High-Frequency Utilization of the Outpatient Messaging System in a Specialized Outpatient Catatonia Clinic for Individuals with Autism Spectrum Disorder

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Smith, J. R., Sengstack, D. G., McCoy, A. B., Lim, S., Marler, S., Williams, Z. J., Hossain, N., & Luccarelli, J. (2025). High-Frequency Utilization of the Outpatient Messaging System in a Specialized Outpatient Catatonia Clinic for Individuals with Autism Spectrum Disorder. Journal of Child and Adolescent Psychopharmacology, 35(7), 424-430. https://doi.org/10.1089/cap.2025.0034

Publication date: 30 Apr 2025 Added to AutiHub: 7 Jul 2026 Type: Article Article language: English
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Authors

Publication authors
8
Publication authors identified as autistic
1 / 8 (12.5%)
  1. Joshua R. Smith
  2. Donald G. Sengstack
  3. Allison B. McCoy
  4. Seri Lim
  1. Sarah Marler
  2. Zachary J. Williams *
  3. Nausheen Hossain
  4. James Luccarelli

Abstract

Purpose:Catatonia is a highly morbid psychomotor disorder that impacts autistic adults and children. There is very little literature that describes outpatient catatonia management practices, none of which discusses the use of the electronic health record (EHR). Thus, we conducted this study to analyze patient messages in a specialized catatonia clinic. Methods:We conducted a retrospective analysis of messaging practices in the EHR for patients in a specialized clinic with autism and catatonia from July 1, 2021, to May 31, 2024. Catatonic symptom severity was recorded via the Bush Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), and Kanner Catatonia Examination (KCE). We conducted Spearman and Pearson correlation coefficients to determine whether a relationship exists between the frequency of patient messages, catatonic symptoms, and length of follow-up. Results:A total of 12,972 messages were sent to the health system or received by the patient or their family. Of those, 6375 (49.1%) messages were sent from the family to the health system. Relationships between message frequency to the health system and all baseline catatonia severity scores (BFCRS, KCS, KCE) were not statistically significant, although message frequency was strongly associated with length of follow-up (r = 0.65, p < 0.001). A total of 5555 (42.8%) messages were sent directly to or received from providers in the catatonia specialty clinic. The rate of messages to providers in the catatonia clinic was 2.9 messages/day. Conclusion:The frequency of patient messaging was high in this catatonia specialty clinic. Health systems should consider this possibility when planning for similar service lines.

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These indicators describe the cited bibliography imported for this publication. Cited-reference metrics use the cited-reference total as denominator. Cited-author metrics state whether they use all cited-author occurrences or only occurrences linked to authors already integrated in the AutiHub database. They use cached links between cited authors and authors integrated in the AutiHub database. Last computed: 16 Aug 2026 11:31.

