Maintenance Electroconvulsive Therapy for Aggression and Self-Injurious Behavior in Two Adolescents With Autism and Catatonia

Abstract

Frequent aggression toward others and repetitive self-injurious behaviors (SIB) can be features of catatonia in patients with autism. Similar to catatonia secondary to other etiologies, catatonia associated with autism responds well to treatment with benzodiazepines and/or electroconvulsive therapy (ECT). The authors report here on two adolescent patients with autism who presented with severe aggression, one of whom also engaged in repetitive SIB. With ongoing treatment with maintenance ECT, dramatic reduction in aggression and SIB were noted, allowing both patients a reasonable quality of life in their own homes. Attempts to taper off ECT coincided with return of aggression symptoms, although not SIB.

High-Frequency Stimulation at the Subthalamic Nucleus Suppresses Excessive Self-Grooming in Autism-Like Mouse Models

“…In fact, in recent years large population-based studies have estimated that 12-18% of autistic adolescents and young adults manifest some symptoms of catatonia (Billstedt et al, 2005;Ghaziuddin et al, 2012;Wing and Shah, 2000). Consistent with the sensitivity of catatonia to electroconvulsive therapy (ECT; Fink and Taylor, 2006), we and others have found ECT can produce life-changing results in ASD patients with extreme SIB that is unresponsive to traditional pharmacological and behavioral therapies (Wachtel and Dhossche, 2013;Consoli et al, 2013;Haq and Ghaziuddin, 2014). At our clinic, we have observed a 490% reduction in frequency of SIB in ASD patients with the most severe forms of self-injury (Wachtel et al, 2008(Wachtel et al, , 2009(Wachtel et al, , 2010(Wachtel et al, , 2014(Wachtel et al, , 2015.…”

“…Such maintenance ECT (mECT) regimes can be as frequent as one treatment every 5 days (Wachtel and Dhossche, 2013;Haq and Ghaziuddin, 2014;Wachtel et al, 2011Wachtel et al, , 2012. The longterm effects of such frequent ECT started as early as childhood in some cases are unknown.…”

Catatonia in Outpatients

“…Some have argued that the features of catatonia overlap with those of autism itself 7 ; therefore, in persons with autism, to be considered catatonic, they must constitute a distinct change, as was the policy for the diagnosis in this report. Clinicians, once they consider the diagnosis of catatonia, must be performing well because patients with autism whom they choose to treat for comorbid catatonia are uniformly responding 7 , 10 , 11 (Table 1 ; Case Report, Supplemental Digital Content 1 http://links.lww.com/JCP/A251 ).…”

Use of Electroconvulsive Therapy In the Treatment of Catatonia

“…In addition to having available equipment and personnel trained in ECT, the patient may require several weeks to months of continuation ECT. Severe cases may require maintenance ECT, where treatment has no definitive end date, to prevent relapse of catatonia [23]. In either case, some families may not be able to adhere to the proscribed schedule of ECT making it less effective.…”

“…Severe and primarily unprovoked aggression and self-injurious behaviors have been hypothesized as an alternative symptom of catatonia and frequently encountered in patients with comorbid autism or intellectual disability [22]. Such patients may require ongoing maintenance ECT to achieve progressive improvement, reach functioning consistent with their baseline level, reduce risk of injury to caregivers and allow these patients to reside in their home environments [23].…”