We present a 9-year-old girl with celiac disease who attends a Health Center referred by her pediatrician for rituals. Her mother describes rituals from early childhood that have been intensified by the death of her grandmother from pancreatic cancer. Since then, thoughts of gluten contamination and behaviors aimed at avoiding such contamination have increased. For example, not using the common household towel and not eating until all the guests have washed their hands. If the patient does not carry out these actions, she presents significant discomfort, crying and screaming until it is done. In addition, such behaviors take up a significant amount of time.

To review the literature of Obsessive-Compulsive Disorder (OCD) in children.

Literature review of scientific articles searching in Pubmed. We considered articles in English and Spanish.

Cognitive Behavioral Therapy and Sertraline up to 50mg were started. After several weeks the frequency of behaviors aimed at avoiding gluten contamination begins to decrease; as well as the anguish if these are not carried out.

OCD in childhood can present characteristics that differentiate it from OCD in adulthood, such as difficulty detecting obsessions and that children do not usually consider thoughts as unreal or excessive. Therefore, it is a real challenge, having to carry out an adequate differential diagnosis with other entities such as specific phobias, for adequate subsequent management.

No significant relationships.

Withdrawal symptoms are common upon discontinuation of many psychotropic drugs. Catatonia, a neuropsychiatric condition characterized by a number of motor, behavioral, emotional, and autonomic abnormalities, has been described as a withdrawal syndrome in a growing number of case reports, but it is not well recognized. Treatment of catatonia usually includes benzodiazepines and electroconvulsive therapy. Standard consensus states that the use of neuroleptics should be avoided, as they are thought to worsen catatonia.

With this case report, we attempt to contribute to the finding in literature that the withdrawal of clozapine may be associated with catatonia, and how reintroduction of clozapine could be indicated for its treatment.

A clinical case is presented of a 37-year-old female with a history of schizophrenia, presenting with altered mental status and new onset of catatonic signs and symptoms in the setting of a 7-day emetic syndrome. The possibility that vomiting prevented proper absorption of clozapine is postulated, causing the patient to present clinical features compatible with malignant catatonia.

The patient required treatment with benzodiazepines, electroconvulsive therapy and clozapine re-initiation, leading to improvement of catatonic symptoms within a few days.

This case serves as a reminder to consider alternative diagnostic hypotheses in cases of catatonic syndrome unresponsive to standard treatments. When the clinical suspicion of drug withdrawal is high, restarting the discontinued medication, even an antipsychotic agent, may be indicated.

No significant relationships.