Cited references
34
Total cited references integrated for this publication.
Cited references with an identified autistic author
2 / 34 (5.9%)
Cited author occurrences identified as autistic
2 / 240 (0.8%)
Among occurrences linked to AutiHub author records: 2 / 57 (3.5%). Distinct cited authors identified as autistic: 2 / 186 (1.1%).
Cited author occurrences linked to AutiHub author records
57 / 240 (23.8%)
Distinct linked cited authors: 28 / 186 (15.1%)
Linked cited-author occurrences not identified as autistic
55 / 57 (96.5%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 55 / 240 (22.9%). Distinct linked cited authors not identified as autistic: 26 / 28 (92.9%).
  1. G. Bush , M. Fink , G. Petrides , F. Dowling , A. Francis (1996). Catatonia. I. Rating scale and standardized examination . Acta Psychiatrica Scandinavica, 93(2), 129-136. Wiley.
    Type: Article DOI: 10.1111/j.1600-0447.1996.tb09814.x OpenAlex: https://openalex.org/W2064531284
    Crossref OpenAlex OpenCitations
  2. Julia Adler-Milstein , Wendi Zhao , Rachel Willard-Grace , Margae Knox , Kevin Grumbach (2020). Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians . Journal of the American Medical Informatics Association, 27(4), 531-538. Oxford University Press (OUP).
    Type: Article DOI: 10.1093/jamia/ocz220 OpenAlex: https://openalex.org/W3005890082
    Crossref OpenAlex OpenCitations
  3. Catherine Lord , Tony Charman , Alexandra Havdahl , Paul Carbone , Evdokia Anagnostou , Brian Boyd et al. (2022). The Lancet Commission on the future of care and clinical research in autism . The Lancet, 399(10321), 271-334. Elsevier BV.
    Type: Article DOI: 10.1016/s0140-6736(21)01541-5 OpenAlex: https://openalex.org/W4200099564
    Crossref OpenAlex OpenCitations
  4. Robert Arnold Johnson (2015). Catatonia in Outpatients . Journal of Clinical Psychopharmacology, 35(1), 89-91. Ovid Technologies (Wolters Kluwer Health).
    Type: Article DOI: 10.1097/jcp.0000000000000239 OpenAlex: https://openalex.org/W2071080322
    Crossref OpenAlex OpenCitations
  5. American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association Publishing.
    Type: Book DOI: 10.1176/appi.books.9780890425787 OpenAlex: https://openalex.org/W4281687410
    Crossref OpenAlex OpenCitations
  6. Dirk Dhossche , Clément de Billy , Claudine Laurent-Levinson , Marie T. Le Normand , Christophe Recasens , Laurence Robel et al. (2023). Early-onset catatonia associated with SHANK3 mutations: looking at the autism spectrum through the prism of psychomotor phenomena . Frontiers in Psychiatry, 14, 1186555-1186555. Frontiers Media SA.
    Type: Article DOI: 10.3389/fpsyt.2023.1186555 OpenAlex: https://openalex.org/W4386956513
    Crossref OpenAlex OpenCitations
  7. Eric P. Slade , John F. McCarthy , Marcia Valenstein , Stephanie Visnic , Lisa B. Dixon (2013). Cost Savings from Assertive Community Treatment Services in an Era of Declining Psychiatric Inpatient Use . Health Services Research, 48(1), 195-217. Wiley.
    Type: Article DOI: 10.1111/j.1475-6773.2012.01420.x OpenAlex: https://openalex.org/W2109957407
    Crossref OpenAlex OpenCitations
  8. Brian G. Arndt , Mark A. Micek , Adam Rule , Christina M. Shafer , Jeffrey J. Baltus , Christine A. Sinsky (2024). More Tethered to the EHR: EHR Workload Trends Among Academic Primary Care Physicians, 2019-2023 . The Annals of Family Medicine, 22(1), 12-18. Annals of Family Medicine.
    Type: Article DOI: 10.1370/afm.3047 OpenAlex: https://openalex.org/W4391116490
    Crossref OpenAlex OpenCitations
  9. Joshua R. Smith , Isaac Baldwin , Katherine Audrey Termini , Trey McGonigle , Simon Vandekar , James Luccarelli (2024). Use of ECT for Children With and Without Catatonia . The Journal of ECT, 40(3), 154-161. Ovid Technologies (Wolters Kluwer Health).
    Type: Article DOI: 10.1097/yct.0000000000000993 OpenAlex: https://openalex.org/W4391174548
    Crossref OpenAlex OpenCitations
  10. Ming Tai-Seale , Cliff W. Olson , Jinnan Li , Albert S. Chan , Criss Morikawa , Meg Durbin et al. (2017). Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine . Health Affairs, 36(4), 655-662. Health Affairs Publishing, LLC.
    Type: Article DOI: 10.1377/hlthaff.2016.0811 OpenAlex: https://openalex.org/W2605217566
    Crossref OpenAlex
