Autistic catatonia

Autistic catatonia is a term used to describe the occurrence of catatonia in autistic people. Catatonia occurs in roughly 10 percent of people diagnosed with an autism spectrum disorder. In addition to the common sign of catatonia (posturing, negativism, mutism, and stupor), autistic people with catatonia are more likely to stim and self-harm.

The DSM-5 lists "with catatonia" as one of the possible specifiers for an autism spectrum disorder diagnosis.

Pathology
There exists debate over the biological origins of autistic catatonia. Some studies have suggested that dysfunction of GABA and its receptors are primary causes for autistic catatonia. Also, neuroimaging studies have indicated that autistic catatonic patients have abnormally small cerebellar structures. Furthermore, genetic studies have implied that alterations on chromosome 15 may underpin the disease.

Alternatively, catatonia has been frequently observed in patients with severe anxiety. Because autism can cause individuals to be susceptible to anxiety, the prevalence of catatonia in autism may be attributable to anxiety.

Symptoms
Autistic catatonia is associated with more than 40 symptoms, many in common with autism.

The most severe cases display stupor, hyperactivity, or severe excitement, which can sometimes continue for weeks or even months. During excitement, individuals show combativeness, can have delusions and hallucinations, and can also pose a danger to themselves and others. In the medium, severe, and lethal states, they will also experience autonomic instability.

Symptoms overlap with autism spectrum disorder. Thus, diagnosis of catatonic breakdown can be difficult. Childhood schizophrenia increases the risk for autistic catatonia later in life dramatically. Also, it seems that the processes that give rise to psychosis, catatonia, and autism are similar.

Treatment
There exists great diversity in treatments for autistic catatonia. The psycho-ecological approach considers the individual's profile of autism, identifies the underlying causes behind their catatonia, and formulates support strategies. These strategies vary depending on the individual and their difficulties.

It has also been shown that benzodiazapines are effective for some patients. More recently, electroconvulsive therapy (ECT) has been trialed, with mixed effect. Several patients have responded well to intensive, multi-month ECT regimens after other treatments failed. Furthermore, ECT was successfully used to treat symptoms in patients prone to self-injury and compulsive behavior. However, it seems that ECT must be continued for long periods of time to prevent re-onset of autistic catatonic symptoms. Furthermore, there is popular resistance to the idea of inducing seizures as treatment - which ECT relies on - especially in pediatric patients.

History
Karl Ludwig Kahlbaum was among the first to systematically describe catatonia, which in 1874 he documented as a separate brain disorder. The phenomenon was later described by Emil Kraepelin as a precursor disease that led to dementia. It was not until the 1970s that catatonia was recognized as a feature of other affective psychiatric disorders in adults, especially manias.