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}}The most severe cases display stupor, hyperactivity, or severe excitement, which can sometimes continue for weeks or even months.<ref>{{Cite journal |last1=Wijemanne |first1=Subhashie |last2=Jankovic |first2=Joseph |date=2015-08-01 |title=Movement disorders in catatonia |url=https://jnnp.bmj.com/content/86/8/825 |journal=Journal of Neurology, Neurosurgery & Psychiatry |language=en |volume=86 |issue=8 |pages=825–832 |doi=10.1136/jnnp-2014-309098 |issn=0022-3050 |pmid=25411548|s2cid=5925700 }}</ref> During excitement, individuals show combativeness, can have delusions and hallucinations, and can also pose a danger to themselves and others.{{citation needed|date=October 2015}} In the medium, severe, and lethal states, they will also experience [[autonomic instability]].<ref name=":0">{{Cite journal |last1=Wilcox |first1=James Allen |last2=Reid Duffy |first2=Pam |date=2015-12-09 |title=The Syndrome of Catatonia |journal=Behavioral Sciences |volume=5 |issue=4 |pages=576–588 |doi=10.3390/bs5040576 |issn=2076-328X |pmc=4695780 |pmid=26690229 |doi-access=free }}</ref>
}}The most severe cases display stupor, hyperactivity, or severe excitement, which can sometimes continue for weeks or even months.<ref>{{Cite journal |last1=Wijemanne |first1=Subhashie |last2=Jankovic |first2=Joseph |date=2015-08-01 |title=Movement disorders in catatonia |url=https://jnnp.bmj.com/content/86/8/825 |journal=Journal of Neurology, Neurosurgery & Psychiatry |language=en |volume=86 |issue=8 |pages=825–832 |doi=10.1136/jnnp-2014-309098 |issn=0022-3050 |pmid=25411548|s2cid=5925700 }}</ref> During excitement, individuals show combativeness, can have delusions and hallucinations, and can also pose a danger to themselves and others.{{citation needed|date=October 2015}} In the medium, severe, and lethal states, they will also experience [[autonomic instability]].<ref name=":0">{{Cite journal |last1=Wilcox |first1=James Allen |last2=Reid Duffy |first2=Pam |date=2015-12-09 |title=The Syndrome of Catatonia |journal=Behavioral Sciences |volume=5 |issue=4 |pages=576–588 |doi=10.3390/bs5040576 |issn=2076-328X |pmc=4695780 |pmid=26690229 |doi-access=free }}</ref>


