Case study: bipolar disorder and catatonia in an adult autistic male with intellectual disability and Phelan-McDermid syndrome (22q13.33 deletion syndrome): psychopharmacological treatment and symptom trajectories

Abstract

Objectives Individuals with Phelan-McDermid syndrome (PHMDS) appear to be at increased risk of bipolar disorder and catatonia. While previous research indicates that standard pharmacological treatment of both conditions may be effective in individuals with PHMDS, there is limited knowledge concerning treatment when bipolar disorder and catatonia co-occur. Moreover, symptom trajectories during treatment of bipolar disorder and catatonia in this population have been sparsely described. Methods Case study describing treatment choices, sequence of interventions, and treatment outcome using standardised checklists, for co-occurring bipolar disorder and catatonia in an adult autistic man with intellectual disabilities. Results The current patient was initially diagnosed with a depressive disorder and catatonia. Treatment of catatonia appeared to trigger mania, indicating that catatonia was associated with, and possibly secondary to, affective symptomatology. The successful treatment of catatonia required the discontinuation of antidepressants and the introduction of a mood stabilising drug, in addition to standard catatonia treatment. Conclusions The current case demonstrates the importance of considering the treatment of catatonia in the context of co-occurring affective disorder, and vice versa, in individuals with PHMDS. The symptom trajectories and outcomes described add to the current evidence base concerning the treatment of bipolar disorder/catatonia in PHMDS.