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Nadeem NJ, Moawad A, Howatson S, Ahmed A, Cassell D. Case report: Diagnostic challenges in an adolescent case of autistic catatonia. Front Psychiatry 2024; 15:1386949. [PMID: 38859882 PMCID: PMC11163276 DOI: 10.3389/fpsyt.2024.1386949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/12/2024] [Indexed: 06/12/2024] Open
Abstract
Catatonia is a complex neuropsychiatric syndrome involving a constellation of psychomotor disturbances including catalepsy, waxy flexibility, stupor, mutism, negativism, agitation, posturing, stereotypes, mannerisms, grimacing, echolalia, and echopraxia. Catatonia occurs in several conditions including psychotic, affective and neurodevelopmental disorders such as autism spectrum disorder (ASD). ASD is a neurodevelopmental disorder characterized by persistent deficits in communication, social interaction, restricted interests, repetitive behaviours and sensory sensitivities. Catatonia can occur in response to life stressors such as extreme fear or threat, interpersonal conflict, tragic events or following significant loss. Those with ASD may be particularly vulnerable to the negative impact of stressors and the link between catatonia and ASD is being increasingly recognized. The overlapping features of catatonia and ASD make it difficult to differentiate often resulting in delayed or missed diagnosis. Catatonia in ASD remains a significant clinical challenge; it is difficult to diagnose and can pose debilitating difficulties for those affected. Catatonia is a treatable condition and prompt recognition is vital in securing the best possible outcome. We report a complex and unique case of a 15-year-old boy who presented with severe cognitive and functional decline with a background history of significant bullying and deterioration in his mental state. This case posed a diagnostic conundrum leading to a diagnosis of underlying ASD, anxiety and trauma.
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Affiliation(s)
- Nighat J. Nadeem
- General Adolescent Inpatient Unit, South West London and St George’s Mental Health National Health Service (NHS) Trust, London, United Kingdom
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2
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Zappia KJ, Shillington A, Fosdick C, Erickson CA, Lamy M, Dominick KC. Neurodevelopmental Disorders Including Autism Spectrum Disorder and Intellectual Disability as a Risk Factor for Delayed Diagnosis of Catatonia. J Dev Behav Pediatr 2024; 45:e137-e142. [PMID: 38451868 DOI: 10.1097/dbp.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/30/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Catatonia is a distinct and severe medical syndrome comprising motor, somatic, and psychiatric symptoms that is reported in upwards of 17% of young patients with autism spectrum disorders. Clinical experience indicates catatonia is often under-recognized in this clinical population. Here we characterize the clinical presentation of catatonia in patients with and without neurodevelopmental disorders (NDDs) including autism, including the time from symptom onset to diagnosis of catatonia. METHOD Retrospective chart review of electronic medical records at a large, academic pediatric medical center identified 113 pediatric and young adult patients with a charted history of catatonia, as identified by an encounter diagnosis or problem list entry between September 2017 and September 2021. Workup, treatments, and diagnoses (psychiatric, neurodevelopmental, and genetic) were identified. RESULTS We observed a clear and substantial delay in identification of catatonia in those with NDDs (diagnosis after 330 days for those without psychosis) compared with neurotypical patients (∼16 days). Psychiatry involvement was associated with shorter delays. CONCLUSION Intellectual disability and autism are risk factors for significantly delayed diagnosis of catatonia. It is unknown whether delayed diagnosis contributes to the difficulty in treating catatonia in this patient population or whether the treatment difficulties relate instead to differential and ongoing biological mechanisms and underlying encephalopathy. Overall, these findings highlight the importance of increased recognition of catatonia symptoms in patients with NDDs and suggest early referral to psychiatric specialists may shorten the delay to diagnosis.