Symptoms overlap with autism spectrum disorder. Thus, diagnosis of catatonic breakdown can be difficult.<ref name=":0" /> Full expression of excitement could be a sign of co-morbid [[bipolar disorder]] but [[further research is needed|more research is needed]].<ref>{{cite book |last1=Wing |first1=Lorna |title=Asperger Syndrome or High-Functioning Autism? |publisher=Springer |year=1998 |isbn=978-0-306-45746-3 |editor1-last=Schopler |editor1-first=Eric |pages=11–28 |chapter=The History of Asperger Syndrome |editor2-last=Mesibov |editor2-first=Gary B. |editor3-last=Kunce |editor3-first=Linda J. |chapter-url=https://books.google.com/books?id=jz_xbeWgG9AC&pg=PA11}}</ref> [[Childhood schizophrenia]] increases the risk for autistic catatonia later in life dramatically. Also, it seems that the processes that give rise to psychosis, catatonia, and autism are similar.<ref>{{cite journal |last1=Shorter |first1=E. |last2=Wachtel |first2=L. E. |year=2013 |title=Childhood catatonia, autism and psychosis past and present: is there an 'iron triangle'? |journal=Acta Psychiatrica Scandinavica |volume=128 |issue=1 |pages=21–33 |doi=10.1111/acps.12082 |pmc=3714300 |pmid=23350770}}</ref><ref>{{cite book |last1=Dhossche |first1=Dirk Marcel |title=Catatonia in Autism Spectrum Disorders |last2=Carroll |first2=Brendan T. |last3=Carroll |first3=Tressa D. |year=2006 |isbn=978-0-12-366873-8 |editor1-last=Dhossche |editor1-first=Dirk Marcel |series=International Review of Neurobiology |volume=72 |pages=151–64 |chapter=Is There a Common Neuronal Basis for Autism and Catatonia? |doi=10.1016/S0074-7742(05)72009-2 |pmid=16697296 |editor2-last=Wing |editor2-first=Lorna |editor3-last=Ohta |editor3-first=Masataka |editor4-last=Neumärker |editor4-first=Klaus‐Jürgen |display-editors=3 |chapter-url=https://books.google.com/books?id=v9FvvOxzZAwC&pg=PA151}}</ref>
Symptoms overlap with autism spectrum disorder. Thus, diagnosis of catatonic breakdown can be difficult.<ref name=":0" /> [[Childhood schizophrenia]] increases the risk for autistic catatonia later in life dramatically. Also, it seems that the processes that give rise to psychosis, catatonia, and autism are similar.<ref>{{cite journal |last1=Shorter |first1=E. |last2=Wachtel |first2=L. E. |year=2013 |title=Childhood catatonia, autism and psychosis past and present: is there an 'iron triangle'? |journal=Acta Psychiatrica Scandinavica |volume=128 |issue=1 |pages=21–33 |doi=10.1111/acps.12082 |pmc=3714300 |pmid=23350770}}</ref><ref>{{cite book |last1=Dhossche |first1=Dirk Marcel |title=Catatonia in Autism Spectrum Disorders |last2=Carroll |first2=Brendan T. |last3=Carroll |first3=Tressa D. |year=2006 |isbn=978-0-12-366873-8 |editor1-last=Dhossche |editor1-first=Dirk Marcel |series=International Review of Neurobiology |volume=72 |pages=151–64 |chapter=Is There a Common Neuronal Basis for Autism and Catatonia? |doi=10.1016/S0074-7742(05)72009-2 |pmid=16697296 |editor2-last=Wing |editor2-first=Lorna |editor3-last=Ohta |editor3-first=Masataka |editor4-last=Neumärker |editor4-first=Klaus‐Jürgen |display-editors=3 |chapter-url=https://books.google.com/books?id=v9FvvOxzZAwC&pg=PA151}}</ref>


==Treatment==
==Treatment==

Revision as of 12:00, 30 July 2023

Autistic catatonia is a term used to describe the occurrence of catatonia in autistic people.[1] Catatonia occurs in roughly 10 percent of people diagnosed with an autism spectrum disorder.[2] In addition to the common sign of catatonia (posturing, negativism, mutism, and stupor), autistic people with catatonia might show an increase in stereotypies and self-injurious behavior.[3]: 60 

The DSM-5 lists "with catatonia" as one of the possible specifiers for an autism spectrum disorder diagnosis.[3]: 57 

Pathology

There exists debate over the biological origins of autistic catatonia. Some studies have suggested that dysfunction of GABA and its receptors are primary causes for autistic catatonia.[2] Also, neuroimaging studies have indicated that autistic catatonic patients have abnormally small cerebellar structures.[2] Furthermore, genetic studies have implied that alterations on chromosome 15 may underpin the disease.[2]

Alternatively, catatonia has been frequently observed in patients with severe anxiety.[2] Because autism can cause individuals to be susceptible to anxiety, the prevalence of catatonia in autism may be attributable to anxiety.[2]

Symptoms

Autistic catatonia is associated with more than 40 symptoms, many in common with autism. These include:

The most severe cases display stupor, hyperactivity, or severe excitement, which can sometimes continue for weeks or even months.[4] During excitement, individuals show combativeness, can have delusions and hallucinations, and can also pose a danger to themselves and others.[citation needed] In the medium, severe, and lethal states, they will also experience autonomic instability.[5]

Symptoms overlap with autism spectrum disorder. Thus, diagnosis of catatonic breakdown can be difficult.[5] Childhood schizophrenia increases the risk for autistic catatonia later in life dramatically. Also, it seems that the processes that give rise to psychosis, catatonia, and autism are similar.[6][7]

