Talk:Autistic catatonia

I linkified the symptoms list; needs revising though

I don't have time to check the links and look for the articles for the redlinks. Someone please revise the links. --152.249.241.53 (talk) 13:42, 10 June 2016 (UTC)

List of symptoms

The list of symptoms is extremely long. Does autistic catatonia really have all these symptoms? Can we compress some of them? Can we find citations for them all (since the current cite apparently misses a lot of the list)? I'm wondering whether the list should just be trimmed, especially looking at Catatonia#Diagnosis and how much neater that section is. (Some of the links look wrong, too, or maybe the symptoms are just out of place – freezing links to the physical process.)

Also, should we try to work catatonia into the lead, somewhere? I assume "autistic catatonia" shares some traits with it – especially looking at the list of common symptoms – so if we can find a source saying they're similar, that'd be good. Throne3d (talk) 13:06, 16 February 2018 (UTC)

Fixed some of the symptoms list here, by removing links around the more obvious things that aren't described well by the relevant articles, and by combining similar items. The list in catatonia really does look quite similar, combining a lot of the items. Throne3d (talk) 13:35, 16 February 2018 (UTC)

Treatment suggestions

Taking citation from this page: https://www.autism.org.uk/advice-and-guidance/professional-practice/catatonia-autism

"There is a recent paper (De Jong, Bunton and Hare, 2014) [...] conclusions are that the quality of the studies is poor and there is no convincing evidence that any particular medication or ECT is effective for catatonia type breakdown. The studies also worryingly ignored the side-effects of these treatments and rarely reported long term follow-up of effects."

I think it's irresponsible and potentially harmful to keep the current, uncited suggestion of ECT, which heavily imply ECT is well-proven. Especially given there are multiple diagnosed cases (admittedly, I don't have sources beyond online case studies and the papers suggested on that link) where medication was not a primary solution, I seriously think this being the only sentence about treatment isn't a good fit for an article on a medical diagnosis, given that ECT is known to be very high-risk.

I don't really edit wiki articles often, so I'm not sure on the proper style, but it's fairly alarming to see the number of "citation needed" annotations. — Preceding unsigned comment added by 151.228.206.208 (talk) 18:07, 6 March 2021 (UTC)

relationship to Karl Leonhard's "system catatonias" and "early childhood catatonias"?

By what I have read so far about catatonia symptoms in ASD, they tend to be more chronic and insidious in their time course compared to more "typical" acute catatonia, as it can be seen in severe depression or states of acute psychosis. Furthermore, extreme symptoms like prolonged stupor or severe excitation seem to be uncommon or occur only after a slow build-up of other symptoms over months to years. By contrast, less obvious symptoms like worsening compulsive behaviors, intensified stimming, distractability, increasing meltdowns/complaints of sensory overload, general motor slowness/stiffness of movements, new or worsening problems with executive functioning and deteriorating self-help skills, apathy and reliance on being prompted are more pathognomic. Interestingly, such symptoms don't fit very well to current DSM-5 catatonia, but they are reminiscent of Karl Leonhard's descriptions of "system catatonias", especially of "manneristic catatonia".

On the other hand, the Wernicke-Kleist-Leonhard school admits that exactly those "system catatonias" - which Leonhard classified as forms of schizophrenia - are difficult to classify by DSM-5 standards, that they can begin in childhood in some cases (called "childhood catatonias" or "early childhood catatonias" depending on age of apparent onset), and that those early-onset system catatonias will most likely get diagnosed as autism spectrum disorder in DSM-5.

Now I'm wondering if there is a connection. Childhood catatonias are sometimes reported to be mild through childhood and only reach a severe residual state after exacerbations in adolescence and/or early adulthood. This means such an early state childhood catatonia would show diffuse and puzzling symptoms that fit well into our current understanding of ASD as a diverse spectrum with many unique and peculiar manifestations. A later exacerbation would then be classified as "autistic catatonia".

So far I haven't found any reliable source that considers linking "autistic catatonia" with Karl Leonhard's "childhood system catatonias" in any way. But it may be worth mentioning that there is some overlap in the desciption of those two conditions? Concluding anything would clearly be original research.

While I abstain from making premature conclusions based on these parallels, they do have some interesting implications... It may be possible that some autistics - and even some people diagnosed with Asperger syndrome - fit into one or the other form of "system catatonia" in the WKL system but are never considered to have anything to do with these conditions. (I said SOME not ALL, I'm not one of these "cause XXX causes autism" advocates.) The "typical" patient depicted with a system catatonia is severely intellectually handicapped and utterly unable to communicate anything meaningful, in contrast to the majority of autistics. So possibly some milder forms of system catatonia get "missed" by WKL school psychiatrists and instead are considered to be "ordinary" autistics. Anyway, that makes no difference in terms of label when the system catatonias themselves get also diagnosed as ASD. But exploring the parallels may shed light on this mysterious "autistic catatonia" and possibly identify at-risk patients before they get really serious problems... That's enough now, this is Wikipedia and not a Medical Science journal.

