P0348 - Catatonia in autism: Etiology, incidence and treatment

Abstract

Aim:

This paper reviews the concomitance of catatonia and autism spectrum disorders, including incidence, diagnostic similarities, etiologic theories and treatment modalities, including electroconvulsive therapy (ECT). Case examples are included.

Method:

A review of the English-language literature on catatonia and autism was conducted, combined with the author's clinical experience working with two autistic individuals with frank catatonic stupor requiring ECT.

Results:

While catatonia is most frequently associated with mood and psychotic disorders, frank diagnosable catatonia has been found in 11-17% of individuals with autism. Significant symptom overlap exists between the two disorders in the domains of motor activity, social interaction, communication and behavior; indeed, both processes may share a common neuronal substrate as well as a shared genetic susceptibility region. DSM-IV-TR catatonic symptoms include motoric immobility and overactivity, negativism and peculiarities of movement and speech, while expanded criteria for catatonia in autism additionally include amotivation, difficulty with task completion, day-night reversal and agitation/excitement. A range of severity exists in catatonia, with some patients developing profound catatonic stupor or malignant catatonia with autonomic instability. Catatonia is readily treatable, with lorazepam and ECT as first-line treatments. However, diagnosis may be delayed in the autistic patient with baseline intellectual disability, behavioral and communicative abnormalities. Similarly, appropriate treatment, especially ECT, may be withheld due to issues surrounding intellectual disability.

Conclusion:

Catatonia is not an infrequent occurrence in autism, and its manifestations can be severe. Prompt clinical recognition and treatment of catatonia in autism is imperative, with further research needed in this field.