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Affiliation(s)
- Katherine J Zappia
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
| | - Amelle Shillington
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cara Fosdick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
| | - Martine Lamy
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
| | - Kelli C Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH; and
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3
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Özbaran NB, Kayan E. Catatonia in a 8-year-old child with autism spectrum disorder: Case report. Asian J Psychiatr 2024; 92:103893. [PMID: 38183739 DOI: 10.1016/j.ajp.2023.103893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Nazlı Burcu Özbaran
- Department of Child and Adolescent Psychiatry, Ege University Faculty of Medicine, İzmir, Turkey
| | - Elif Kayan
- Department of Child and Adolescent Psychiatry, Ege University Faculty of Medicine, İzmir, Turkey.
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Shillington A, Zappia KJ, White L, Fosdick C, Erickson CA, Lamy M, Dominick KC. Genetic syndromes are prevalent in patients with comorbid neurodevelopmental disorders and catatonia. Am J Med Genet A 2023; 191:2716-2722. [PMID: 37642312 DOI: 10.1002/ajmg.a.63379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
Catatonia occurs at high rates in idiopathic and syndromic neurodevelopmental disorders. At our institution's multidisciplinary catatonia clinic, clinical genetic testing (including microarray, fragile X PCR and methylation, autism/ID expanded panels, and exome sequencing) was commonly completed as part of clinical workup on patients with co-occurring neurodevelopmental disorders and catatonia (performed in 36/48 cases or 75%). This testing identified a pathogenic or likely pathogenic finding in 15/36 patients (42%). Testing identified a VUS (variant of uncertain significance) in 9/36 patients (25%). On review of the VUS findings, 4/9 were felt to be suspicious and potentially diagnostic. Testing was negative for 12/36 patients (33%). Many of the variants identified in this cohort were found in genes involved in gamma aminobutyric acid (GABA) and glutamatergic synaptic signaling; imbalances of these neurotransmitters are hypothesized to be drivers of catatonia. More work is needed to further characterize the molecular underpinnings of catatonia in the setting of neurodevelopmental disorders, including expanding genetic testing to larger cohorts in the future.
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Affiliation(s)
- Amelle Shillington
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Katherine J Zappia
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lori White
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Cara Fosdick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Martine Lamy
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kelli C Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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5
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Reinfeld S, Gill P. Diagnostic overshadowing clouding the efficient recognition of pediatric catatonia: a case series. CNS Spectr 2023; 28:587-591. [PMID: 36440510 DOI: 10.1017/s1092852922001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Catatonia is a neuropsychiatric condition that causes disruption of movement, emotion, and behaviors. Children and adults with underlying psychiatric conditions are particularly susceptible to developing catatonia, which may result in medical and psychiatric complications. Although catatonia research has been growing at a rapid rate in the last 20 years, it continues to be met with inefficiencies in its diagnosis and incertitude in its treatment. In the pediatric population, catatonia is plagued by diagnostic overshadowing, where the catatonia is erroneously attributed to existing pathologies that lead to a prolonged disease state. This paper describes three pediatric patients with catatonia that fell victim to diagnostic overshadowing. More rigorous training and education are imperative to improve the efficient recognition and treatment of children with catatonia.
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Affiliation(s)
- Samuel Reinfeld
- Department of Psychiatry and Behavioral Health, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Poonamdeep Gill
- Department of Psychiatry and Behavioral Health, Stony Brook University Hospital, Stony Brook, NY, USA
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Dell’Osso L, Amatori G, Cremone IM, Massimetti E, Nardi B, Gravina D, Benedetti F, Muscatello MRA, Pompili M, Politi P, Vita A, Maj M, Carpita B. Autistic and Catatonic Spectrum Symptoms in Patients with Borderline Personality Disorder. Brain Sci 2023; 13:1175. [PMID: 37626531 PMCID: PMC10452061 DOI: 10.3390/brainsci13081175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Recent literature has shown that a considerable percentage of patients with severe mental disorders can develop, over time, full-blown or subthreshold catatonia. Some studies corroborate the model of an illness trajectory in which different mental disorders would be arranged along a continuum of severity until the development of catatonia. In such an illness pathway, autistic traits (AT) and borderline personality disorder (BPD) may represent important steps. In order to further explore the association between AT, BPD, and catatonia, the aim of this study was to compare catatonic spectrum symptoms and AT among patients with major depressive disorder (MDD), BPD, and healthy controls (CTL), also evaluating possible predictive dimensions of the different diagnoses. METHODS A total of 90 adults affected by BPD, 90 adults with a diagnosis of MDD, and 90 CTL, homogeneous in terms of gender and age, were recruited from six Italian university departments of psychiatry and assessed with the SCID-5-RV, the Catatonia Spectrum (CS), and the Adult Autism Subthreshold Autism Spectrum (AdAS Spectrum). RESULTS The total CS score was significantly higher in the BPD and MDD groups than in the CTL group, while the majority of CS domain scores were significantly higher in the BPD group than in the MDD group, which scored significantly higher than the CTL group. The total AdAS Spectrum score and the AdAS Spectrum domain scores were significantly higher in the BPD group than in the MDD group, which in turn scored significantly higher than the CTL group. The CS domains "psychomotor activity" and "impulsivity", and AdAS Spectrum domains "verbal communication", "empathy", and "hyper-/hyporeactivity to sensory input" were associated with the risk of presenting a diagnosis of BPD.
