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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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Gesi C, Giacovelli L, Reibman YL, Dell'Osso B. Beyond imagination: Sorting out and treating psychosis in the context of autism spectrum disorder. J Psychiatr Res 2024; 173:363-366. [PMID: 38593694 DOI: 10.1016/j.jpsychires.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
In the last decades, growing caseness for Autism Spectrum Disorder (ASD) has been observed, owing to the diagnostic accretion of low-impairment forms, over and above other possible causes. Unrecognized ASD is likely to be mislabeled as a psychotic disorder (PD), as people in the spectrum may show 'pseudopsychotic' symptoms, resembling both negative and positive symptoms. On the other hand, PDs are likely to be overlooked when they arise in people with ASD, due to the 'diagnostic overshadowing' of new-onset conditions by lifelong core autistic symptoms. The three available metanalyses on the occurrence of psychosis in adults with ASD convergently reported a rate of PDs that is at least ten times higher than in the general population. Therefore, the lack of literature addressing risk factors, outcomes, and treatment options for psychosis in the context of ASD is utterly concerning. The present review aims to summarize up-to-date knowledge of PDs with comorbid ASD in terms of clinical features, course, and treatment.
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Affiliation(s)
- Camilla Gesi
- Department of Psychiatry and Addiction ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Luca Giacovelli
- Psychiatry 2 Unit, Luigi Sacco University Hospital, University of Milan, Milan, Italy.
| | - Yacob Levin Reibman
- Department of Psychiatry and Addiction ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Bernardo Dell'Osso
- Psychiatry 2 Unit, Luigi Sacco University Hospital, University of Milan, Milan, Italy; "Aldo Ravelli" Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; "Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche", University of Milan, Milan, Italy
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Meeder R, Peterson A, Reynard H, Andersen L. Dyadic Work in Conjunction With Electroconvulsive Therapy in a 12-Year-Old Female With Autism Spectrum Disorder and Catatonia. Ochsner J 2024; 24:141-146. [PMID: 38912185 PMCID: PMC11192222 DOI: 10.31486/toj.23.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background: Attachment-based interventions have been extensively studied in neurotypical patient populations. In neurodivergent patient populations, however, emphasis on and current research into attachment-based interventions are centered on early childhood. Minimal research has been conducted in school-aged children with autism spectrum disorder (ASD), and even less research has focused on attachment-based interventions for children with significant comorbidities such as catatonia. Case Report: We present the case of a 12-year-old female that involved dyadic work in conjunction with biologic interventions for the treatment of ASD and catatonia. Psychosocial interventions were centered on an attachment-based framework and behavioral skills training that incorporated elements of parent management training. We observed and tracked the patient's uncooperativeness, underproductive speech, emotional withdrawal, and anxiety via the Brief Psychiatric Rating Scale for Children. Attachment- and behavioral-based interventions in conjunction with psychotropic medications and electroconvulsive therapy resulted in improvements. Conclusion: This case illustrates the potential advantages that attachment- and behavioral-based psychotherapeutic interventions can confer in complex cases involving neurodivergent patients. The case also highlights the lack of current research into and understanding of attachment theory in children and adolescents with ASD. Research is needed into the role of attachment-based interventions in patients with ASD and other psychiatric comorbidities, particularly in patient populations beyond preschool age. Initiating nonbiologic interventions in conjunction with biologic interventions may also enhance outcomes and warrants further investigation.
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Affiliation(s)
| | | | - Hannah Reynard
- Department of Child and Adolescent Psychiatry, University of Michigan, Ann Arbor, MI
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Karl S, Sartorius A, Aksay SS. Catatonia and ECT across the lifespan. Schizophr Res 2024; 263:246-251. [PMID: 37087393 DOI: 10.1016/j.schres.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/10/2023] [Accepted: 04/12/2023] [Indexed: 04/24/2023]
Abstract
Electroconvulsive therapy (ECT) is a safe and effective treatment for catatonia with high response rates. Although empirical data suggest that tolerability and efficacy are at least as good as in adults, ECT treatment of children, adolescents, and geriatric patients seems to pose a specific challenge for many practitioners. This article intends to explore and discuss reasons hindering the use of ECT in these patient groups, give an overview on the use of ECT to treat catatonia and provide practical advice on ECT in children, adolescents, and geriatric patients for the treatment of catatonia. Classification of catatonia as a subform of schizophrenia and a diagnostic overlap with other common conditions in children, adolescents, and geriatric patients might lead to underdiagnosis of catatonia. Concerns about the mechanism of action and about a lack of controlled studies as well as general concerns about the use of ECT in children and adolescents might lead to underutilization of ECT. However, studies of ECT to treat catatonia in children, adolescents, and geriatric patients consistently show its safety and effectiveness. Administration of ECT needs to consider some specific characteristics of children, adolescents, and geriatric patients. In conclusion, ECT is a safe and highly effective treatment for catatonia across the lifespan. Existing evidence does not warrant restrictions of its use in certain age groups.
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Affiliation(s)
- Sebastian Karl
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany.
