1 2 Lorazepam, fluoxetine and packing therapy in an adolescent with pervasive 3 developmental disorder and catatonia 4 Angèle Consoli a,b , Charles Gheorghiev a,d , Claire Jutard a , Nicolas Bodeau a , Anja Kloeckner a , Victor Pitron a , 5 David Cohen a,b,c,⇑ , Olivier Bonnot a,c 6 a Department of Child and Adolescent Psychiatry, APHP, GH Pitié-Salpétrière, Paris, France 7 b CNRS UMR 8189 ‘‘Psychologie et Neurosciences Cognitives”, GH Pitié-Salpétrière, Paris, France 8 c Centre Référent Maladies Rares à Expression Psychiatrique, APHP, GH Pitié-Salpétrière, Paris, France 9 d Department of Psychiatry, Service de Santé des Armées, Paris, France 10 12 article info 13 Article history: 14 Available online xxxx 15 Keywords: 16 Catatonia 17 Autism 18 Sensory integration 19 Packing 20 Adolescent 21 22 abstract 23 Packing therapy is an adjunct symptomatic treatment used for autism and/or catatonia. Here, we report 24 the case of a 15-year-old boy with pervasive developmental disorder who developed catatonia. At admis- 25 sion, catatonic symptoms were severe and the patient required a feeding tube. Lorazepam up to 15 mg/ 26 day moderately improved the catatonic symptoms. On day 36 we added fluoxetine and on day 62 we 27 added packing therapy (twice per week, 10 sessions). After three packing sessions, the patient showed 28 a significant clinical improvement (P < 0.001). At discharge (day 96), he was able to return to his special 29 education program. Although we do not consider packing as a psychodynamic treatment, this case chal- 30 lenges the concept of embodied self that has opened new perspectives on a dialogue between psycho- 31 analysis and neuroscience. Indeed, better body representation following packing sessions, as shown in 32 patient’s drawing, paralleled clinical improvement, and supports the concept of embodied self. This con- 33 cept may serve as a link between psychoanalysis and attachment theory, developmental psychology with 34 the early description of ‘‘sense of self”, and cognitive neurosciences that more and more support the con- 35 cept of embodied cognition. Further clinical studies are necessary to clarify the efficacy and underlying 36 mechanism of packing treatment and to understand how patient’s experience may illustrate the concept 37 of embodied self. 38 Ó 2010 Elsevier Ltd. All rights reserved. 39 40 41 1. Introduction 42 The concept of embodied self has open new perspectives on a 43 dialogue between psychoanalysis and neurosciences (Fonagy and 44 Target, 2007; Gallese, 2007). In this report, we aimed to discuss 45 how packing therapy that was given to an adolescent with autism 46 and catatonia, and the clinical response over time, illustrate the 47 concept of embodied self. Before summarizing and discussing the 48 case report, a brief overview on packing therapy, on sensory inte- 49 gration and catatonia is warranted. 50 1.1. Packing therapy 51 Packing therapy is based on multisensory (tactile, cenesthesic 52 and proprioceptive) stimulations. Ross et al. (1988) conducted a 53 national survey which demonstrated that it was rarely used in 54 modern American psychiatry. By reviewing its use in 46 hospital- 55 ized psychiatric patients, they concluded that the treatment was 56 safe and had interesting and useful effects that go beyond the con- 57 cept of simple restraint. 58 The overall treatment encompasses a series of two sessions per 59 week over a minimum one-month period. Usually, each session 60 lasts one hour; however, the session time can be expanded to 61 two hours depending on the patient’s response. Sessions are con- 62 ducted under the supervision of a psychomotricien 1 and at least 63 two members of the patient’s care team are present Q2 (Cohen et al., 64 2009; Delion, 2006). First, the patient is wrapped in damp sheets 65 (cold phase). Then, the patient is covered up with a rescue cover 66 and a dry blanket, and the body spontaneously warms up (warm 67 phase). The head of the patient remains free from the wrapping, 68 which allows for communication through visual and auditory 69 channels. Cardiac and respiratory frequencies and blood pressure 70 are monitored before and after the session to detect adverse 0928-4257/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.jphysparis.2010.09.002 ⇑ Corresponding author at: Department of Child and Adolescent Psychiatry, Groupe Hospitali Q1 er Pitié-Salpétrière, AP-HP, 47-83 Blvd de l’Hôpital, 75013 Paris, France. Tel.: +33 11 331 42 16 23 51. E-mail address: david.cohen@psl.aphp.fr (D. Cohen). 1 A psychomotricien is a therapist holding a French diploma in psychomotricité which is specialized training in psychomotor disturbances within the Occupational Therapy course. Journal of Physiology - Paris xxx (2010) xxx–xxx Contents lists available at ScienceDirect Journal of Physiology - Paris journal homepage: www.elsevier.com/locate/jphysparis PHYSIO 446 No. of Pages 6, Model 5G 6 October 2010 Please cite this article in press as: Consoli, A., et al. Lorazepam, fluoxetine and packing therapy in an adolescent with pervasive developmental disorder and catatonia. J. Physiol. (2010), doi:10.1016/j.jphysparis.2010.09.002