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Affiliation(s)
- Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.D.); (I.M.C.); (B.N.); (D.G.); (F.B.); (B.C.)
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.D.); (I.M.C.); (B.N.); (D.G.); (F.B.); (B.C.)
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.D.); (I.M.C.); (B.N.); (D.G.); (F.B.); (B.C.)
| | - Enrico Massimetti
- ASST Bergamo Ovest, SSD Psychiatric Diagnosis and Treatment Service, 24047 Treviglio, Italy;
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.D.); (I.M.C.); (B.N.); (D.G.); (F.B.); (B.C.)
| | - Davide Gravina
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.D.); (I.M.C.); (B.N.); (D.G.); (F.B.); (B.C.)
| | - Francesca Benedetti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.D.); (I.M.C.); (B.N.); (D.G.); (F.B.); (B.C.)
| | - Maria Rosaria Anna Muscatello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98124 Messina, Italy;
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health and Sense Organs, University of Roma “La Sapienza”, 00185 Roma, Italy;
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy;
| | - Mario Maj
- Department of Psychiatry, University of Naples “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.D.); (I.M.C.); (B.N.); (D.G.); (F.B.); (B.C.)
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Dell’Osso L, Amatori G, Carpita B, Massimetti G, Nardi B, Gravina D, Benedetti F, Bonelli C, Casagrande D, Luciano M, Berardelli I, Brondino N, De Gregorio M, Deste G, Nola M, Reitano A, Muscatello MRA, Pompili M, Politi P, Vita A, Maj M. The mediating effect of mood spectrum on the relationship between autistic traits and catatonia spectrum. Front Psychiatry 2023; 14:1092193. [PMID: 37547215 PMCID: PMC10397411 DOI: 10.3389/fpsyt.2023.1092193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Background In the recent years, several studies have shown a correlation between autism spectrum disorder (ASD) and catatonia. It is also known that both conditions are found to be associated with mood disorders. This study aimed to investigate the relationship between autistic traits and catatonic symptoms, as well as the potential mediating role of mood disorder spectrum in the relationship between them. Methods The total sample of 514 subjects was composed by four diagnostic groups, composed by patients affected by catatonia (CTN), borderline personality disorder (BPD), major depressive disorder (MDD) and healthy controls (HC). Subjects were assessed with the SCID-5-RV, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Catatonia Spectrum (CS) and the Mood Spectrum Self-Report (MOODS-SR). Statistical analyses included Pearson's coefficient calculation, multiple linear regression, and mediation analysis. Results all the correlations appear to be strongly positive and significant with the strongest coefficient emerging between AdAS Spectrum total score and CS total score (r = 0.762, p < 0.001). The Mediation Analysis showed that AdAS Spectrum total score showed a significant indirect effect on CS total score through MOODS-SR total score (b = 0.168, 95% bootstrapped CI [0.127:0.207]). Conclusion The present study highlights the presence of a mediating role of the mood disorder spectrum in the relationship between autistic traits and the catatonia spectrum.
