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Autistic catatonia is a rare type of disorder[citation needed] that affects roughly 10 percent of all adults with autism spectrum disorder. Most are not severely affected but a few exhibit stupor and severe excitement, which is the most extreme form of the disorder. Full expression of excitement could be a sign of comorbid bipolar disorder but more research is needed.[1]
More than 40 symptoms have been identified to be a result of the disorder, but some of the symptoms overlap with those of autism spectrum disorder, making diagnosing difficult even for a seasoned professional. In a few cases stupor and hyperactivity can continue for weeks or even months.[citation needed] During the excitement phase individuals show combativeness and can have delusions and hallucinations and can also pose a danger to themselves or others and can make marked destruction of property.[citation needed] In the later stages of medium and even more in the severe (and, if left untreated, lethal) state they will also experience autonomic instability.[2]
Childhood schizophrenia increases the risk for autistic catatonia later in life dramatically. There seems to be a common font of brain pathology for psychosis, catatonia and autism.[3]
Autistic Catatonia[edit]
Catatonia in individuals with autism spectrum disorders (ASDs) is also referred to as "catatonia-like deterioration" or "autistic catatonia."[4][5]
Catatonia-like deterioration is a neurological complication that can occur in ASDs that affects movement, verbal responses, initiation and completion of actions, motivation, and physiological necessities (e.g. eating, drinking, excretion). This deterioration often results in an increased dependence on others for physical or verbal prompts.[5][6][7] Catanonia may be mild, moderate, or severe and may be life-threatening.[5] In its most severe form, these symptoms affect the individual's autonomic system (e.g. heart rate, body temperature, digestion, metabolism, urination and defecation, breathing and swallowing).[4] Mood disorders, anxiety, language impairments, and passivity in social interactions in people with ASDs increase the risk of catatonia-like deterioration in this population.[5][8]
The reported age of onset varies from as early as 10 years with a typical age range from 15 to 20 years of age.[5][4][8] Younger patients presenting isolated symptoms that progress over time.[5]
The prevalence of catatonia-like deterioration in adolescents and young adults with ASDs ranges from 6.5 percent[9] to between 12 and 18 percent.[5][4][10]
Symptoms related to catatonia in individuals with ASDs overlap with those found in other psychiatric disorders (e.g., schizophrenia, depression, obsessive-compulsive disorder, Tourette syndrome and Attention-deficit hyperactivity disorder),[8][7] learning disabilities of an unspecified nature,[9] and Neurodevelopmental disorders (e.g., Prader-Willi syndrome, Parkinsonism),[9][6] making the condition difficult to diagnose. Researchers have yet to reach agreement on whether catatonia is a comorbid condition or a subtype of autism.[9][5][8] The catatonic-like symptoms that occur in ASD (e.g., motor stereotypies, mannerisms, rituals, mutism, echolalia, and negativism)[6] do not always encompass wider definitions of catatonia.[9] Some researchers believe the presence of psychiatric disorders increases "the risk of catatonia emerging in persons with autism."[8] Due to the overlap in symptoms, diagnosis of autistic catatonia is indicated with the emergence of new symptoms[5] or "an obvious and marked deterioration in movement, pattern of activities, self-care and practical skills, compared with previous levels."[7]
Other causes of catatonia that should be ruled out include: antipsychotic medications[4] and illicit drugs (e.g. PCP, mescaline, psilocybin, cocaine, opiates, and opioids), disulfiram, steroids, antibiotic agents (ciprofloxacin), and bupropion), rapid withdrawal of benzodiazepines, gabapentin, and dopaminergic drugs[7], as well as infectious, metabolic, endocrinological, neurological and autoimmune diseases.[7][11][4]
Observation and treatment of autistic catatonia has, to date, been based on clinical reports, but no controlled studies investigating the causes, nature, and treatment of catatonia in individuals with ASDs have been published. [9][12][7]
Catatonia has been almost completely absent in autism research and vice versa. However, catatonia in ASDs warrants special attention, as the condition is associated with considerable impairment. However, there is still a lack of awareness of both ASDs and catatonia hampering case finding and the design of good studies in this field. The assessment of catatonia among the myriad of autistic symptoms requires specialized training and clinical acumen.[7]
Symptoms[edit]
Symptoms of catatonia-like deterioration are generally marked by a loss of language skills, inertia, intellectual decline, and, in some cases, seizures [8] which may affect existing patterns of activities, self-care, and practical skills.[7]
