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[Preprint]. 2024 Sep 6:2024.09.05.24312724.
doi: 10.1101/2024.09.05.24312724.

Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism with and without Profound Impairment: An Observational Study

Joshua Ryan Smith  1   2   3 , Seri Lim  1 , Snehal Bindra  4 , Sarah Marler  1 , Bavani Rajah  1 , Zachary J Williams  4 , Isaac Baldwin  1 , Nausheen Hossain  1 , Jo Ellen Wilson  3   5   6 , D Catherine Fuchs  1 , James Luccarelli  7   8
Affiliations

Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism with and without Profound Impairment: An Observational Study

Joshua Ryan Smith et al. medRxiv. .

Update in

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 1st, 2021 to May 31st, 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.

Keywords: Aggression; Autism; Catatonia; Electroconvulsive Therapy; Psychopharmacology; Self-Injurious Behavior.

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Conflict of interest statement

JRS receives funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Axial Therapeutics, and Roche. ZJW has received consulting fees from Roche and Autism Speaks. He also serves as the Vice-chair of Autistic and Neurodivergent Scholars Working for Equity in Research (ANSWER), a division of the Autism Intervention Research Network on Physical Health (AIR-P). JW receives support from the Department of Veterans Affairs, Geriatric, Research, Education and Clinical Center (GRECC) at the Tennessee Valley Healthcare System in Nashville, TN. JL receives funding from Harvard Medical School, the Rappaport Foundation, and the Foundation for Prader-Willi Research. He holds equity and has received consulting income from Revival Therapeutics, Inc.

Figures

Figure 1:
Figure 1:
Length of Overall Outpatient Follow-Up
Figure 2:
Figure 2:
Number of Medication Classes for Catatonia in Autism
Figure 3:
Figure 3:
Clinical Outcomes for Catatonia in Autism
See this image and copyright information in PMC

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