Skip to main content
Springer Nature Link
Log in

Catatonia in autism: implications across the life span

  • ORIGINAL CONTRIBUTION
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Background

There is increasing evidence that catatonia is an important source of impairment in adolescents and adults with autism.

Aim

Review of the evaluation, diagnosis, differential diagnosis, and treatment of catatonia in autism.

Method

Presentation and discussion of a case-vignette spanning early childhood to adulthood.

Results

Autistic and catatonic symptoms overlap, yet catatonia is diagnosable in about one of seven adolescents and young adults with autism. Case-reports suggest that benzodiazepines and electroconvulsive therapy are effective treatments in the acute and maintenance phase for people with autism who develop catatonia.

Conclusions

Catatonia should be assessed in people with autism when there is an obvious and marked deterioration in movement, vocalizations, pattern of activities, self-care, and practical skills. Benzodiazepines and electroconvulsive therapy are favored options for acute and maintenance treatment in these cases. Further studies on the possible biological-genetic overlap between autism and catatonia would be helpful.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abrams R (2002) Electroconvulsive therapy, 4th edn. Oxford University Press, New York

    Google Scholar 

  2. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  3. Ayd F (1961) A survey of drug-induced extrapyramidal reactions. JAMA 175:102–108

    Google Scholar 

  4. Bailine S, Petraviciute S (2007) Catatonia in autistic twins: role of electroconvulsive therapy. J ECT 23:21–22

    Article  PubMed  Google Scholar 

  5. Bender K, Feutrill J (2000) Comatoid catatonia. Aust NZ J Psychiatry 34:169–170

    CAS  Google Scholar 

  6. Benegal V, Hingorani S, Khanna S (1993) Idiopathic catatonia: validity of the concept. Psychopathology 26:41–46

    Article  PubMed  CAS  Google Scholar 

  7. Billstedt E, Gilberg C, Gilberg C (2005) Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. J Autism Dev Disord 35:351–360

    Article  PubMed  Google Scholar 

  8. Brasic J, Zagzag D, Kowalik S, Prichep L, John E, Liang H, Klurchko B, Cancro R (1999) Progressive catatonia. Psychol Rep 84:239–246

    Article  PubMed  CAS  Google Scholar 

  9. Bumke O (1924) Lehrbuch der Geisterkrankheiten, 2nd edn. Bergmann, Munich

    Google Scholar 

  10. Caroff S, Mann S, Francis A, Fricchione G (2004) Catatonia. From psychopathology to neurobiology. American Psychiatric Publishing, Washington, DC

    Google Scholar 

  11. Carroll B, Goforth H (2004) Medical catatonia. In: Caroff S, Mann S, Francis A, Fricchione G (eds) Catatonia. From psychopathology to neurobiology. American Psychiatric Publishing, Washington DC

    Google Scholar 

  12. Chagnon Y (2006) Shared susceptibility region on chromosome 15 between autism and catatonia. Int Rev Neurobiol 72:165–178

    Article  PubMed  Google Scholar 

  13. Cohen D (2006) Towards a valid nosography and psychopathology of catatonia in children and adolescents. Int Rev Neurobiol 72:131–147

    Article  PubMed  Google Scholar 

  14. de Winter C, van Dijk F, Verhoeven W, Dhossche D, Stolker J (2007) Autism and catatonia: successful treatment using lorazepam. A case study. Tijdschr Psychiatr 49:257–261

    PubMed  Google Scholar 

  15. DeLong R (2004) Autism and familial major mood disorders: are they related? J Neuropsychiatr Clin Neurosci 16:199–213

    CAS  Google Scholar 

  16. Dhossche D, Bouman N (1997) Catatonia in an adolescent with Prader–Willi Syndrome. Ann Clin Psychiatry 4:247–253

    Google Scholar 

  17. Dhossche D (1998) Catatonia in autistic disorders (brief report). J Autism Dev Disord 28:329–331

    Article  PubMed  CAS  Google Scholar 

  18. Dhossche D (2004) Autism as early expression of catatonia. Med Sci Monit 10:RA31–39

    PubMed  Google Scholar 

  19. Dhossche D, Rout U (2006) Are autistic and catatonic regression related? A few working hypotheses involving GABA, Purkinje cell survival, neurogenesis, and ECT. Int Rev Neurobiol 72:55–79

    Article  PubMed  Google Scholar 

  20. Dhossche D, Shah A, Wing L (2006) Blueprints for the assessment, treatment, and future study of catatonia in autism spectrum disorders. Int Rev Neurobiol 72:267–284

    Article  PubMed  Google Scholar 

  21. Dhossche D, Wing L, Ohta M, Neumarker K-J (eds) (2006) Catatonia in Autism Spectrum Disorders. Elsevier, San Diego

  22. Elia J, Dell M, Friedman D, Zimmerman R, Balamuth N, Ahmed A, Pati S (2005) PANDAS with catatonia: a case-report. Therapeutic response to lorazepam and plasmapheresis. J Am Acad Child Adolesc Psychiatry 44:1145–1150

