What follows is the draft of an annotated bibliography of research related to autistic catatonia, published in the years 2021-2025. Fortunately for autistic people, these years have been excellent years for catatonia research. More and more people are studying the condition and learning how to help autistic people suffering from this problem.
This bibliography was generated using a kind of computer program known as "citation management software." All of the research summaries, or "abstracts," were provided by the researchers themselves, to summarize the findings of their study. If you are interested in reading these studies, you can ask a reference librarian to help you find them. If you are a university student, you can probably find them yourself by using your university library catalog.
This bibliography still needs to be edited, for formatting. It is provided here, as a draft, in case the information is useful to anybody.
A Cross-National Reliability Study of Catatonia in Individuals with
Neurodevelopmental Disorders
Item Type Journal Article
Author Mohammad Ghaziuddin
Author Neera Ghaziuddin
Author Carina Gillberg
Author Elisabeth Fernell
Author Valdemar Landgren
Author Christopher Gillberg
Abstract Catatonia is a neuropsychiatric disorder characterized by abnormalities of
movement, communication, and behavior, often accompanied by a disturbance
of mood, thought and perception. If untreated, it may lead to serious
complications, including death. Although often described in adults with
schizophrenia and severe mood disorders, it can also occur in persons with
neurodevelopmental disorders (NDD), particularly autism spectrum disorder
(ASD). Since its diagnosis is more likely to be missed by clinicians with limited
experience, we attempted to determine if experienced psychiatrists can make a
reliable diagnosis of catatonia in a group of patients with NDD. Twenty patients
with catatonia with ASD/NDD (12 males 8 females; age range 13–34 years;
mean 17.5; SD 4.8), diagnosed by two American psychiatrists, were reevaluated
by a group of Swedish psychiatrists. In the initial round, agreement
was reached in 15 (75%) cases. However, a careful review of additional
material and several virtual discussions were required to reach agreement in the
remaining 5 (25%) of cases. The diagnosis of catatonia in individuals with NDD
is challenging, even for experienced clinicians. Reasons for the lack of
diagnostic agreement in the five patients are discussed to highlight the barriers
for accurately diagnosing catatonia in patients with NDD.
Date 2025
Language eng
Library Catalog librarysearch.library.utoronto.ca
Extra Place: United States
Publication Journal of autism and developmental disorders
DOI 10.1007/s10803-025-06817-9
ISSN 0162-3257
Date Added 8/23/2025, 5:05:18 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
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Autism spectrum disorder (ASD), autistic catatonia, catatonia, Catatonia, Cross-national,
Neurodevelopmental disorders, Psychology, Psykologi, Reliability
Another Option for Aggression and Self-Injury, Alternative Benzodiazepines
for Catatonia in Profound Autism
Item Type Journal Article
Author Joshua Ryan Smith
Author Tasia York
Author Samuel Warn
Author Darara Borodge
Author Donald L. Pierce
Author D. Catherine Fuchs
Abstract Introduction: Individuals with profound autism often present for inpatient care
due to aggression. Diagnostic and treatment options are limited. Agitated
catatonia is a treatable comorbidity in autism, which should be considered in
cases of aggression. Preliminary data report high clinical response rates of
catatonia in autism when treated with electroconvulsive therapy (ECT), with
poor response to lorazepam. However, access to ECT is often limited,
especially in pediatric populations. Methods: We conducted a retrospective
chart review to identify cases of hyperactive catatonia with partial response to
lorazepam in profoundly autistic children presenting to the pediatric medical
hospital. Five cases were identified, all of whom were followed by the child and
adolescent psychiatry consult-liaison service during admission and treated
without the use of ECT. Data from the medical record were obtained after
institutional review board (IRB) approval including the following: (1) treatment
course, (2) Bush-Francis Catatonia Rating Scale (BFCRS) scores, and (3)
Kanner Catatonia Rating Scale (KCRS) severity scores. The Clinical Global
Impressions–Improvement (CGI-I) Scale was applied retrospectively to each
case. Results: All five patients demonstrated clinically significant
improvements. The average CGI-I score was 1.2. The average percentage
reduction in the BFCRS and KCRS severity scores was 63% and 59%,
respectively. Two of five patients were first stabilized with infusions midazolam
and dexmedetomidine due to the symptom severity and then transitioned to
long-acting oral benzodiazepines. Overall, four of five patients were stabilized
with oral clonazepam and one of five with oral diazepam. Notably, four of five
patients experienced an acute worsening of aggression, self-injury, and other
catatonic symptoms with escalating dosages of antipsychotic treatment, which
occurred before inpatient admission. All patients experienced resolution of
physical aggression toward self and/or others, experienced improvement in their
communicative abilities, and were able to return home or enter residential level
of care upon discharge. Conclusions: Given the limited availability of ECT and
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the unclear utility of lorazepam for hyperactive catatonia in autism, the use of
long-acting benzodiazepines and/or midazolam infusion may offer a safe and
readily available treatment alternative.