  11. Jennifer Connell , Mark Oldham , Pratik Pandharipande , Robert S Dittus , Amanda Wilson , Matthew Mart et al. (2023). Malignant Catatonia: A Review for the Intensivist . Journal of Intensive Care Medicine, 38(2), 137-150. SAGE Publications.
    Type: Article DOI: 10.1177/08850666221114303 OpenAlex: https://openalex.org/W4286111624
    Crossref OpenAlex OpenCitations
  12. Carroll BT (2008). B5 Psychiatry Edgmont, 5(12), 42.
    Type: Other
    Crossref
  13. Joshua R. Smith , Isaac Baldwin , Tasia York , Carina Anderson , Trey McGonigle , Simon Vandekar et al. (2023). Alternative psychopharmacologic treatments for pediatric catatonia: a retrospective analysis . Frontiers in Child and Adolescent Psychiatry, 2. Frontiers Media SA.
    Type: Article DOI: 10.3389/frcha.2023.1208926 OpenAlex: https://openalex.org/W4381433696
    Crossref OpenAlex OpenCitations
  14. Hari Hara Suchandra , Venkata Senthil Kumar Reddi , Bhaskaran Aandi Subramaniyam , Krishna Prasad Muliyala (2021). Revisiting lorazepam challenge test: Clinical response with dose variations and utility for catatonia in a psychiatric emergency setting . Australian & New Zealand Journal of Psychiatry, 55(10), 993-1004. SAGE Publications.
    Type: Article DOI: 10.1177/0004867420968915 OpenAlex: https://openalex.org/W3095552801
    Crossref OpenAlex OpenCitations
  15. Dusan Hirjak , Jonathan P. Rogers , Robert Christian Wolf , Katharina Maria Kubera , Stefan Fritze , Jo Ellen Wilson et al. (2024). Catatonia . Nature Reviews Disease Primers, 10(1), 49-49. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1038/s41572-024-00534-w OpenAlex: https://openalex.org/W4400786596
    Crossref OpenAlex OpenCitations
  16. A Jay Holmgren , N Lance Downing , Mitchell Tang , Christopher Sharp , Christopher Longhurst , Robert S Huckman (2022). Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use . Journal of the American Medical Informatics Association, 29(3), 453-460. Oxford University Press (OUP).
    Type: Article DOI: 10.1093/jamia/ocab268 OpenAlex: https://openalex.org/W4200043507
    Crossref OpenAlex OpenCitations
  17. Joshua R. Smith , Tasia York , Sarah Hart , Anuj Patel , Heather L. Kreth , Katherine Spencer et al. (2024). The Development of a Pediatric Catatonia Clinical Roadmap for Clinical Care at Vanderbilt University Medical Center . Journal of the Academy of Consultation-Liaison Psychiatry, 65(6), 570-578. Elsevier BV.
    Type: Article DOI: 10.1016/j.jaclp.2024.08.003 OpenAlex: https://openalex.org/W4402280485
    Crossref OpenAlex OpenCitations
  18. Vladimir Ferrafiat , Lee Wachtel , Dirk Dhossche , Aaron Hauptman (2024). Catatonia is an outpatient reality. What do we do now? Schizophrenia Research, 264, 233-235. Elsevier BV.
    Type: Article DOI: 10.1016/j.schres.2023.12.019 OpenAlex: https://openalex.org/W4390631189
    Crossref OpenAlex OpenCitations
  19. Stephan Heckers , Sebastian Walther (2023). Catatonia . New England Journal of Medicine, 389(19), 1797-1802. Massachusetts Medical Society.
    Type: Article DOI: 10.1056/nejmra2116304 OpenAlex: https://openalex.org/W4388484306
    Crossref OpenAlex OpenCitations
  20. J. Vaquerizo-Serrano , G. Salazar De Pablo , J. Singh , P. Santosh (2022). Catatonia in autism spectrum disorders: A systematic review and meta-analysis . European Psychiatry, 65(1), e4-e4. Royal College of Psychiatrists.
    Type: Article DOI: 10.1192/j.eurpsy.2021.2259 OpenAlex: https://openalex.org/W4200172356
    Crossref OpenAlex OpenCitations
  21. Aaron J Hauptman , David Cohen , Dirk Dhossche , Marie Raffin , Lee Wachtel , Vladimir Ferrafiat (2023). Catatonia in neurodevelopmental disorders: assessing catatonic deterioration from baseline . The Lancet Psychiatry, 10(3), 228-234. Elsevier BV.
    Type: Article DOI: 10.1016/s2215-0366(22)00436-9 OpenAlex: https://openalex.org/W4318022984
    Crossref OpenAlex OpenCitations
  22. Lee Wachtel , James Luccarelli , John Michael Falligant , Joshua R. Smith (2025). Electroconvulsive therapy in autism spectrum disorders: an update to the literature . Current Opinion in Psychiatry, 38(2), 79-86. Ovid Technologies (Wolters Kluwer Health).
    Type: Article DOI: 10.1097/yco.0000000000000985 OpenAlex: https://openalex.org/W4406308239
    Crossref OpenAlex OpenCitations