    Article  PubMed  Google Scholar 

  23. Fink M (1995) Recognizing NMS as a type of catatonia. Neuropsychiatry Neuropsychol Behav Neurol 8:75–67

    Google Scholar 

  24. Fink M, Taylor M (2003) Catatonia. A clinician’s guide to diagnosis and treatment. Cambridge University Press, Cambridge

    Google Scholar 

  25. Fink M, Taylor M (2006) Neuroleptic malignant syndrome is malignant catatonia, warranting treatments efficacious for catatonia. Prog Neuropsychopharmacol Biol Psychiatry 30:1182–1183

    Article  PubMed  Google Scholar 

  26. Fink M, Taylor M, Ghaziuddin N (2006) Catatonia in autistic spectrum disorders: a medical treatment algorithm. Int Rev Neurobiol 72:233–244

    Article  PubMed  Google Scholar 

  27. Freudenreich O, McEvoy J, Goff D, Fricchione G (2007) Catatonic coma with profound bradycardia. Psychosomatics 48:74–78

    Article  PubMed  Google Scholar 

  28. Ghaziuddin M, Quinlan P, Ghaziuddin N (2005) Catatonia in autism: a distinct subtype? J Intellect Dis Res 49:102–105

    Article  CAS  Google Scholar 

  29. Green W, Campbell M, Hardesty A, Grega D, Padron-Gayol M, Shell J, Erlenmeyer-Kimling L (1984) A comparison of schizophrenic and autistic children. J Am Acad Child Psychiatry 23:399–409

    Article  PubMed  CAS  Google Scholar 

  30. Hare D, Malone C (2004) Catatonia and autism spectrum disorders. Autism 8:183–195

    Article  PubMed  Google Scholar 

  31. Harris V (2006) Electroconvulsive therapy: administrative codes, legislation, and professional recommendations. J Am Acad Psychiatry Law 34:406–411

    PubMed  Google Scholar 

  32. Hem E, Andreassen O, Robasse J-M, Vatnaland T, Opjodsoen S (2005) Should catatonia be part of the differential diagnosis of coma? Nord J Psychiatry 59:528–530

    Article  PubMed  Google Scholar 

  33. Hermesh H, Hoffnung R, Aizenberg D, Molcho A, Munitz H (1989) Catatonic signs in severe obsessive compulsive disorder. J Clin Psychiatry 50:303–305

    PubMed  CAS  Google Scholar 

  34. Jimenez-Jimenez F, Garcia-Ruiz P, Molina J (1997) Drug-induced movement disorders. Drug Saf 16:180–204

    PubMed  CAS  Google Scholar 

  35. Kakooza A, Stoppelbein L, Dhossche D (2006) Psychosis in autism. In: Fujii D, Ahmed I (eds) The spectrum of psychotic disorders: neurobiology, etiology & pathogenesis. Cambridge University Press, Cambridge, pp 233–246

    Google Scholar 

  36. Karadenizli D, Dilbar N, Bayam G (2005) Gilles de la Tourette Syndrome Response to Electroconvulsive Therapy. J ECT 21:246–248

    Article  PubMed  Google Scholar 

  37. Lachner C, Sandson N (2003) A case of catatonia-induced deep venous thrombosis. Psychosomatics 44:512–414

    Article  PubMed  Google Scholar 

  38. Larsson H, Eaton W, Madsen K, Vestergaard M, Olesen A, Agerbo E, Schendel D, Thorsen P, Mortensen P (2005) Risk factors for autism: perinatal factors, parental psychiatric history, and socioeconomic factors. Am J Epidemiol 161:1–10

    Article  Google Scholar 

  39. Lopez-Canino A, Francis A (2004) Drug-induced catatonia. In: Caroff S, Mann S, Francis A, Fricchione G (eds) Catatonia. From psychopathology to neurobiology. American Psychiatric Publishing, Washington DC

    Google Scholar 

  40. Mahendra B (1981) Where have all the catatonics gone? (editorial). Psychol Med 11:669–671

    Article  PubMed  CAS  Google Scholar 

  41. McCall W, Mann S, Shelp F, Caroff S (1995) Fatal pulmonary embolism in the catatonic syndrome: two case reports and a literature review. J Clin Psychiatry 56:21–25

    PubMed  CAS  Google Scholar 

  42. O’ Gorman G (1970) The nature of childhood autism, 2nd edn. Butterworths, London

    Google Scholar 

  43. Ohta M, Kano Y, Nagai Y (2006) Catatonia in individuals with autism spectrum disorders in adolescence and early adulthood: a long-term prospective study. Int Rev Neurobiol 72:41–54