Date 2023
Language eng
Library Catalog librarysearch.library.utoronto.ca
Extra Place: United States Publisher: Mary Ann Liebert, Inc., publishers
Volume 33
Pages 109–117
Publication Journal of child and adolescent psychopharmacology
DOI 10.1089/cap.2022.0067
Issue 3
ISSN 1044-5463
Date Added 8/23/2025, 5:29:51 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
Adolescent, Aggression, Antipsychotics, Autism, autistic catatonia, Autistic Disorder - drug
therapy, Benzodiazepines, Benzodiazepines - therapeutic use, catatonia, Catatonia, Catatonia -
diagnosis, Catatonia - drug therapy, Child, Child & adolescent psychiatry, Clinical significance,
Clonazepam, Comorbidity, Diazepam, Electroconvulsive Therapy, Genotype & phenotype,
Humans, Hyperactivity, Lorazepam, Lorazepam - therapeutic use, Midazolam, Midazolam -
therapeutic use, Pandemics, Patients, Pediatrics, Response rates, Retrospective Studies, Self
destructive behavior, Self-Injurious Behavior, Self-injury
Caring for the Patient With Catatonia
Item Type Journal Article
Author Stephan Heckers
Author Sebastian Walther
Date 2021
Language eng
Library Catalog librarysearch.library.utoronto.ca
Extra Place: United States Publisher: American Medical Association
Volume 78
Pages 560–561
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Publication JAMA psychiatry (Chicago, Ill.)
DOI 10.1001/jamapsychiatry.2021.0096
Issue 5
ISSN 2168-622X
Date Added 8/23/2025, 5:27:00 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
autistic catatonia, catatonia, Catatonia - diagnosis, Catatonia - prevention & control, Catatonia -
therapy, Humans
Case report: Diagnostic challenges in an adolescent case of autistic catatonia
Item Type Journal Article
Author Nighat J. Nadeem
Author Abduallah Moawad
Author Sophie Howatson
Author Adeel Ahmed
Author Diana Cassell
Abstract Catatonia is a complex neuropsychiatric syndrome involving a constellation of
psychomotor disturbances including catalepsy, waxy flexibility, stupor, mutism,
negativism, agitation, posturing, stereotypes, mannerisms, grimacing, echolalia,
and echopraxia. Catatonia occurs in several conditions including psychotic,
affective and neurodevelopmental disorders such as autism spectrum disorder
(ASD). ASD is a neurodevelopmental disorder characterized by persistent
deficits in communication, social interaction, restricted interests, repetitive
behaviours and sensory sensitivities. Catatonia can occur in response to life
stressors such as extreme fear or threat, interpersonal conflict, tragic events or
following significant loss. Those with ASD may be particularly vulnerable to
the negative impact of stressors and the link between catatonia and ASD is
being increasingly recognized. The overlapping features of catatonia and ASD
make it difficult to differentiate often resulting in delayed or missed diagnosis.
