Charge symptomatique longitudinale et prise en charge pharmacologique de la catatonie dans l'autisme avec déficience intellectuelle : une étude observationnelle

Titre original en anglais : Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism With Intellectual Disability: 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. (2025). Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism With Intellectual Disability: An Observational Study. Autism Research, 18(2), 449-462. https://doi.org/10.1002/aur.3315

Date de publication: 27/01/2025 Ajout dans AutiHub: 07/07/2026 Type: Article Langue de l’article: Anglais
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Auteurs

Auteur·ices des publications
11
Auteur·ices de la publication identifié·es comme autistes
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

Résumé

La catatonie est un trouble psychomoteur et affectif à forte morbidité, qui peut toucher les personnes autistes avec ou sans déficience intellectuelle. Les symptômes catatoniques peuvent être traités par pharmacothérapie et électroconvulsivothérapie, mais l'efficacité longitudinale de ces traitements chez les personnes autistes n'a pas été décrite. Nous avons mené une étude de cohorte observationnelle prospective de patients autistes présentant une catatonie comorbide qui ont reçu des soins ambulatoires dans une clinique ambulatoire spécialisée du 1er juillet 2021 au 31 mai 2024. Des données portant sur les interventions pharmacologiques et des mesures cliniques, notamment la Bush Francis Catatonia Rating Scale (BFCRS), la Kanner Catatonia Severity Scale (KCS), le Kanner Catatonia Examination (KCE) et la Clinical Global Impression-Improvement (CGI-I), ont été recueillies. Quarante-cinq patients autistes présentant une catatonie comorbide ont été traités pendant la période d'étude. L'âge moyen était de 15,6 ans (ET = 7,9) [Mdn = 16,0, intervalle 6,0-31,0]. Quarante et un patients (91,1 %) répondaient aux critères d'autisme avec déficience intellectuelle concomitante. Tous les patients ont reçu une pharmacothérapie. Quarante-quatre (97,8 %) ont été traités par benzodiazépines, avec une dose quotidienne maximale moyenne de 17,4 mg (ET = 15,8) en équivalents de lorazépam. Trente-cinq patients (77,8 %) ont nécessité plus d'une classe médicamenteuse pour le traitement. Seize patients (35,6 %) ont reçu une électroconvulsivothérapie. Quatorze patients (31,1 %) ont tenté de réduire progressivement les benzodiazépines après avoir obtenu une amélioration clinique pendant la période d'étude ; parmi eux, 5 patients (11,1 %) ont réussi à arrêter progressivement le traitement, et les 9 restants (17,8 %) ont interrompu la réduction en raison d'une réapparition des symptômes catatoniques. Une amélioration statistiquement significative a été observée dans tous les domaines cliniques, à l'exception de la KCS. Toutefois, la majorité est restée au moins partiellement symptomatique pendant la période d'étude. Trois patients (6,7 %) sont décédés pendant la période d'étude. Malgré des améliorations cliniques sous le traitement de référence pour la prise en charge psychopharmacologique de la catatonie, des symptômes chroniques ont persisté chez la majorité des patients atteints de catatonie pendant la période d'étude, et peu ont pu réduire progressivement puis arrêter le traitement par benzodiazépines. Il convient de noter que le plan d'étude ouvert constitue un facteur limitant lors de l'interprétation des résultats.

Catatonia is a highly morbid psychomotor and affective disorder, which can affect autistic individuals with and without intellectual disability. Catatonic symptoms are treatable with pharmacotherapy and electroconvulsive therapy, but the longitudinal effectiveness of these treatments in autistic individuals has not been described. 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, 2021 to May 31, 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. Forty-five autistic patients with co-morbid catatonia were treated during the study period. The mean age was 15.6 (SD = 7.9) years [Mdn = 16.0, range 6.0-31.0]. Forty-one patients (91.1%) met criteria for autism with co-occurring intellectual disability. All patients received pharmacotherapy. Forty-four (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. Sixteen (35.6%) patients received electroconvulsive therapy. Fourteen patients (31.1%) attempted to taper off benzodiazepines after achieving clinical improvement 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 at least partially symptomatic over the study period. Three patients (6.7%) died over the study period. 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. Notably, the open label design of this study is a limiting factor when interpreting the results.

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Références citées
71
Nombre total de références citées intégrées pour cette publication.
Références citées avec un·e auteur·ice identifié·e comme autiste
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Parmi les occurrences rattachées à des auteurices intégré·es à la base de données AutiHub : 1 / 62 (1,6 %). Auteurices cité·es distinct·es identifié·es comme autistes : 1 / 331 (0,3 %).
Occurrences citées rattachées à la base AutiHub
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Auteurices cité·es distinct·es rattaché·es : 30 / 331 (9,1 %)
Occurrences rattachées, non identifiées comme autistes
61 / 62 (98,4 %)
Parmi les seules occurrences rattachées. Sur l’ensemble des occurrences d’auteurices cité·es : 61 / 395 (15,4 %). Auteurices cité·es distinct·es rattaché·es, non identifié·es comme autistes : 29 / 30 (96,7 %).
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