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Affiliation(s)
- Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Gravina
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Benedetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Danila Casagrande
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Naples “Luigi Vanvitelli”, Naples, Italy
| | - Isabella Berardelli
- Department of Neuroscience, Mental Health and Sense Organs, University of Roma “La Sapienza”, Rome, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marianna De Gregorio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marta Nola
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antonino Reitano
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | | | - Maurizio Pompili
- Department of Neuroscience, Mental Health and Sense Organs, University of Roma “La Sapienza”, Rome, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mario Maj
- Department of Psychiatry, University of Naples “Luigi Vanvitelli”, Naples, Italy
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Cuevas-Esteban J, Serra-Mestres J, Grover S, Jaimes-Albornoz W. Editorial: Catatonia across the lifespan. Front Psychiatry 2022; 13:1048715. [PMID: 36578298 PMCID: PMC9791212 DOI: 10.3389/fpsyt.2022.1048715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jorge Cuevas-Esteban
- Hospital Germans Trias i Pujol, Badalona, Spain.,Germans Trias i Pujol Health Science Research Institute (IGTP), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Sandeep Grover
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Neuroleptic Malignant Syndrome in Children with Autism Spectrum Disorder (ASD): A Case Report and Brief Review of Recent Literature. CHILDREN 2021; 8:children8121201. [PMID: 34943397 PMCID: PMC8700593 DOI: 10.3390/children8121201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022]
Abstract
Neuroleptic malignant syndrome (NMS) is a rare, life-threatening, idiosyncratic adverse reaction to antipsychotic drugs. Despite the increasing rates in the prescription of antipsychotics in pediatric patients with autism spectrum disorder (ASD), little is known about the occurrence and hallmarks of NMS in this specific population. NMS appears to be part of the larger catatonia domain, based on the frequent relationship between ASD and catatonia, on the shared, when not overlapping, clinical features with malignant catatonia, and on the effectiveness of catatonia treatments on the NMS/MC symptoms. The intrinsic difficulties of exploring NMS in ASD in controlled studies accounts for the subsequent lack of available information. Based on recent reports and on our case report, clinical features of NMS in the pediatric ASD population appear to be the same as the non-ASD population. Further studies are needed to confirm these results.
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10
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Catatonia: Back to the future of the neuropsychiatric syndrome. Med Clin (Barc) 2021; 158:369-377. [PMID: 34924197 DOI: 10.1016/j.medcli.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
Catatonia is an undertreated and underdiagnosed neuropsychiatric syndrome whose prognosis is benign if treated early, thus avoiding possible complications and compromising the health of patients. The latest epidemiological studies indicate a prevalence of catatonia of 9.2%, being frequent in medical pathologies (especially neurological ones), as well as in psychiatric pathologies. The use of validated scales is recommended for its diagnosis, to be able to measure the severity and response to treatment. Once catatonia has been identified, it is necessary to perform a protocolized diagnostic study of the underlying aetiology («Catatonia Workup»). Treatment of choice is benzodiazepines and electroconvulsive therapy. In recent years, new therapeutic alternatives such as non-invasive transcranial magnetic stimulation have emerged. In this review we propose several initiatives to promote the dissemination and knowledge of catatonia in the clinical setting.