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Suna Su Aksay
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
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Leslie AC, O’Sullivan M. The Triad of Childhood-Onset Schizophrenia, Autism Spectrum Disorder, and Catatonia: A Case Report. Schizophr Bull 2023; 49:239-243. [PMID: 36719136 PMCID: PMC10016408 DOI: 10.1093/schbul/sbac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Childhood-onset schizophrenia (COS) is a rare and severe form of schizophrenia with an estimated prevalence of 1/10,000. Schizophrenia and Autism spectrum disorder (ASD) have shared phenotypic features and shared genetic etiology. There is growing research surrounding the co-occurrence of psychomotor syndromes like catatonia with neurodevelopmental disorders like ASD or psychiatric disorders like schizophrenia. In 2013, Shorter and Wachtel described a phenomenon of the 'Iron Triangle' where COS, ASD, and catatonia often co-occur. The Iron Triangle theory is based on observation of historical case literature, which showed that all three diagnoses in the Iron Triangle were routinely assigned to children and adolescents. The pattern of this "Iron Triangle" suggests there may be a single underlying pathology resulting in a unique mixed form of catatonia, autism, and psychosis. We describe the case of a boy with sequential development of COS, ASD, and catatonia who also has syndromic facial and musculoskeletal features. This case highlights overlapping diagnostic features of these three disorders and can help us better understand how "hidden" features of catatonia may occur in patients with COS or ASD but go unrecognized, because they are grouped as features under autism/schizophrenia rather than a distinct diagnosis of catatonia. Further study is warranted to elucidate if this phenotypic pattern constitutes a new single diagnosis that is not well understood, an endophenotype of schizophrenia, or if this is the result of phenomenological overlap between catatonia, ASD, and COS.
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Affiliation(s)
- Alison C Leslie
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michael O’Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
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Sierakowska A, Roszak M, Lipińska M, Bieniasiewicz A, Łabuz-Roszak B. AUTISM SPECTRUM DISORDER AND SCHIZOPHRENIA - SIMILARITIES BETWEEN THE TWO DISORDERS WITH A CASE REPORT OF A PATIENT WITH DUAL DIAGNOSIS. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:172-177. [PMID: 37254766 DOI: 10.36740/merkur202302111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This paper presents the genetic, molecular and neuroanatomical similarities between autism spectrum disorder (ASD) and schizophrenia using the case report of a 34-year-old female patient with a previous diagnosis of schizophrenia as an example. As a result of repeat hospitalization, expanded history, psychological testing and verification of persistent symptoms of psychopathology, a cooccurring diagnosis of autism spectrum disorder was made.
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Affiliation(s)
- Alicja Sierakowska
- STUDENT ASSOCIATION OF NEUROLOGY AT THE DEPARTMENT OF NEUROLOGY, INSTITUTE OF MEDICAL SCIENCES, OPOLE UNIVERSITY, OPOLE, POLAND
| | - Mateusz Roszak
- STUDENT ASSOCIATION OF NEUROLOGY AT THE DEPARTMENT OF NEUROLOGY, INSTITUTE OF MEDICAL SCIENCES, OPOLE UNIVERSITY, OPOLE, POLAND
| | - Milena Lipińska
- DEPARTMENT OF PSYCHIATRY, ST. JADWIGA REGIONAL SPECIALIZED HOSPITAL, OPOLE, POLAND
| | - Anna Bieniasiewicz
- DEPARTMENT OF NEUROLOGY, INSTITUTE OF MEDICAL SCIENCES, UNIVERSITY OF OPOLE, OPOLE, POLAND; DEPARTMENT OF NEUROLOGY, ST. JADWIGA REGIONAL SPECIALIZED HOSPITAL, OPOLE, POLAND
| | - Beata Łabuz-Roszak
- DEPARTMENT OF NEUROLOGY, INSTITUTE OF MEDICAL SCIENCES, UNIVERSITY OF OPOLE, OPOLE, POLAND; DEPARTMENT OF NEUROLOGY, ST. JADWIGA REGIONAL SPECIALIZED HOSPITAL, OPOLE, POLAND
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Neurodevelopmental Disorders, Schizophrenia Spectrum Disorders and Catatonia: The "Iron Triangle" Rediscovered in a Case Report. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010077. [PMID: 36670628 PMCID: PMC9856853 DOI: 10.3390/children10010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
Catatonia is a complex neuropsychiatric syndrome, occurring in the context of different psychiatric and neurodevelopmental disorders, in neurological and medical disorders, and after substance abuse or withdrawal. The relationship between Autism Spectrum Disorder (ASD), Schizophrenia Spectrum Disorders (SSDs) and catatonia has been previously discussed, with the three disorders interpreted as different manifestations of the same underlying brain disorder (the "Iron Triangle"). We discuss in this paper the diagnostic, clinical and therapeutic implications of this complex relationship in an adolescent with ASD, who presented an acute psychotic onset with catatonia, associated with mixed mood symptoms. Second-generation antipsychotics were used to manage psychotic, behavioral and affective symptoms, with worsening of the catatonic symptoms. In this clinical condition, antipsychotics may be useful at the lowest dosages, with increases only in the acute phases, especially when benzodiazepines are ineffective. Mood stabilizers with higher GABAergic effects (such as Valproate and Gabapentin) and Lithium salts may be more useful and well tolerated, given the frequent association of depressive and manic symptoms with mixed features.
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Ishizuka K, Tachibana M, Inada T. Possible Commonalities of Clinical Manifestations Between Dystonia and Catatonia. Front Psychiatry 2022; 13:876678. [PMID: 35573366 PMCID: PMC9098969 DOI: 10.3389/fpsyt.2022.876678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/08/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kanako Ishizuka
- Health Support Center, Nagoya Institute of Technology, Nagoya, Japan
| | - Masako Tachibana
- Department of Psychiatry, Nagoya University Hospital, Nagoya, Japan
| | - Toshiya Inada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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