Medicine:Autistic catatonia

From HandWiki

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 are more likely to stim and self-harm.[3](p60)

The DSM-5 lists "with catatonia" as one of the possible specifiers for an autism spectrum disorder diagnosis.[3](p57)

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.[citation needed]

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" (in en). npj Mental Health Research 1: 12. doi:10.1038/s44184-022-00012-9. 
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Vaquerizo-Serrano, J.; Pablo, G. Salazar De; Singh, J.; Santosh, P. (2022). "Catatonia in autism spectrum disorders: A systematic review and meta-analysis" (in en). European Psychiatry 65 (1): e4, 1–10. doi:10.1192/j.eurpsy.2021.2259. PMID 34906264. 
  3. ↑ 3.0 3.1 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. 
  4. ↑ Wijemanne, Subhashie; Jankovic, Joseph (2015-08-01). "Movement disorders in catatonia" (in en). Journal of Neurology, Neurosurgery & Psychiatry 86 (8): 825–832. doi:10.1136/jnnp-2014-309098. ISSN 0022-3050. PMID 25411548. https://jnnp.bmj.com/content/86/8/825. 
  5. ↑ 5.0 5.1 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. 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. 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.. Catatonia in Autism Spectrum Disorders. International Review of Neurobiology. 72. pp. 151–64. doi:10.1016/S0074-7742(05)72009-2. ISBN 978-0-12-366873-8. https://books.google.com/books?id=v9FvvOxzZAwC&pg=PA151. 
  8. ↑ Shah, Amitta Catatonia, Shutdown and Breakdown in Autism: A Psycho-Ecological Approach. Jessica Kingsley Publishers, 2019, p. 97.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 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. http://dx.doi.org/10.1097/yct.0b013e3181957363. 

Further reading



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