    Article  PubMed  Google Scholar 

  44. Petrides G, Dhossche D, Fink M, Francis A (1994) Continuation ECT: relapse prevention in affective disorders. Convuls Ther 10:189–194

    PubMed  CAS  Google Scholar 

  45. Petrides G, Divadeenam KM, Bush G, Francis A (1997) Synergism of lorazepam and electroconvulsive therapy in the treatment of catatonia. Biol Psychiatry 42:375–381

    Article  PubMed  CAS  Google Scholar 

  46. Rabheru K, Persad E (1997) A review of continuation and maintenance electroconvulsive therapy. Can J Psychiatry 42:476–484

    PubMed  CAS  Google Scholar 

  47. Realmuto G, August G (1991) Catatonia in autistic disorder: a sign of comorbidity or variable expression. J Autism Dev Disord 21:517–528

    Article  PubMed  CAS  Google Scholar 

  48. Schieveld J (2006) Case reports with a child psychiatric exploration of catatonia, autism, and delirium. Int Rev Neurobiol 72:195–206

    Article  PubMed  Google Scholar 

  49. Shah A, Wing L (2006) Psychological approaches to chronic catatonia-like deterioration in autism spectrum disorders. Int Rev Neurobiol 72:245–264

    Article  PubMed  Google Scholar 

  50. Shorter E, Healy D (2007) Shock therapy: a history of electroconvulsive treatment in mental illness. Rutgers University Press/University of Toronto Press, Piscataway

    Google Scholar 

  51. Sienaert P, Peuskens J (2006) Electoconvulsive therapy: an effective therapy of medication-resistent bipolar disorder. Bipol Disord 8:304–306

    Article  Google Scholar 

  52. Sporn A, Addington A, Gogtay N, Ordonez A, Gornick M, Clasen L, Greenstein D, Tossell J, Gochman P, Lenane M, Sharp W, Straub R, Rapaport J (2004) Pervasive developmental disorder and childhood-onset schizophrenia: comorbid disorder or a phenotypic variant of a very early onset illness? Biol Psychiatry 55:989–994

    Article  PubMed  Google Scholar 

  53. Stoppelbein L, Greening L, Kakooza A (2006) The importance of catatonia and stereotypies in autistic spectrum disorders. Int Rev Neurobiol 72:103–118

    Article  PubMed  Google Scholar 

  54. Suzuki K, Awata S, Takano T, Ebina Y, Iwasaki H, Matsuoka H (2005) Continuation electroconvulsive therapy for relapse prevention in middle-aged and elderly patients with intractable schizophrenia. Psychiatry Clin Neurosci 59:481–489

    Article  PubMed  Google Scholar 

  55. Trivedi H, Mendelowitz A, Fink M (2003) Gilles de la Tourette form of catatonia: response to ECT. J ECT 19:115–117

    Article  PubMed  Google Scholar 

  56. Wachtel L, Kahng S, Dhossche D, Cascella N, Reti I (2008) ECT for catatonia in an autistic girl. Am J Psychiatry 165:329–333

    Google Scholar 

  57. Watkins J, Asarnow R, Tanguay P (1988) Symptom development in childhood onset schizophrenia. J Child Psychol Psychiatry 29:865–878

    Article  PubMed  CAS  Google Scholar 

  58. Wing L, Shah A (2000) Catatonia in autistic spectrum disorders. Br J Psychiatry 176:357–362

    Article  PubMed  CAS  Google Scholar 

  59. Winslade W, Liston E, Ross J, Weber K (1984) Medical, Judicial, and Statuatory Regulations of ECT in the United States. Am J Psychiatry 141:1349–1355

    PubMed  CAS  Google Scholar 

  60. Zaw F, Bates G, Murali V, Bentham P (1999) Catatonia, autism, and ECT. Dev Med Child Neurol 41:843–845

    Article  PubMed  CAS  Google Scholar 

  61. Zervas I, Fink M (1991) ECT for refractory Parkinson’s disease. Convuls Ther 7:222–223

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics and Child Health, Makerere University Medical School, P.O. Box 7072, Kampala, Uganda

    Angelina Kakooza-Mwesige MB.Ch.B, M.Med

  2. Kennedy Krieger Institute/Johns Hopkins, School of Medicine, 707 North Broadway Street, Room 232, Baltimore, MD, 21205, USA

    Lee E. Wachtel M.D.

  3. Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Dirk M. Dhossche M.D., Ph.D.

Authors
  1. Angelina Kakooza-Mwesige MB.Ch.B, M.Med
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Lee E. Wachtel M.D.
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Dirk M. Dhossche M.D., Ph.D.
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Dirk M. Dhossche M.D., Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kakooza-Mwesige, A., Wachtel, L.E. & Dhossche, D.M. Catatonia in autism: implications across the life span. Eur Child Adolesc Psychiatry 17, 327–335 (2008). https://doi.org/10.1007/s00787-008-0676-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-008-0676-x

Keywords