  23. Jonathan P Rogers , Mark A Oldham , Gregory Fricchione , Georg Northoff , Jo Ellen Wilson , Stephan C Mann et al. (2023). Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology . Journal of Psychopharmacology, 37(4), 327-369. SAGE Publications.
    Type: Article DOI: 10.1177/02698811231158232 OpenAlex: https://openalex.org/W4364354368
    Crossref OpenAlex OpenCitations
  24. Jeremy Weleff , Brian S. Barnett , Deborah Y. Park , Teddy J. Akiki , Awais Aftab (2023). The State of the Catatonia Literature: Employing Bibliometric Analysis of Articles From 1965–2020 to Identify Current Research Gaps . Journal of the Academy of Consultation-Liaison Psychiatry, 64(1), 13-27. Elsevier BV.
    Type: Article DOI: 10.1016/j.jaclp.2022.07.002 OpenAlex: https://openalex.org/W4285499989
    Crossref OpenAlex OpenCitations
  25. A Jay Holmgren , Nate C. Apathy , Christine A. Sinsky , Julia Adler-Milstein , David W. Bates , Lisa Rotenstein (2025). Trends in Physician Electronic Health Record Time and Message Volume . JAMA Internal Medicine, 185(4), 461. American Medical Association (AMA).
    Type: Article DOI: 10.1001/jamainternmed.2024.8138 OpenAlex: https://openalex.org/W4407902871
    Crossref OpenAlex OpenCitations
  26. David F. Penson (2018). Re: Electronic Health Record Logs Indicate that Physicians Split Time Evenly between Seeing Patients and Desktop Medicine . Journal of Urology, 199(1), 20-20. Ovid Technologies (Wolters Kluwer Health).
    Type: Article DOI: 10.1016/j.juro.2017.09.105 OpenAlex: https://openalex.org/W2761496111
    OpenCitations
  27. Mylène Moyal , Marion Plaze , Ambre Baruchet , David Attali , Cora Cravero , Marie Raffin et al. (2022). Efficacity of tDCS in catatonic patients with Phelan McDermid syndrome, a case series . Brain Stimulation, 15(6), 1432-1434. Elsevier BV.
    Type: Article DOI: 10.1016/j.brs.2022.10.005 OpenAlex: https://openalex.org/W4307658828
    Crossref OpenAlex OpenCitations
  28. Joshua R. Smith , Tasia York , Isaac Baldwin , Catherine Fuchs , Gregory Fricchione , James Luccarelli (2024). Diagnostic features of paediatric catatonia: multisite retrospective cohort study . BJPsych Open, 10(3), e96-e96. Royal College of Psychiatrists.
    Type: Article DOI: 10.1192/bjo.2024.61 OpenAlex: https://openalex.org/W4396519093
    Crossref OpenAlex OpenCitations
  29. Joshua R. Smith , Corey E. Hopkins , Jiangmei Xiong , James Luccarelli , Elizabeth Shultz , Simon Vandekar (2024). Use of ECT in Autism Spectrum Disorder and/or Intellectual Disability: A Single Site Retrospective Analysis . Journal of Autism and Developmental Disorders, 54(3), 963-982. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-022-05868-6 OpenAlex: https://openalex.org/W4311811311
    Crossref OpenAlex OpenCitations
  30. James Luccarelli , Jacqueline A. Clauss , Tasia York , Isaac Baldwin , Simon Vandekar , Trey McGonigle et al. (2024). Exploring the Trajectory of Catatonia in Neurodiverse and Neurotypical Pediatric Hospitalizations: A Multicenter Longitudinal Analysis . medRxiv. openRxiv.
    Type: Preprint DOI: 10.1101/2024.06.06.24308554 OpenAlex: https://openalex.org/W4399423069
    Crossref OpenAlex OpenCitations
  31. James Luccarelli , Mark Kalinich , Gregory Fricchione , Felicia Smith , Scott R. Beach , Joshua R. Smith (2024). Diagnostic and demographic factors of pediatric and adult catatonia hospitalizations: A 2016–2020 National Inpatient Sample Study . Acta Psychiatrica Scandinavica, 150(4), 234-244. Wiley.
    Type: Article DOI: 10.1111/acps.13744 OpenAlex: https://openalex.org/W4401446286
    Crossref OpenAlex OpenCitations
  32. James Luccarelli , Thomas H. McCoy , Tasia York , Isaac Baldwin , Gregory Fricchione , Catherine Fuchs et al. (2024). The effectiveness of the lorazepam challenge test in pediatric catatonia: A multisite retrospective cohort study . Schizophrenia Research, 270, 410-415. Elsevier BV.
    Type: Article DOI: 10.1016/j.schres.2024.07.004 OpenAlex: https://openalex.org/W4400438829
    Crossref OpenAlex OpenCitations
  33. James Luccarelli , Joshua R. Smith , Mark Kalinich , Ali Amad , Jonathan P. Rogers (2025). The Population-Based Incidence and Prevalence of Catatonia . The Journal of Neuropsychiatry and Clinical Neurosciences, 37(2), 160-162. American Psychiatric Association Publishing.
    Type: Article DOI: 10.1176/appi.neuropsych.20240072 OpenAlex: https://openalex.org/W4406250056
    Crossref OpenAlex OpenCitations