To prove that I'm not just talking some random nonsense to get public attention, I will add some sources about autistic catatonia on one side and system catatonias on the other...

https://www.autism.org.uk/advice-and-guidance/topics/mental-health/catatonia on autistic catatonia

https://autismawarenesscentre.com/autism-related-catatonia/ also

https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/20451 WKL childhood catatonias (German), here referred to as schizophrenia in the WKL tradition. It seems notable that patients with "manneristic" components tend to have late exacerbations in adolescence or adulthood.

http://www.cercle-d-excellence-psy.org/fileadmin/Cours/WKL_STB/Periodic_and_Systematic_Catatonias_20-11-2015.pdf WKL system catatonias

http://www.cercle-d-excellence-psy.org/en/informations/classification-de-wkl/introduction/ about WKL vs. ICD and DSM categories

http://europepmc.org/article/PMC/3714300 is also notable, as those "system catatonias" seem to blur the line between the autistic and the schizophrenic spectrum.

https://www.movementdisorders.org/MDS/Journals/Clinical-Practice-E-Journal-Overview/Clinical-Practice---Volume-2-Issue-2/Revisiting-Syndrome-Obsessional-Slowness.htm seems unrelated at first, but both "manneristic catatonia" and some features of catatonia in ASD bear similarities to the condition "obsessional slowness", and in the linked study one of the three subjects affected by it is said to show autistic features. Like chronic catatonia, obsessional slowness is also sometimes seen in individuals with intellectual disability.

Wow, such a long talk entry because of one potential extra sentence in the article mentioning parallels between two different conditions in two different classification concepts... but maybe it will stir some more research on the topic in the neuropsychology community etc., maybe it's a good inspiration... --2003:E7:772A:E656:5B3:4067:93F3:1054 (talk) 00:15, 18 May 2021 (UTC)

The relationship of this with Childhood disintegrative disorder is also somewhat blurry. In case a fulminant catatonia-like regression occurs in a mildly autistic child before age 10, "autistic catatonia" becomes more or less identical to CDD. On the other hand, the similarities between Heller's description of CDD and Leonhard's childhood catatonias have already been noted in some sources. This seems to be a messy field with many different but partially overlapping concepts and no clear consensus on treatment and prognosis.

Autistic catatonia is deemed treatable when adressed early, or at least partially reversible. System catatonias are said to have an overall bleak prognosis, although recent exacerbations can sometimes be treated and reversed effectively. CDD is considered largely irreversible, with possible rare exceptions. Obsessional slowness is thought of as a severe form of OCD, and treatment outcomes vary, with refractory cases being assumed a result of comorbid conditions. --2003:E7:772A:E615:F4A5:33A9:3392:EE26 (talk) 21:12, 18 May 2021 (UTC)

See also the newly coined term ”iron triangle“, I think it pretty much describes the same thing as those early-onset system catatonias. By the way, the names have been updated, and ”manneristic catatonia“ is now called ”pseudocompulsive catatonia“, if that matters anyway.

After studying Wernicke-Kleist-Leonhard for some time, I think that probably some cases of autistic catatonia fit these entities, but not all. Sometimes the chronic ”catatonia“ may have a simpler reason, such as an over- or understimulating environment or psychological trauma, medication side effects, or rarely an organic brain disorder.

BTW those ”system catatonia“ patients were often socially isolated and over- or understimulated as well, and even considered ineducatable and therefore locked away into institutions where they lacked any consistent caregivers. You know what that sounds like? Exactly. Reactive Attachment Disorder. Or in other words, most neurotypical kids would go crazy under such circumstances as well... 2003:E7:7733:2075:E98F:CA49:E349:3258 (talk) 23:15, 16 June 2024 (UTC)

In addition to all the terms and diagnoses already mentioned, there is also this thing called PANS/PITANDS/PANDAS. Many of the symptoms in case reports resemble descriptions of catatonia. The defining feature of PANS is a notable response to immunomodulation, which suggests an autoimmune origin. But its diagnostic validity is still debated. There are also reports of catatonia and even psychosis occuring in the context of neurodevelopmental disorders like Down Syndrome where psychopharmacology proved ineffective but symptoms improved upon immunomodulation. Often such case reports sound suspicious for system catatonias when looked at through the lens of Wernicke-Kleist-Leonhard.

Maybe what Karl Leonhard thought to be homogenous phenotypes were actually grossly different things that just happened to look very similar. From regressive autism to trauma to burnout to anxiety to psychosis to autoimmune disease and perhaps even early-onset dementias. But our current diagnostic manuals are no better in that respect.

Diagnostic decisions like autistic catatonia vs. autistic burnout or various psychiatric disorders (depression, OCD, bipolar, schizophrenia, personality disorders, agoraphobia etc.) are always somewhat subjective. And Karl Leonhard, no matter how interesting his works may be, doesn't play a notable role in contemporary psychiatry. So this thread is not going to lead anywhere.

The Future will hopefully tell what autism catatonia is and how it can be treated...

(Excuses for any autocorrect blunders that may have creeped into my text. This is a mobile edit.) 91.12.214.245 (talk) 17:33, 30 September 2024 (UTC)

Wiki Education assignment: Communicating the Fundamentals of Epidemiology

This article was the subject of a Wiki Education Foundation-supported course assignment, between 24 January 2023 and 27 April 2023. Further details are available on the course page. Student editor(s): Stewman223 (article contribs).

— Assignment last updated by Stewman223 (talk) 01:12, 27 March 2023 (UTC)

I am in the process of adding sources to this article...

...but I have to take a break for the evening. I will continue to work on this article tomorrow. I know that there are too many block quotes, which all need to be paraphrased and more smoothly integrated, and there is a lot of other work to be done as well. There is a lot of solid scientific research to be incorporated here. Lotf629 (talk) 04:26, 28 September 2024 (UTC)