Catatonia in ASD remains a significant clinical challenge; it is difficult to
diagnose and can pose debilitating difficulties for those affected. Catatonia is a
treatable condition and prompt recognition is vital in securing the best possible
outcome. We report a complex and unique case of a 15-year-old boy who
presented with severe cognitive and functional decline with a background
history of significant bullying and deterioration in his mental state. This case
posed a diagnostic conundrum leading to a diagnosis of underlying ASD,
anxiety and trauma.
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Date 2024
Language eng
Short Title Case report
Library Catalog librarysearch.library.utoronto.ca
Extra Place: Switzerland Publisher: Frontiers Media S.A
Volume 15
Pages 1386949-
Publication Frontiers in psychiatry
DOI 10.3389/fpsyt.2024.1386949
ISSN 1664-0640
Date Added 8/23/2025, 5:03:59 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
adolescents, autism spectrum disorder (ASD), autistic catatonia, CAMHS, catatonia,
neuropsychiatric, Psychiatry
Case Reports: Clozapine for the Treatment of Catatonia in Autism Spectrum
Disorder
Item Type Journal Article
Author Robyn P. Thom
Author Christopher J. McDougle
Abstract Catatonia is a severe clinical syndrome which has been increasingly reported in
autism spectrum disorder (ASD). The prevalence of catatonia in ASD is
unknown. Diagnosing catatonia in ASD is complicated by overlapping clinical
features such as mutism, stereotypies, and echophenomena. Here, we present
the clinical histories of two individuals with ASD and catatonia who were
successfully treated with clozapine. We have reported on a novel potential
treatment option for catatonia in ASD. Additional studies are needed to evaluate
the safety, efficacy, and tolerability of clozapine for the treatment of catatonia
in ASD.
Date 2022
Language eng
Short Title Case Reports
Library Catalog librarysearch.library.utoronto.ca
Extra Place: New York Publisher: Springer US
Volume 52
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Pages 2855–2858
Publication Journal of autism and developmental disorders
DOI 10.1007/s10803-021-05149-8
Issue 6
ISSN 0162-3257
Date Added 8/23/2025, 5:12:43 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
Autism, Autism Spectrum Disorders, autistic catatonia, Behavioral Science and Psychology, Case
reports, Case studies, catatonia, Catatonia, Child and School Psychology, Clozapine, Complications
and side effects, Dosage and administration, Drug Therapy, Efficacy, Human Body, Intervention,
Language Acquisition, Letter to the Editor, Mental Disorders, Mutism, Neurosciences, Pediatrics,
Pervasive Developmental Disorders, Psychology, Public Health, Risk factors, Speech Therapy,
Verbal Communication
Catatonia
Item Type Journal Article
Author Stephan Heckers
Author Sebastian Walther
Contributor Allan H. Ropper
Abstract Catatonia, characterized by staring, immobility, mutism, and unusual postures,
has diverse causes. Treatment of an underlying disorder and intravenous
lorazepam, sometimes at high doses, are usually successful.
Date 2023
Language eng
Library Catalog librarysearch.library.utoronto.ca
Extra Place: United States Publisher: Massachusetts Medical Society
Volume 389
Pages 1797–1802
Publication The New England journal of medicine
DOI 10.1056/NEJMra2116304
Issue 19
ISSN 0028-4793
Date Added 8/23/2025, 5:26:51 PM
Modified 8/23/2025, 5:46:14 PM
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Tags:
Anti-Anxiety Agents, Antipsychotics, Autism, autistic catatonia, Behavior, catatonia, Catatonia,
Catatonia - diagnosis, Catatonia - etiology, Catatonia - therapy, Dopamine, Electroconvulsive
Therapy, Emergency medical care, Emergency Medicine, Emergency Medicine General, Humans,
Hyperthermia, Lorazepam, Mental disorders, Mental health, Metabolic disorders, Neurology,
Neurosurgery, Neurosurgery General, Patients, Psychiatry, Psychiatry General, Schizophrenia
Catatonia in autism and other neurodevelopmental disabilities: a state-of-theart
review
Item Type Journal Article
Author Shavon Moore
Author Debha N. Amatya
Author Michael M. Chu
Author Aaron D. Besterman
Abstract Individuals with neurodevelopmental disabilities (NDDs) may be at increased
risk for catatonia, which can be an especially challenging condition to diagnose
and treat. There may be symptom overlap between catatonia and NDDassociated
behaviors, such as stereotypies. The diagnosis of catatonia should
perhaps be adjusted to address symptom overlap and to include extreme
behaviors observed in patients with NDDs, such as severe self-injury. Risk
factors for catatonia in individuals with NDDs may include trauma and certain
genetic variants, such as those that disrupt SHANK3. Common etiologic
features between neurodevelopmental disabilities and catatonia, such as
excitatory/inhibitory imbalance and neuroimmune dysfunction, may partially
account for comorbidity. New approaches leveraging genetic testing and
neuroimmunologic evaluation may allow for more precise diagnoses and
effective treatments.