List of symptoms that has been observed in those with individuals with catatonia. Some of these overlap with individuals with ASD that exhibit catatonia-like deterioration. Researchers advise that "studies may need to employ head-to-head comparisons of patients with autism and catatonia in order to substantiate common biological, neuropsychological, or genetic factors."[13]
- Stupor[7]
- Mutism[6][7]
- Hyperactivity [citation needed]
- Agitation [citation needed]
- Excitement[7]
- Posturing[9][12]
- Negativism[6]
- Rigidity[14]
- Waxy flexibility,[9] mitmachen, mitgehen – tendency to remain in immobile posture, inability to resist external pressure on posture
- Automatic obedience [citation needed]
- Combativeness (during excitement) [citation needed]
- Aggressivity [citation needed]
- Stereotypies[6][8]
- Tics [citation needed]
- Grimacing[9]
- Echolalia[6]
- Echopraxia/Echophenomena [7][11]
- Perseveration[13]
- Verbigeration [citation needed]
- Staring, gaze fixation[9]
- Withdrawal [citation needed]
- Immobility[7][4]
- Challenging behaviour [citation needed]
- Tremor [citation needed]
- Slowness[7]
- Amotivation [citation needed]
- Grasp reflex [citation needed]
- Choreoathetoid movements of the trunk and extremities [citation needed]
- Autonomic instability (during excitement)[7][4]
- Inability to start or stop actions[7] (if during excitement episodes needs acute psychiatric care)
- Impulsivity[12]
- Psychotic [citation needed]
- Sleep problems, reversal of day and night[7]
- Urinary or fecal incontinence[12][7][4]
- Passivity[9]
- Eyerolling [citation needed]
- Stiff muscles [citation needed]
- Catalepsy[9]
- Gegenhalten [citation needed]
- Ambitendency – contradictory behavior [citation needed]
- Rituals – repetitive behaviors[6][12]
Treatment[edit]
A 2019 report states that "the evidence basis supporting the treatment for catatonia in individuals with ASDs is limited, but growing."[4] However, articles written prior to that year report a "lack of evidence concerning the most appropriate treatments for catatonia in people with ASDs" and an "absence of treatable cause."[6][12] Single case studies record a variety of medications used as interventions and "no or only short-lived beneficial effects." [12] Wachtel, Hermida, and Dhossche wrote in 2010:
There are currently no diagnostic biomarkers for catatonia and no biological parameters that predict relapse and can guide the type, length and intensity of maintenance treatment. Future biological studies should attempt to find valid markers for diagnosis and treatment monitoring of catatonia in patients with and without autism. [10]
Physical and Verbal Prompts[edit]
Physical and verbal prompts may help people with catatonia-like deterioration to move on or complete an action or activity and/or stop a repetitive action once started.[12][7] The amount, level, and type of prompting is dependent on the individual's needs for any given situation and may vary even with the same individual.[12] Teaching strategies based on the principles of applied behavior analysis (ABA) may provide some benefit to individuals afflicted with this condition.[4]
Activity[edit]
Physical activity involving rhythmic, repetitive movements that reduce stress and keep individuals active, mobile, and stimulated may reduce the effects of catatonia-like deterioration.[12][5]
Electroconvulsive Therapy (ECT)[edit]
Electroconvulsive Therapy (ECT) is used in treating severe cases of catatonia, particularly with individuals at risk of starvation and death, or when other approaches have proved ineffective.[10][5][7][8] The use of ECT may result in partial resolution of catatonic symptoms, but effects may be temporary. ECT is often combined with various medication for sustained benefit.[5] Researchers call for "modern studies that meet acceptable scientific standards" to address the treatment needs of people with and without ASDs.[7][10]
Side effects include headache, confusion, subjective memory loss and prolonged seizures. Repeated administration of ECT over a lengthy period may also have cumulative effects, which are not well documented particularly in pediatric populations.[5]
Lorazepam[edit]
The "lorazepam challenge test," the administration of a small dose of the drug, may be conducted to diagnose severe forms of catatonia. A positive response results in rapid resolution of symptoms. Zolpidem has also been used. [4] Individual case studies have reported a positive response to medication and/or ECT for individuals with ASDs and catatonia-like states. However, for individuals with chronic catatonia-like deterioration without stupor, medical interventions sho no or only partial remission of symptoms.[12]
Side effects include allergic reactions to the medication and complications due to sedation.[7]
History[edit]
In the 19th century the psychiatrist Karl Ludwig Kahlbaum observed several symptoms of the disorder. Among them were stupor, mutism, excitement, hyperactivity, posing, negativism, rigidity, waxy flexibility and automatic obedience, stereotypies, tics, grimacing, echo-phenomenon, and self-harming.[citation needed]
Also marbling of the skin, profuse sweating, deviation of the pupils and odd reaction to light were considered catatonic phenomenons.
