment and diagnosis of this patient.

  • rheumatology
  • adolescent health
  • paediatrics
  • mental health
  • child psychiatry

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  • Contributors Lead article writing, formatting and patient communication with significant involvement in patient care were done by LP-B. Significant involvement in patient care and report writing, editing and formatting was by NS, DI and AJ in order of contribution. Lead consultant for patient care, supervision of article with writing, editing and formatting contribution were by VS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.