Date 2022-09-14
Language en
Short Title Catatonia in autism and other neurodevelopmental disabilities
Library Catalog www.nature.com
URL https://www.nature.com/articles/s44184-022-00012-9
Accessed 9/27/2024, 7:06:09 PM
Rights 2022 The Author(s)
Extra Publisher: Nature Publishing Group
Volume 1
Pages 1-10
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Publication npj Mental Health Research
DOI 10.1038/s44184-022-00012-9
Issue 1
Journal Abbr npj Mental Health Res
ISSN 2731-4251
Date Added 9/27/2024, 7:06:09 PM
Modified 9/27/2024, 7:06:09 PM
Tags:
Autism spectrum disorders, Clinical genetics, Human behaviour, Immunopathogenesis
Catatonia in autism spectrum disorder: Analysis of clinical characteristics,
stressful life events, and validation of the attenuated behavior questionnaire
(ABQ)
Item Type Journal Article
Author Makbule Esen Öksüzoğlu
Author Tahsin Rollas
Author İ Mert Erdoğan
Author E. Selin Akbaş Aliyev
Author Dilek Ünal
Author Sevilay Karahan
Author Tuna Çak Esen
Author A. Elif Anıl Yağcıoğlu
Abstract •10.7 % of the participants with ASD were diagnosed with catatonia,
highlighting its relatively high occurrence in this population.•The Turkish
version of the Attenuated Behavior Questionnaire (ABQ) showed strong
validity and reliability (Spearman-Brown coefficient = 0.979) for identifying
catatonic symptoms in individuals with ASD.•Individuals with ASD and
catatonia had significantly higher rates of late regression, impairments in social
and language skills, and psychiatric comorbidities.•The ABQ proved to be an
effective tool for screening and diagnosing catatonia in ASD, emphasizing the
need for early recognition and intervention. Autism spectrum disorder (ASD)
and catatonia exhibit overlapping motor and behavioral symptoms; however,
catatonia is often underdiagnosed in individuals with ASD. This study evaluates
the validity and reliability of the Turkish version of the Attenuated Behavior
Questionnaire (ABQ) and explores the clinical characteristics of individuals
with ASD and catatonia. The study involved 300 participants with ASD, aged
12–25 years. Parents completed the ABQ, Repetitive Behavior Scale (RBS),
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and Aberrant Behavior Checklist (ABC), while clinicians evaluated catatonia
using DSM-5 criteria, the Bush Francis Catatonia Rating Scale (BFCRS),
KANNER Scale, and Childhood Autism Rating Scale (CARS). Regression in
social and language skills and stressful life events from the previous six months
were also assessed. The mean age of participants was 16.0 years, with 32 (10.7
%) diagnosed with catatonia; among these, 15.3 % experienced regression, and
25.0 % reported stressful life events. The ABQ showed strong validity and
reliability (Spearman-Brown coefficient = 0.979), with ROC analysis
determining diagnostic (92.5) and screening (39.5) cut-off points. Participants
with ASD and catatonia had significantly elevated rates of late regression,
impairments in social and language skills, psychiatric comorbidities, and
stressful life events, and they scored considerably higher on BFCRS, KANNER,
CARS, RBS, and ABC (all p < .05). Our findings highlight high prevalence of
catatonia among individuals with ASD and its association with late regression,
social and language impairments, psychiatric comorbidities, and stressful life
events and underscore the clinical utility of the ABQ in identifying catatonic
symptoms in ASD and emphasize the importance of early recognition and
intervention.
