
==== Front
medRxiv
MEDRXIV
medRxiv
Cold Spring Harbor Laboratory

10.1101/2024.09.05.24312724
preprint
1
Article
Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism with and without Profound Impairment: An Observational Study
Smith Joshua Ryan http://orcid.org/0000-0001-7008-165X

Lim Seri http://orcid.org/0009-0008-0716-0695

Bindra Snehal http://orcid.org/0000-0002-8865-4249

Marler Sarah http://orcid.org/0009-0003-8663-357X

Rajah Bavani
Williams Zachary J. http://orcid.org/0000-0001-7646-423X

Baldwin Isaac http://orcid.org/0000-0002-1176-0836

Hossain Nausheen
Wilson Jo Ellen
Fuchs D. Catherine http://orcid.org/0000-0003-1387-4092

Luccarelli James http://orcid.org/0000-0002-1606-3917

06 9 2024
2024.09.05.24312724https://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows reusers to copy and distribute the material in any medium or format in unadapted form only, for noncommercial purposes only, and only so long as attribution is given to the creator.
http://medrxiv.org/lookup/doi/10.1101/2024.09.05.24312724
nihpp-2024.09.05.24312724.pdf
Abstract

Introduction

Catatonia is a highly morbid psychomotor and affective disorder which can affect autistic individuals with and without profound impairment. Catatonic symptoms are treatable with pharmacotherapy and electroconvulsive therapy, but the longitudinal effectiveness of these treatments has not been described.

Methods

We conducted a prospective observational cohort study of patients with autism and co-morbid catatonia who received outpatient care in a specialized outpatient clinic from July 1 st , 2021 to May 31 st , 2024. Data investigating pharmacologic interventions, and clinical measures including the Bush Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), Kanner Catatonia Examination (KCE), and Clinical Global Impression – Improvement (CGI-I) were collected.

Results

Forty-five patients were identified with 39 (86.7%) meeting criteria for profound autism. All patients received pharmacotherapy. 44 (97.8%) were treated with benzodiazepines with a mean maximal daily dose of 17.4 mg (SD=15.8) lorazepam equivalents. Thirty-five patients (77.8%) required more than one medication class for treatment. Fourteen patients (31.1%) attempted to taper off benzodiazepines during the study period; of these, 5 patients (11.1%) were successfully tapered off, and the remaining 9 (17.8%) discontinued the taper due to a return of catatonic symptoms. Statistically significant improvement was observed across all clinical domains except the KCS. However, the majority remained symptomatic over the study period.

Conclusions

Despite clinical improvements while receiving the gold standard for psychopharmacologic management of catatonia, chronic symptoms remained for the majority of catatonia patients over the study period, and few were able to taper and discontinue benzodiazepine treatment.

Lay Summary

Catatonia is a condition which can significantly impact the quality of life for autistic individuals with and without profound impairment. Symptoms of catatonia such as aggression and self-injury can improve with treatment. However, over the three-year period of this study, most patients experienced residual symptoms, and few could discontinue psychotropic medication.
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