Autistic catatonia

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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] :60

Contents

The DSM-5 lists "with catatonia" as one of the possible specifiers for an autism spectrum disorder diagnosis. [3] :57

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]

Related Research Articles

<span class="mw-page-title-main">Catatonia</span> Psychiatric behavioral syndrome

Catatonia is a complex neuropsychiatric behavioral syndrome that is characterized by abnormal movements, immobility, abnormal behaviors, and withdrawal. The onset of catatonia can be acute or subtle and symptoms can wax, wane, or change during episodes. It has historically been related to schizophrenia, but catatonia is most often seen in mood disorders. It is now known that catatonic symptoms are nonspecific and may be observed in other mental, neurological, and medical conditions. Catatonia is now a stand-alone diagnosis, and the term is used to describe a feature of the underlying disorder.

Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Asperger syndrome</span> Neurodevelopmental diagnosis now categorized under Autism Spectrum Disorder

Asperger syndrome (AS), also known as Asperger's syndrome, formerly described a neurodevelopmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior, interests, and activities. The syndrome has been merged with other disorders into autism spectrum disorder (ASD) and is no longer considered a stand-alone diagnosis. It was considered milder than other diagnoses that were merged into ASD by relatively unimpaired spoken language and intelligence.

<span class="mw-page-title-main">Electroconvulsive therapy</span> Medical procedure in which electrical current is passed through the brain

Electroconvulsive therapy (ECT) or electroshock therapy (EST) is a psychiatric treatment where a generalized seizure is electrically induced to manage refractory mental disorders. Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple or from front to back of one side of the head. However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.

In psychology, schizotypy is a theoretical concept that posits a continuum of personality characteristics and experiences, ranging from normal dissociative, imaginative states to extreme states of mind related to psychosis, especially schizophrenia. The continuum of personality proposed in schizotypy is in contrast to a categorical view of psychosis, wherein psychosis is considered a particular state of mind, which the person either has or does not have.

Autism spectrum disorders (ASD) are neurodevelopmental disorders that begin in early childhood, persist throughout adulthood, and affect three crucial areas of development: communication, social interaction and restricted patterns of behavior. There are many conditions comorbid to autism spectrum disorders such as attention-deficit hyperactivity disorder and epilepsy.

High-functioning autism (HFA) was historically an autism classification where a person exhibits no intellectual disability, but may experience difficulty in communication, emotion recognition, expression, and social interaction.

Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.

A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".

Oneiroid syndrome (OS) is a condition involving dream-like disturbances of one's consciousness by vivid scenic hallucinations, accompanied by catatonic symptoms (either catatonic stupor or excitement), delusions, or psychopathological experiences of a kaleidoscopic nature. The term is from Ancient Greek "ὄνειρος" (óneiros, meaning "dream") and "εἶδος" (eîdos, meaning "form, likeness"; literally dream-like / oneiric or oniric, sometimes called "nightmare-like"). It is a common complication of catatonic schizophrenia, although it can also be caused by other mental disorders. The dream-like experiences are vivid enough to seem real to the patient. OS is distinguished from delirium by the fact that the imaginative experiences of patients always have an internal projection. This syndrome is hardly mentioned in standard psychiatric textbooks, possibly because it is not listed in DSM.

<span class="mw-page-title-main">Waxy flexibility</span> Catatonia psychomotor symptom

Waxy flexibility is one of the twelve symptoms that can lead to the diagnosis of catatonia. It is a psychomotor symptom that results in a decreased response to stimuli and a tendency to remain in an immobile posture. If one were to move the arm of someone with waxy flexibility, the patient would keep that arm where it had been positioned until moved again as if positioning malleable wax. Attempts to reposition the patient are met by "slight, even resistance".

Dual diagnosis is the condition of having a mental illness and a comorbid substance use disorder. There is considerable debate surrounding the appropriateness of using a single category for a heterogeneous group of individuals with complex needs and a varied range of problems. The concept can be used broadly, for example depression and alcohol use disorder, or it can be restricted to specify severe mental illness and substance use disorder, or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Diagnosing a primary psychiatric illness in people who use substances is challenging as substance use disorder itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness.

<span class="mw-page-title-main">Classic autism</span> Neurodevelopmental condition

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism,Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

<span class="mw-page-title-main">Autism spectrum</span> Neurodevelopmental disorder

Autism, formally called autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder marked by impaired social communication and restricted and repetitive patterns of behavior. Other common signs include difficulty with social interaction, verbal and nonverbal communication, along with perseverative interests, stereotypic body movements, rigid routines, and hyper- or hyporeactivity to sensory input. Autism is clinically regarded as a spectrum disorder, meaning that it can manifest very differently in each person. For example, some are nonspeaking, while others have proficient spoken language. Because of this, there is wide variation in the support needs of people across the autism spectrum.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

<span class="mw-page-title-main">Imprinted brain hypothesis</span> Conjecture on the causes of autism and psychosis

The imprinted brain hypothesis is an unsubstantiated hypothesis in evolutionary psychology regarding the causes of autism spectrum and schizophrenia spectrum disorders, first presented by Bernard Crespi and Christopher Badcock in 2008. It claims that certain autistic and schizotypal traits are opposites, and that this implies the etiology of the two conditions must be at odds.

In psychiatry, stilted speech or pedantic speech is communication characterized by situationally inappropriate formality. This formality can be expressed both through abnormal prosody as well as speech content that is "inappropriately pompous, legalistic, philosophical, or quaint". Often, such speech can act as evidence for autism spectrum disorder (ASD) or a thought disorder, a common symptom in schizophrenia or schizoid personality disorder.

Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.

The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.

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". npj Mental Health Research. 1: 12. doi: 10.1038/s44184-022-00012-9 .
  2. 1 2 3 4 5 6 Vaquerizo-Serrano, J.; Pablo, G. Salazar De; Singh, J.; Santosh, P. (2022). "Catatonia in autism spectrum disorders: A systematic review and meta-analysis". European Psychiatry. 65 (1): e4, 1–10. doi:10.1192/j.eurpsy.2021.2259. PMC   8792870 . PMID   34906264.
  3. 1 2 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. S2CID   249488050.
  4. Wijemanne, Subhashie; Jankovic, Joseph (2015-08-01). "Movement disorders in catatonia". Journal of Neurology, Neurosurgery & Psychiatry. 86 (8): 825–832. doi: 10.1136/jnnp-2014-309098 . ISSN   0022-3050. PMID   25411548. S2CID   5925700.
  5. 1 2 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. PMC   4695780 . 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. PMC   3714300 . 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. (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.
  8. Shah, Amitta Catatonia, Shutdown and Breakdown in Autism: A Psycho-Ecological Approach. Jessica Kingsley Publishers, 2019, p. 97.
  9. 1 2 3 4 5 6 7 8 9 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.

Further reading