Date 2025
Language eng
Short Title Catatonia in autism spectrum disorder
Library Catalog librarysearch.library.utoronto.ca
Extra Place: Ireland Publisher: Elsevier B.V
Volume 351
Pages 116643-
Publication Psychiatry research
DOI 10.1016/j.psychres.2025.116643
ISSN 0165-1781
Date Added 8/23/2025, 5:39:58 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
Attenuated behavior, Autism, autistic catatonia, catatonia, Catatonia, Late regression
Catatonia in autism spectrum disorders: A systematic review and metaanalysis
Item Type Journal Article
Author J. Vaquerizo-Serrano
Author G. Salazar De Pablo
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Author J. Singh
Author P. Santosh
Abstract Catatonic features can appear in autism spectrum disorders (ASDs). There can
be overlap in symptoms across catatonia and ASD. The overall aim of this
review is to provide evidence for the presence of catatonic features in subjects
with ASD. A systematic literature search using the Web of Science database
from inception to July 10, 2021 was conducted following PRISMA, MOOSE
guidelines and the PROSPERO protocol. (CRD42021248615). Twelve studies
with information about catatonia and ASD were reviewed. Data from a subset
was used to conduct meta-analyses of the presence of catatonia in ASD. The
systematic review included 12 studies, seven of which were used for the metaanalysis,
comprising 969 individuals. The mean age was 21.25 (7.5) years. Two
studies (16.6%) included only children and adolescents. A total of 70-100%
were males. Our meta-analysis showed that 10.4% (5.8-18.0 95%CI) of
individuals with ASD have catatonia. Motor disturbances were common in ASD
subjects with catatonia. No differences were found in comorbidity. Several
treatments have been used in ASD with catatonic features, including
benzodiazepines, antipsychotics, and electroconvulsive therapy (ECT). The
findings of the systematic review showed that ECT might help manage
catatonic symptoms. Different features of catatonia can exist in individuals with
ASD and core symptoms of catatonia are reported in ASD. Longitudinal and
longer-term studies are required to understand the relationship between
catatonia and ASD, and the response of catatonic symptoms to treatment.
Date 2022
Language eng
Short Title Catatonia in autism spectrum disorders
Library Catalog librarysearch.library.utoronto.ca
Extra Place: England Publisher: Cambridge University Press
Volume 65
Pages e4-
Publication European psychiatry
DOI 10.1192/j.eurpsy.2021.2259
Issue 1
ISSN 0924-9338
Date Added 8/23/2025, 5:06:53 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
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Adolescent, Antipsychotic Agents, ASD, Autism, Autism Spectrum Disorder - complications,
Autism Spectrum Disorder - epidemiology, autism spectrum disorders, autistic catatonia,
Benzodiazepines, catatonia, Catatonia, Catatonia - epidemiology, Catatonia - therapy, catatonic
symptoms, Citation indexes, Echolalia, Electroconvulsive Therapy, Emotional disorders,
Epidemiology, Humans, Longitudinal studies, Male, Mental disorders, Meta-analysis, Mood
disorders, Review/Meta-analysis, Schizophrenia, Systematic review
Attachments
Full Text
Catatonia in autism spectrum disorders: Prevalence, functional impact, and
diagnostic insights
Item Type Journal Article
Author Esra Yurumez
Author Rahime Duygu Temelturk
Author Banu Kaymak
Author Yağmur Özgür Karabıyıkoğlu
Author Nisa Didem Zengin
Abstract •The prevalence of catatonia was found 35 % among the 12–18-year-old
children with ASD, based on parent reports.•The presence of catatonia was
associated with impaired functionality in ASD.•MDD subgroup scales of
RCADS-CV were correlated with the presence of catatonia; thus, symptoms of
mood disorders should be carefully questioned in children and adolescents with
ASD.•These results emphasize the importance of the awareness and knowledge
of clinicians for catatonia diagnosis among children and adolescents with ASD.