Treatment

There exists great diversity in treatments for autistic catatonia. The psycho-ecological approach considers the individual's profile of autism, identifies the underlying causes behind their catatonia, and formulates support strategies. These strategies vary depending on the individual and their difficulties.[8]

It has also been shown that benzodiazapines are effective for some patients.[9] More recently, electroconvulsive therapy (ECT) has been trialed, with mixed effect.[9] Several patients have responded well to intensive, multi-month ECT regimens after other treatments failed.[9] Furthermore, ECT was successfully used to treat symptoms in patients prone to self-injury and compulsive behavior.[9] However, it seems that ECT must be continued for long periods of time to prevent re-onset of autistic catatonic symptoms.[9] Furthermore, there is popular resistance to the idea of inducing seizures as treatment - which ECT relies on - especially in pediatric patients.[9]

History

Karl Ludwig Kahlbaum was among the first to systematically describe catatonia, which in 1874 he documented as a separate brain disorder.[9] The phenomenon was later described by Emil Kraepelin as a precursor disease that led to dementia.[9] It was not until the 1970s that catatonia was recognized as a feature of other affective psychiatric disorders in adults, especially manias.[9]

References

  1. ^ Moore, Shavon; Amatya, Debha N.; Chu, Michael M.; Besterman, Aaron D. (2022). "Catatonia in autism and other neurodevelopmental disabilities: a state-of-the-art review". npj Mental Health Research. 1: 12. doi:10.1038/s44184-022-00012-9.
  2. ^ a b c d e f Vaquerizo-Serrano, J.; Pablo, G. Salazar De; Singh, J.; Santosh, P. (2022). "Catatonia in autism spectrum disorders: A systematic review and meta-analysis". European Psychiatry. 65 (1): e4, 1–10. doi:10.1192/j.eurpsy.2021.2259. PMC 8792870. PMID 34906264.
  3. ^ a b American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. Washington, DC: American Psychiatric Association. doi:10.1176/appi.books.9780890425787. ISBN 978-0-89042-575-6. S2CID 249488050.
  4. ^ Wijemanne, Subhashie; Jankovic, Joseph (2015-08-01). "Movement disorders in catatonia". Journal of Neurology, Neurosurgery & Psychiatry. 86 (8): 825–832. doi:10.1136/jnnp-2014-309098. ISSN 0022-3050. PMID 25411548. S2CID 5925700.
  5. ^ a b Wilcox, James Allen; Reid Duffy, Pam (2015-12-09). "The Syndrome of Catatonia". Behavioral Sciences. 5 (4): 576–588. doi:10.3390/bs5040576. ISSN 2076-328X. PMC 4695780. PMID 26690229.
  6. ^ Shorter, E.; Wachtel, L. E. (2013). "Childhood catatonia, autism and psychosis past and present: is there an 'iron triangle'?". Acta Psychiatrica Scandinavica. 128 (1): 21–33. doi:10.1111/acps.12082. PMC 3714300. PMID 23350770.
  7. ^ Dhossche, Dirk Marcel; Carroll, Brendan T.; Carroll, Tressa D. (2006). "Is There a Common Neuronal Basis for Autism and Catatonia?". In Dhossche, Dirk Marcel; Wing, Lorna; Ohta, Masataka; et al. (eds.). Catatonia in Autism Spectrum Disorders. International Review of Neurobiology. Vol. 72. pp. 151–64. doi:10.1016/S0074-7742(05)72009-2. ISBN 978-0-12-366873-8. PMID 16697296.
  8. ^ Shah, Amitta Catatonia, Shutdown and Breakdown in Autism: A Psycho-Ecological Approach. Jessica Kingsley Publishers, 2019, p. 97.
  9. ^ a b c d e f g h i Dhossche, Dirk M.; Reti, Irving M.; Wachtel, Lee E. (March 2009). "Catatonia and Autism". The Journal of ECT. 25 (1): 19–22. doi:10.1097/yct.0b013e3181957363. ISSN 1095-0680. PMID 19190507.

Further reading

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