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Vaquerizo-Serrano J, Salazar De Pablo G, Singh J, Santosh P. Catatonia in autism spectrum disorders: A systematic review and meta-analysis. Eur Psychiatry 2021; 65:e4. [PMID: 34906264 PMCID: PMC8792870 DOI: 10.1192/j.eurpsy.2021.2259] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Catatonic features can appear in autism spectrum disorders (ASDs). There can be overlap in symptoms across catatonia and ASD. The overall aim of this review is to provide evidence for the presence of catatonic features in subjects with ASD. METHODS A systematic literature search using the Web of Science database from inception to July 10, 2021 was conducted following PRISMA, MOOSE guidelines and the PROSPERO protocol. (CRD42021248615). Twelve studies with information about catatonia and ASD were reviewed. Data from a subset was used to conduct meta-analyses of the presence of catatonia in ASD. RESULTS The systematic review included 12 studies, seven of which were used for the meta-analysis, comprising 969 individuals. The mean age was 21.25 (7.5) years. Two studies (16.6%) included only children and adolescents. A total of 70-100% were males. Our meta-analysis showed that 10.4% (5.8-18.0 95%CI) of individuals with ASD have catatonia. Motor disturbances were common in ASD subjects with catatonia. No differences were found in comorbidity. Several treatments have been used in ASD with catatonic features, including benzodiazepines, antipsychotics, and electroconvulsive therapy (ECT). The findings of the systematic review showed that ECT might help manage catatonic symptoms. CONCLUSIONS Different features of catatonia can exist in individuals with ASD and core symptoms of catatonia are reported in ASD. Longitudinal and longer-term studies are required to understand the relationship between catatonia and ASD, and the response of catatonic symptoms to treatment.
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Affiliation(s)
- J. Vaquerizo-Serrano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, LondonSE5 8AF, United Kingdom
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases
(CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley
Hospital, LondonSE5 8AB, United Kingdom
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of
Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, LondonSE5 8AF, United Kingdom
- Institute of Psychiatry and Mental Health, Department of Psychiatry, Hospital
General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio
Maranón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental
(CIBERSAM), 28009Madrid, Spain
| | - G. Salazar De Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, LondonSE5 8AF, United Kingdom
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of
Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College
London, LondonSE5 8AF, United Kingdom
- Institute of Psychiatry and Mental Health, Department of Psychiatry, Hospital
General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio
Maranón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental
(CIBERSAM), 28009Madrid, Spain
| | - J. Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, LondonSE5 8AF, United Kingdom
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases
(CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley
Hospital, LondonSE5 8AB, United Kingdom
| | - P. Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, LondonSE5 8AF, United Kingdom
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases
(CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley
Hospital, LondonSE5 8AB, United Kingdom
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Rice T, Crow M, Cardieri B, Acheampong D, Coffey BJ. High-Dose Benzodiazepines in Treatment of Malignant Catatonia in an Adolescent: Lorazepam, Clonazepam, and Differing Efficacy. J Child Adolesc Psychopharmacol 2021; 31:450-454. [PMID: 34403598 DOI: 10.1089/cap.2021.29207.bjc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Timothy Rice
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Megan Crow
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brielle Cardieri
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Barbara J Coffey
- Department of Psychiatry and Behavioral Science, Miller School of Medicine, University of Miami, Miami, Florida, USA
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13
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Traverso A, Ancora C, Zanato S, Raffagnato A, Gatta M. Diagnostic and Therapeutic Challenges of Catatonia in an Adolescent With High Functioning Autism Spectrum Disorder: A Case Report. Front Psychiatry 2021; 12:644727. [PMID: 34149473 PMCID: PMC8211461 DOI: 10.3389/fpsyt.2021.644727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/04/2021] [Indexed: 12/27/2022] Open
Abstract
Catatonia is a psychomotor syndrome with specific clusters of speech, behavioral and motor features. Although potentially life-threatening, especially in its malignant form accompanied with autonomic dysregulation and medical complications, it is a treatable condition, when promptly identified. For a long time catatonia was considered a marker of schizophrenia, thus limiting the possibility of diagnosis and treatment. Due to growing awareness and studies on the subject, it is now known that catatonia can occur in the context of a number of diseases, including psychotic, affective and neurodevelopmental disorders. In recent years, there's been a renewed interest in the recognition and definition of catatonia in neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD), where the differential diagnosis poses great challenges, given the considerable overlapping of signs and symptoms between the conditions. We present the case of a 15 year old boy with High Functioning ASD with a sudden onset of severe catatonic symptoms and the co-existence of psychotic symptoms, whose complex clinical course raises many questions on the differentiation and relation of said disorders.
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Affiliation(s)
- Annalisa Traverso
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Caterina Ancora
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Silvia Zanato
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Michela Gatta
- Child and Adolescent Neuropsychiatry Unit, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
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