Autistic Catatonia
Autistic catatonia is a rare type of disorder that affects roughly 10 percent of all adults with autism spectrum disorder. Most are not severely affected but a few exhibit stupor and severe excitement, which is the most extreme form of the disorder. Full expression of excitement could be a sign of comorbid bipolar disorder but more research is needed.
More than 40 symptoms have been identified to be a result of the disorder, but some of the symptoms overlap with those of autism spectrum disorder, making diagnosing difficult even for a seasoned professional. In a few cases stupor and hyperactivity can continue for weeks or even months. During the excitement phase individuals show combativeness and can have delusions and hallucinations and can also pose a danger to themselves or others and can make marked destruction of property. In the later stages of medium and even more in the severe (and, if left untreated, lethal) state they will also experience autonomic instability.
Childhood schizophrenia increases the risk for autistic catatonia later in life dramatically. There seems to be a common font of brain pathology for psychosis, catatonia and autism.
Symptoms
List of symptoms that has been observed in those with autistic catatonia:
- Stupor
- Mutism
- Hyperactivity
- Agitation
- Excitement
- Posing
- Negativism
- Rigidity
- Waxy flexibility, mitmachen, mitgehen – tendency to remain in immobile posture, inability to resist external pressure on posture
- Automatic obedience
- Combativeness (during excitement)
- Aggressivity
- Stereotypies
- Tics
- Grimacing
- Echolalia
- Echopraxia
- Perseveration
- Verbigeration
- Staring, gaze fixation
- Withdrawal
- Immobility
- Challenging behaviour
- Tremor
- Slowness
- Amotivation
- Grasp reflex
- Choreoathetoid movements of the trunk and extremities
- Autonomic instability (during excitement)
- Inability to start or stop actions (if during excitement episodes needs acute psychiatric care)
- Impulsivity
- Psychosis
- Sleep problems, reversal of day and night
- Urinary or fecal incontinence
- Passivity
- Eyerolling
- Stiff muscles
- Catalepsy
- Gegenhalten
- Ambitendency – contradictory behavior
- Rituals – repetitive behaviors
Treatment
Treatment consists of high-dose lorazepam or in some cases ECT. The response to the treatment is usually good, especially if detected early.
History
In the 19th century the psychiatrist Karl Ludwig Kahlbaum observed several symptoms of the disorder. Among them were stupor, mutism, excitement, hyperactivity, posing, negativism, rigidity, waxy flexibility and automatic obedience, stereotypies, tics, grimacing, echo-phenomenon, and self-harming.
Also marbling of the skin, profuse sweating, deviation of the pupils and odd reaction to light were considered catatonic phenomenons.
During most of the 20th century catatonia was regarded as schizophrenic in its nature, but towards the end of the century it was more commonly observed in those with bipolar disorder and autism spectrum disorder. Now only 15 percent of those with catatonia are considered to have schizophrenia.
See also
- Catatonia