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

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Smith, J. R., Lim, S., Bindra, S., Marler, S., Rajah, B., Williams, Z. J., Baldwin, I., Hossain, N., Wilson, J. E., Fuchs, D. C., & Luccarelli, J. (2024). Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism with and without Profound Impairment: An Observational Study [Preprint]. openRxiv. https://doi.org/10.1101/2024.09.05.24312724

Publication date: 6 Sep 2024 Added to AutiHub: 7 Jul 2026 Type: Preprint Article language: English
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Authors

Publication authors
11
Publication authors identified as autistic
1 / 11 (9.1%)
  1. Joshua R. Smith
  2. Seri Lim
  3. Snehal Bindra
  4. Sarah Marler
  1. Bavani Rajah
  2. Zachary J. Williams *
  3. Isaac Baldwin
  4. Nausheen Hossain
  1. Jo Ellen Wilson
  2. D. Catherine Fuchs
  3. James Luccarelli

Abstract

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 1 st, 2021 to May 31 st, 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. Lay Summary Catatonia is a condition which can significantly impact the quality of life for autistic individuals with and without profound impairment. Symptoms of catatonia such as aggression and self-injury can improve with treatment. However, over the three-year period of this study, most patients experienced residual symptoms, and few could discontinue psychotropic medication.

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Cited references
73
Total cited references integrated for this publication.
Cited references with an identified autistic author
2 / 73 (2.7%)
Cited author occurrences identified as autistic
2 / 396 (0.5%)
Among occurrences linked to AutiHub author records: 2 / 66 (3.0%). Distinct cited authors identified as autistic: 2 / 329 (0.6%).
Cited author occurrences linked to AutiHub author records
66 / 396 (16.7%)
Distinct linked cited authors: 32 / 329 (9.7%)
Linked cited-author occurrences not identified as autistic
64 / 66 (97.0%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 64 / 396 (16.2%). Distinct linked cited authors not identified as autistic: 30 / 32 (93.8%).
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