Onset of Catatonia at Puberty Electroconvulsive Therapy Response in Two Autistic Adolescents

Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109-5734, USA.
The journal of ECT (Impact Factor: 1.39). 12/2010; 26(4):274-7. DOI: 10.1097/YCT.0b013e3181de332e
Source: PubMed

ABSTRACT Catatonia is a syndrome of motor and behavioral disturbance. It is a poorly understood condition, which is underrecognized and may go untreated despite intensive medical workup and numerous unsuccessful medication trials. However, with treatments known to be effective, such as benzodiazepines and/or electroconvulsive therapy, patients may return to their baseline functioning. Autism and catatonia have been previously reported together. We report 2 patients with autism and mental retardation who developed catatonic symptoms at the onset of puberty. Both patients experienced persistent symptoms over several years and presented with a history of motor disturbance, functional decline, and episodic aggression. Both patients were treated with electroconvulsive therapy resulting in a positive response and functional improvement. Catatonia may persist as a chronic condition, lasting over several months or years, if not recognized and treated.

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    ABSTRACT: A systematic review was conducted to examine the efficacy of a range of treatments for autistic catatonia. The review identified 22 relevant papers, reporting a total of 28 cases including both adult and paediatric patients. Treatment methods included electroconvulsive therapy (ECT), medication, behavioural and sensory interventions. Quality assessment found the standard of the existing literature to be generally poor, with particular limitations in treatment description and outcome measurement. There is some limited evidence to support the use of ECT, high dose lorazepam and behavioural interventions for people with autistic catatonia. However, there is a need for controlled, high-quality trials. Reporting of side effects and adverse events should also be improved, in order to better evaluate the safety of these treatments.
    Journal of Autism and Developmental Disorders 03/2014; 44(9). DOI:10.1007/s10803-014-2085-y · 3.06 Impact Factor
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    ABSTRACT: There is lot of skepticism about the use of electroconvulsive therapy (ECT) in children and adolescents. However, available literature suggests that use of ECT can be at times life-saving in adolescents, especially those presenting with severe catatonia. We treated a 16-year-old female who presented to us with catatonia with a course of nine ECTs, with which she showed marked improvement. Review of the literature suggests that ECT should be considered as the second line treatment in the management of catatonia in adolescents.
    Indian Journal of Psychological Medicine 04/2014; 36(2):195-7. DOI:10.4103/0253-7176.130994
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    ABSTRACT: Background: Around 8% of people with autistic spectrum disorders (ASD) present with catatonic symptoms, typically developing in mid-adolescence. Core features include being very still for long periods of time, getting ‘stuck’ when trying to do something, difficultly stopping actions once they have been started, difficulties in initiating actions, moving very slowly and taking a long time to finish actions and requiring physical and /or verbal prompts to finish actions. These symptoms have a significant impact on patients’ quality of life and independence. Various treatments for autistic catatonia have been proposed, and treatment guidelines published. However, the existing literature is limited and has not been systematically reviewed Objectives: The aim of the review was to systematically examine treatments that have been used to address catatonic symptoms in ASD, and to consider the evidence for the safety and efficacy of these interventions. Methods: A systematic review of the existing literature was conducted, including search of three major online databases. Search terms included autism and catatonia, along with similar and related terms. Reference sections of included papers were hand searched for additional results. Any paper describing treatment of catatonic symptoms in at least one patient with an ASD was included in the review. So-called “grey literature” and non-English language papers were excluded. Study quality was also assessed and methodological limitations considered Results: 22 papers describing a total of 28 cases were included in the final review, encompassing both adult and paediatric cases. All papers described either single case reports or small case series. Treatments utilised included electroconvulsive therapy (ECT), various pharmacological interventions, behavioural and sensory interventions. Study quality was generally low, with particular limitations in outcome measurement, description of treatment and failure to control for confounding variables. There is some evidence for short term benefit of both electroconvulsive therapy and pharmacological interventions, particularly lorazepam. However, any benefit appears to be temporary and symptom remission is usually incomplete. Behavioural interventions also show some promise although evidence is currently limited to a very small number of cases. Side effects and adverse reactions were poorly addressed across the literature. Publication bias is also likely to be a significant issue. Conclusions: Various treatments have been used to address catatonic symptoms in people with ASD, including ECT, pharmacological and behavioural interventions. However, the existing literature is limited to single case designs with serious methodological limitations. There is therefore little evidence to support any specific treatment. Behavioural interventions seem to show some promise, in that benefit may be better maintained than for other treatments and there is lower risk of serious side effects. Further research is needed to establish effective treatments for catatonic symptoms in ASD.
    2014 International Meeting for Autism Research; 05/2014


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May 16, 2014