During most of the 20th century catatonia was regarded as schizophrenic in its nature, but towards the end of the century it was more commonly observed in those with bipolar disorder and autism spectrum disorder. Now only 15 percent of those with catatonia are considered to have schizophrenia.[medical citation needed]
See also[edit]
References[edit]
- ^ WIng, Lorna (1998). "The History of Asperger Syndrome". In Schopler, Eric; Mesibov, Gary B.; Kunce, Linda J. (eds.). Asperger Syndrome or High-Functioning Autism?. Springer. pp. 11–28. ISBN 978-0-306-45746-3.
- ^ Wilcox, James Allen; Reid Duffy, Pam (2015-12-09). "The Syndrome of Catatonia". Behavioral Sciences. 5 (4): 576–588. doi:10.3390/bs5040576. PMC 4695780. PMID 26690229.
- ^ 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.
- ^ a b c d e f g h i j k l Downey, J.M.; McDonald, M.E. (2019). "Clinical Corner: Catatonia in autism spectrum disorder". Science in Autism Treatment. 16 (3): 245–264. Retrieved 22 August 2020.
- ^ a b c d e f g h i j k l m De Jong, Hannah; Bunton, Penny; Hare, Dougal J. (2014). "A Systematic Review of Interventions Used to Treat Catatonic Symptoms in People with Autistic Spectrum Disorder". Journal of Autism and Developmental Disoders. 44 (9): 2127–2136. doi:10.1007/s10803-014-2085-y. PMID 24643578. S2CID 22002956. Retrieved 22 August 2020.
- ^ a b c d e f g h i Wing, Lorna; Shah, Amita (2000). "Catatonia in autistic spectrum disorders". British Journal of Psychiatry. 176 (4): 357–362. doi:10.1192/bjp.176.4.357. PMID 10827884. S2CID 40112518. Retrieved 22 August 2020.
- ^ a b c d e f g h i j k l m n o p q r s t u v Dhossche, Dirk Marcel; Shah, Amita; Wing, Lorna (2006). "Blueprints for the Assessment, Treatment, and Future Study of Catatonia in Autism Spectrum Disorders". International Review of Neurobiology. 72: 267–284. doi:10.1016/S0074-7742(05)72016-X. ISBN 9780123668738. PMID 16697303. Retrieved 22 August 2020.
- ^ a b c d e f g h Ghaziuddin, M.; Quinlan, P.; Ghaziuddin, N. (January 2005). "Catatonia in autism: a distinct subtype?". Journal of Intellectual Disability Research. 49 (Part 1): 102–105. doi:10.1111/j.1365-2788.2005.00666.x. hdl:2027.42/71765. PMID 15634317. Retrieved 22 August 2020.
- ^ a b c d e f g h i j k l Hare, Dougal Julian; Malone, Caroline (2004). "Catatonia and autism spectrum disorders". The National Autistic Society. 8 (2): 183–195. doi:10.1177/1362361304042722. PMID 15165434. S2CID 36914828. Retrieved 22 August 2020.
- ^ a b c d Wachtel, Lee E.; Hermida, Adriana; Dhossche, Dirk M. (2010). "Maintenance electroconvulsive therapy in autistic catatonia: A case series review". Progress in Neuro-Psychopharmachological & Biological Psychiatry. 34 (4): 581–587. doi:10.1016/j.pnpbp.2010.03.012. PMID 20298732. S2CID 207409230. Retrieved 22 August 2020.
- ^ a b Dhossche, Dirk M. (November 6, 2014). "Decalogue of catatonia in autism spectrum disorders". Frontiers in Psychiatry. 5 (157 Opinion Article): 157. doi:10.3389/fpsyt.2014.00157. PMC 4222130. PMID 25414675.
- ^ a b c d e f g h i j k Shah, Amita; Wing, Lorna (2006). "Psychological approaches to chronic catatonia-like deterioration in autism spectrum disorders". International Review of Neurobiology. 72. Elsevier, Inc.: 245–264. doi:10.1016/S0074-7742(05)72015-8. ISBN 9780123668738. PMID 16697302. Retrieved 22 August 2020.
- ^ a b 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.
- ^ Brake, Jonathan A.; Abidi, Sabina (2010). "A Case of Adolescent Catatonia". Journal of the Canadian Academy of Child and Adolescent Psychiatry. 19 (2): 38–40. PMC 2868561. PMID 20467550.
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