Autistic catatonia
Autistic catatonia is a term used to describe the occurrence of catatonia in individuals with autism.
The condition affects roughly 10 percent of all adults with autism spectrum disorder and intellectual disabilities and is associated with more than 40 symptoms. Because autistic catatonia arises only in those with autism, the symptoms of autistic catatonia overlap with those of autism, which can make diagnosis difficult.
First described by Karl Ludwig Kahlbaum in 1874, only recently was catatonia defined as a feature of psychiatric disorders and not a disorder in its own right. Individuals with autistic catatonia suffer from the barriers that autism and catatonia present concurrently, including the social stigma and symptoms. Treatments for autistic catatonia include benzodiazapines and behavioral therapies that follow the Psycho-Ecological Approach. Recently, electroconvulsive therapy (ECT) has been employed.
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. Also, neuroimaging studies have indicated that autistic catatonic patients have abnormally small cerebellar structures. Furthermore, genetic studies have implied that alterations on chromosome 15 may underpin the disease.
Alternatively, catatonia has been frequently observed in patients with severe anxiety. Because autism can cause individuals to be susceptible to anxiety, the prevalence of catatonia in autism may be attributable to anxiety.
Symptoms
Autistic catatonia is associated with more than 40 symptoms, many in common with autism. These include:
- Stupor
- Mutism
- Hyperactivity
- Agitation
- Excitement
- Posing
- Negativism
- Rigidity
- Waxy flexibility, mitmachen, mitgehen – tendency to remain in immobile posture, inability to resist external pressure on posture
- Automatic obedience
- Combativeness (during excitement)
- Aggressivity
- Stereotypies
- Tics
- Grimacing
- Echolalia
- Echopraxia
- Perseveration
- Verbigeration
- Staring, gaze fixation
- Withdrawal
- Immobility
- Challenging behaviour
- Tremor
- Slowness
- Amotivation
- Grasp reflex
- Choreoathetoid movements of the trunk and extremities
- Autonomic instability (during excitement)
- Inability to start or stop actions (if during excitement episodes needs acute psychiatric care)
- Impulsivity
- Psychosis
- Sleep problems, reversal of day and night
- Urinary or fecal incontinence
- Passivity
- Eyerolling
- Stiff muscles
- Catalepsy
- Gegenhalten
- Ambitendency – contradictory behavior
- Rituals – repetitive behaviors
The most severe cases display stupor, hyperactivity, or severe excitement, which can sometimes continue for weeks or even months. During excitement, individuals show combativeness, can have delusions and hallucinations, and can also pose a danger to themselves and others. In the medium, severe, and lethal states, they will also experience autonomic instability.
As the name of the disorder suggests, some symptoms are also displayed in autism spectrum disorder. Thus, diagnosis of catatonic breakdown can be difficult. Full expression of excitement could be a sign of co-morbid bipolar disorder but more research is needed.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.
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.
It has also been shown that benzodiazapines are effective for some patients. More recently, electroconvulsive therapy (ECT) has been trialed, with mixed effect. Several patients have responded well to intensive, multi-month ECT regimens after other treatments failed. Furthermore, ECT was successfully used to treat symptoms in patients prone to self-injury and compulsive behavior. However, it seems that ECT must be continued for long periods of time to prevent re-onset of autistic catatonic symptoms. Furthermore, there is popular resistance to the idea of inducing seizures as treatment - which ECT relies on - especially in pediatric patients.
History
Karl Ludwig Kahlbaum was among the first to systematically describe catatonia, which in 1874 he documented as a separate brain disorder. The phenomenon was later described by Emil Kraepelin as a precursor disease that led to dementia. It was not until the 1970s that catatonia was recognized as a feature of other affective psychiatric disorders in adults, especially manias.
Recent observations have shown that while catatonia can present in a variety of other diseases, it often presents in patients diagnosed with autism. The two often share similar symptoms such as mutism, rigidity, mannerisms, and sterotypies. However, patients with autistic catatonia also often suffer from marbling of the skin, profuse sweating, deviation of the pupils and odd reaction to light.
See also
Further reading
- Dhossche, Dirk M. (2014). "Decalogue of Catatonia in Autism Spectrum Disorders". Frontiers in Psychiatry. 5: 157. doi:10.3389/fpsyt.2014.00157. PMC 4222130. PMID 25414675.
- Ghaziuddin, M.; Quinlan, P.; Ghaziuddin, N. (2005). "Catatonia in autism: a distinct subtype?" (PDF). Journal of Intellectual Disability Research. 49 (1): 102–5. doi:10.1111/j.1365-2788.2005.00666.x. hdl:2027.42/71765. PMID 15634317.