Decalogue of Catatonia in Autism Spectrum Disorders

Dhossche, Dirk M.

doi:10.3389/fpsyt.2014.00157

Cited by 36 publications

(21 citation statements)

References 26 publications

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“…Furthermore, loss of skills beyond infancy—such as catatonic symptoms in adolescence or adulthood—may occur at higher rates than previously thought [Breen & Hare, ]. Although research is limited, further research into the similarities and differences between loss of skills in infancy and adolescence or adulthood is warranted and may suggest directions for investigation of etiology such as autoimmunity [Kiani et al, ] and genetic factors [Breckpot et al, ], as well as possible treatments [Dhossche, ]. Importantly, attempts to explore etiology should move beyond retrospective parent‐report of regression, utilizing prospective designs and considering dimensional definitions of regression alongside categorical approaches.…”

Section: Evidence For Regression and Prevalence Ratesmentioning

confidence: 99%

Regression in autism spectrum disorder: Reconciling findings from retrospective and prospective research

et al. 2018

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The way in which the behavioral manifestations of autism spectrum disorder (ASD) emerge in infancy is variable. Regression-loss of previously acquired skills-occurs in a subset of children. However, the etiology and significance of regression remains unclear. Until recently, investigation of regression relied on retrospective report by parents or examination of home videos from early in life. However, home videos and retrospective report of the nature and timing of regression, and association with factors such as illness or immunization, is potentially subject to bias. The advent of prospective studies of infant siblings at familial high-risk of ASD has the potential to document regression as it occurs. Recent research has suggested that subtle loss of skills occurs in a larger proportion of children with ASD than previously assumed; however, there are few reports of clear-cut regressions, such as that involving dramatic loss of language and other established skills, in the prospective literature. This could be because of the following: clear-cut regression occurs less commonly than parent report suggests, study design limits the potential to detect regression, or there are differences between multiplex and simplex families in the rate of de novo genetic mutations and therefore regression risk. This review will bring together literature from retrospective and prospective research and attempt to reconcile diverging findings, with a specific focus on methodological issues. Changing conceptualizations of regression will be discussed, as well as etiological factors that may be associated with regression. The main challenges that need to be addressed to measure regression in prospective studies will be set out.Lay Summary: Regression-a loss of previously established skills-occurs in a subset of children with ASD. Parental recall is not always accurate but studying younger siblings of children with ASD, 10-20% of whom will develop ASD, should make it possible to measure regression as it occurs. Clear-cut regression, like loss of language, has not often been reported in infant sibling studies, but recent research suggests that gradual loss of social engagement might be more common. This review looks at the evidence for regression from infant sibling studies and asks how study design affects the likelihood of capturing regression.

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Section: Evidence For Regression and Prevalence Ratesmentioning

confidence: 99%

Regression in autism spectrum disorder: Reconciling findings from retrospective and prospective research

et al. 2018

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“…The synergy of lorazepam and ECT treatment using flumazenil was observed in a case series, and the use of flumazenil has been proposed in benzodiazepine-free patients as a novel method for managing the decline of ECT seizure quality [24,74,75]. The remission of catatonia in paediatric patients in general and specifically in autistic youth, requires more frequent seizures than those necessary for the relief of major depression [11,61,62]. The UK standard practice of two seizures a week, although effective for major depression, may not be so for catatonia.…”

Section: Treatment Approachesmentioning

confidence: 99%

“…The number of sessions that will be needed before substantial improvement or remission occur cannot be predicted. Therefore, the patient's overall response should be evaluated after the first five or six treatments and then again after 10 or 12 treatments [11,61,62,76]. Treatment course should be intensive and generally it should be followed by a maintenance treatment (weekly or bi-weekly ECT sessions for 6 months or longer) to prevent relapses [11,61,62].…”

Section: Treatment Approachesmentioning

confidence: 99%

“…Generally, the presence of catatonia in autistic patients should be assessed only when there is a conspicuous and obvious change in symptoms such as a marked increase or decrease of motor and speech behaviors, compared with the previous level [61,62]. The criteria proposed by Fink and Taylor [11] are widely used for the diagnosis of catatonia because of their clinical relevance and conformity to DSM-IV [11].…”

Section: From Dsm-iv-tr To Dsm-5: Diagnostic Peculiarity In Asdsmentioning

confidence: 99%

“…In fact, to our knowledge, there is a lack of controlled studies exploring the medical treatment of catatonia in ASD patients. Currently, benzodiazepines are the most frequently used medications [11,62]. The medical treatment algorithm for catatonia in ASDs [11,62] suggests a benzodiazepine challenge test of 1 or 2 mg of lorazepam (administrated orally, intravenously, or intramuscularly) [ Fig.…”

Section: Treatment Approachesmentioning

confidence: 99%

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Catatonia in Patients with Autism: Prevalence and Management

et al. 2014

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Although recent studies have shown that catatonia can occur in patients with autism spectrum disorders (ASDs), the overlap of the behavioral features between these disorders raises many diagnostic challenges. In fact, in clinical practice it is common to misinterpret catatonic symptoms, including mutism, stereotypic speech, repetitive behaviors, echolalia, posturing, mannerisms, purposeless agitation and rigidity, as features of ASDs. The current medical treatment algorithm for catatonia in ASDs recommends the use of benzodiazepines. Electroconvulsive therapy (ECT) is indicated when patients are unresponsive, or insufficiently responsive, to benzodiazepines. Other pharmacological options are also described for the treatment of catatonic patients resistant to benzodiazepines and ECT, and there is evidence for the effectiveness of a psychological treatment, co-occurring with medical treatments, in order to support the management of these patients. In this article we provide a summary of studies exploring catatonia in ASDs and our clinical experience in the management and treatment of this syndrome through the presentation of three brief case studies. Moreover, we review the mechanisms underlying symptoms of catatonia in ASDs, as well as the diagnostic challenges, providing an outline for the management and treatment of this syndrome in this clinical population.

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Lorazepam

Lecarie¹

2018

Encyclopedia of Autism Spectrum Disorders

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Decalogue of Catatonia in Autism Spectrum Disorders

Cited by 36 publications

References 26 publications

Regression in autism spectrum disorder: Reconciling findings from retrospective and prospective research

Regression in autism spectrum disorder: Reconciling findings from retrospective and prospective research

Catatonia in Patients with Autism: Prevalence and Management

Lorazepam

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