Abstract
Background: Catatonia is a unique syndrome characterized by specific motor signs, at times life-threatening when aggravated by autonomic dysfunction and fever, yet treatable if recognized early. Catatonia occurs in patients with various disorders including autism and related developmental disorders. Sometimes catatonia develops after severe psychological trauma, supporting the view that it is an extreme motor reaction to fear. Methods: Review of literature on the role of fear in the development of catatonia in autism, and its treatment. Results: There are no empirical studies in the literature addressing the role of fear in the development of catatonia in autism. Case-reports support that stressful events often precede the development of catatonia in autistic people and that catatonia in autism is a treatable syndrome, often requiring psychosocial interventions to reduce anxiety, and the use of benzodiazepines, electroconvulsive therapy, and maintenance electroconvulsive therapy for safe reversal. Autistic people may be particularly vulnerable to catatonia due to social, cognitive, and sensory deficits. Conclusion: Further studies are warranted in autistic people, measuring states of anxiety in response to various stressors, and assessing their relationship to catatonia, and applying various treatments including benzodiazepines, electroconvulsive therapy, and psychosocial interventions, in those with catatonia.
Highlights
Catatonia is a unique syndrome characterized by specific motor signs, at times life-threatening when aggravated by autonomic dysfunction and fever, yet treatable with benzodiazepines and electroconvulsive therapy (ECT) if recognized early [1,2]
A growing literature indicates that ECT is safe and efficacious in the acute treatment of catatonia in autism
There is a support from case-reports that catatonia in autism is a treatable syndrome, often requiring the use of benzodiazepines, ECT, and maintenance ECT for safe reversal
Summary
Catatonia is a unique syndrome characterized by specific motor signs, at times life-threatening when aggravated by autonomic dysfunction and fever, yet treatable with benzodiazepines and electroconvulsive therapy (ECT) if recognized early [1,2].Signs observed in catatonia include immobility or severe motor slowing, sometimes alternating with excessive motor activity that is mostly purposeless and not influenced by external stimuli, extreme negativism, reduction of speech or mutism, repetitive movements or stereotypy, echolalia, echopraxia, and other peculiarities of voluntaryDevelopmental Disorders Autistic Disorder [13,14,15,16] Childhood Disintegrative Disorder [12,17] Mental Retardation [5] including Down Syndrome [18] Prader Willi Syndrome [10]Medical and Neurological Disorders Catatonia due to a general medical condition (brain structural damage, seizures, metabolic, endocrine, and autoimmune disorders) [19,20,21,22,23]Psychiatric Disorders Psychotic Disorders [24] Mood Disorders [24] Substance-induced disorders [19] Medication-induced movement disorder (NMS) [25,26] Tourette’s Syndrome [3,6,27]Miscellaneous Conditions Anti-NMDA (N-methyl-d-aspartic acid) receptor encephalitis [28,29,30,31,32], PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) [20,22], encephalitis lethargica [33], and other aseptic encephalitides [34] Kleine Levin Syndrome [12] Psychogenic catalepsy [35] Anaclitic depression [36,37] Pervasive Refusal Syndrome [38,39]movement. Catatonia is a unique syndrome characterized by specific motor signs, at times life-threatening when aggravated by autonomic dysfunction and fever, yet treatable with benzodiazepines and electroconvulsive therapy (ECT) if recognized early [1,2]. During the last 15 years, catatonia has been further delineated in children, adolescents, and young adults across a wide range of disorders, including autism [5,6,7]. An overview of pediatric and adult disorders, in which catatonia can emerge, is given, showing that catatonia occurs in patients with psychotic, affective, drug-induced, medical, autistic, developmental, tic, and psychogenic disorders. Catatonia is a unique syndrome characterized by specific motor signs, at times life-threatening when aggravated by autonomic dysfunction and fever, yet treatable if recognized early. Catatonia occurs in patients with various disorders including autism and related developmental disorders. Sometimes catatonia develops after severe psychological trauma, supporting the view that it is an extreme motor reaction to fear
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