Charge symptomatique longitudinale et prise en charge pharmacologique de la catatonie dans l'autisme avec et sans atteinte profonde : une etude observationnelle

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

Cette publication est incluse dans le projet « Contributions académiques de personnes autistes sur l’autisme ». un auteur·ice de cette publication est identifié·e comme autiste dans le projet.

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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. R. (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

Date de publication: 06/09/2024 Ajout dans AutiHub: 07/07/2026 Type: Prépublication 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 Ryan 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 Ryan Luccarelli

Résumé

Resume Introduction La catatonie est un trouble psychomoteur et affectif hautement morbide qui peut toucher des personnes autistes avec et sans atteinte profonde. Les symptomes catatoniques sont traitables par pharmacotherapie et electroconvulsivotherapie, mais l'efficacite longitudinale de ces traitements n'a pas ete decrite. Methodes Nous avons mene une etude de cohorte observationnelle prospective de patients atteints d'autisme et de catatonie comorbide ayant recu des soins ambulatoires dans une clinique ambulatoire specialisee du 1er juillet 2021 au 31 mai 2024. Des donnees examinant les interventions pharmacologiques et des mesures cliniques, notamment la Bush Francis Catatonia Rating Scale (BFCRS), la Kanner Catatonia Severity Scale (KCS), la Kanner Catatonia Examination (KCE) et la Clinical Global Impression – Improvement (CGI-I), ont ete recueillies. Resultats Quarante-cinq patients ont ete identifies, dont 39 (86,7 %) remplissaient les criteres d'autisme profond. Tous les patients ont recu une pharmacotherapie. Quarante-quatre (97,8 %) ont ete traites par benzodiazepines, avec une dose quotidienne maximale moyenne de 17,4 mg (ET = 15,8) en equivalents lorazepam. Trente-cinq patients (77,8 %) ont necessite plus d'une classe de medicaments pour le traitement. Quatorze patients (31,1 %) ont tente de reduire progressivement les benzodiazepines au cours de la periode d'etude ; parmi eux, 5 patients (11,1 %) ont reussi a les arreter progressivement, et les 9 restants (17,8 %) ont interrompu la reduction en raison du retour des symptomes catatoniques. Une amelioration statistiquement significative a ete observee dans tous les domaines cliniques, a l'exception de la KCS. Cependant, la majorite est restee symptomatique au cours de la periode d'etude. Conclusions Malgre des ameliorations cliniques pendant la reception du traitement de reference pour la prise en charge psychopharmacologique de la catatonie, des symptomes chroniques ont persiste chez la majorite des patients atteints de catatonie au cours de la periode d'etude, et peu ont pu reduire progressivement puis arreter le traitement par benzodiazepines. Resume en langage courant La catatonie est une affection qui peut avoir un impact important sur la qualite de vie des personnes autistes avec et sans atteinte profonde. Les symptomes de catatonie tels que l'agressivite et l'autoagression peuvent s'ameliorer avec le traitement. Cependant, au cours de la periode de trois ans de cette etude, la plupart des patients ont presente des symptomes residuels, et peu ont pu arreter les medicaments psychotropes.

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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Références citées
73
Avec un DOI
63
Sans DOI, à partir du texte brut de la bibliographie
8
3 / 73 (4,1 %) références citées comprennent au moins une personne identifiée comme autiste.
Références avec données à compléter
7 / 73 (9,6 %)
Références avec noms d’auteurices détectés
66 / 73 (90,4 %)
Sans nom d’auteurice détecté
7
Sans titre structuré
5
Sans identifiant stable
7
Références avec noms bruts d’auteurices restant à vérifier
5
Références avec problème de récupération des métadonnées externes
0
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Noms d’auteurices détectés dans la bibliographie citée
396
À partir du DOI ou de métadonnées externes
396
À partir du texte brut validé de la bibliographie
0
Noms bruts déjà validés
0
Noms bruts restant à vérifier
6
89 / 396 (22,5 %) noms sont associés à un·e auteurice déjà présent·e dans AutiHub. 307 / 396 (77,5 %) noms ne sont pas encore associés.
Noms associés à une personne identifiée comme autiste
4 / 396 (1,0 %)
Calculé sur l’ensemble des noms d’auteurices détectés dans la bibliographie citée. Parmi les noms associés à un·e auteurice déjà présent·e dans AutiHub : 4 / 89 (4,5 %). Personnes distinctes identifiées comme autistes : 4 / 333 (1,2 %).
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