The current study aimed to evaluate subtle catatonia behaviors and functionality
in adolescents with autism spectrum disorders (ASD). The sample consisted of
48 patients (11 female, 37 male) aged 12–18 (13.77 ± 2.01). DSM-5 catatonia
criteria and Bush-Francis Catatonia Rating Scale (BCRS) was utilized to assess
catatonia, while the impairment in functionality was appraised using the Global
Assessment Scale. Parents fulfilled the Revised Child Anxiety and Depression
Scale-Parent version (RCADS-PV) and Repetitive Behavior Scale-Revised
(RBS-R). The presence of catatonia was detected in 18 out of 48 (37.5 %)
participants according to BCRS, and in 16 cases (35.4 %) according to DSM-5
criteria. A significant association between two diagnostic tools was observed (p
< 0.001). In the group with mild impairment in functionality, 2 cases had
catatonia (12.5 %), while in the group with more impaired functionality, 16
cases (50 %) had catatonia (p = 0.011) according to BCRS. Major depressive
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disorder subscale scores of RCADS-PV and stereotypic movements (RBS-R)
were correlated with the presence of catatonia (p < 0.05). The findings suggest a
higher prevalence of catatonia in ASD, and a potential correlation between the
presence of catatonia and functionality. More research is warranted to highlight
the presence and course of catatonia beginning from the early years of ASD.
Date 2024
Language eng
Short Title Catatonia in autism spectrum disorders
Library Catalog librarysearch.library.utoronto.ca
Extra Place: Ireland Publisher: Elsevier B.V
Volume 342
Pages 116250-
Publication Psychiatry research
DOI 10.1016/j.psychres.2024.116250
ISSN 0165-1781
Date Added 8/23/2025, 5:08:28 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
Adolescent, Autism spectrum disorder, Autism Spectrum Disorder - complications, Autism
Spectrum Disorder - diagnosis, Autism Spectrum Disorder - epidemiology, autistic catatonia,
catatonia, Catatonia, Catatonia - diagnosis, Catatonia - epidemiology, Child, Female, Humans,
Male, Prevalence, Psychiatric Status Rating Scales
Catatonia in Autistic Adults in a Tertiary Inpatient and Outpatient
Neurodevelopmental Service: A Retrospective Review
Item Type Journal Article
Author Syeda Hasan
Author Pushpal Desarkar
Author Yona Lunsky
Author Anupam Thakur
Abstract Catatonia is a syndrome that affects movement, speech and behaviours, in
varying degrees of severity. There is an increasing research interest in catatonia
in autistic adults. Bulk of the studies are in children and youth, and few have
reported on clinical presentation and treatment outcomes of catatonia in autistic
adults. The aim of the study is to determine the prevalence, clinical
characteristics and treatment outcomes for catatonia in adults with autism
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spectrum disorder in a tertiary neurodevelopmental service. This retrospective
chart review was carried out to identify autistic adults presenting with catatonic
symptoms. Wing and Shah criteria for catatonia were used for confirmation of
the diagnosis. Out of 143 individuals with a confirmed diagnosis of autism
spectrum disorder, sixteen (11.1%) of them were identified to have catatonic
symptoms and co-occurring intellectual disability Commonly reported catatonic
symptoms included difficulties in initiating actions (n = 16), posturing (n = 14),
freezing (n = 6), and reduced motor movements (n = 16). Eleven (11) of them
responded rapidly to lorazepam (dose range 6 mg- 24 mg). One participant
received ECT with full improvement in catatonic symptoms, and two declined.
The prevalence rate of catatonia (11.1%) in autistic adults in the tertiary
neurodevelopmental service, a specialized setting, is similar to previous studies.
Most study participants showed complete resolution of symptoms with a
combination of high dosages of benzodiazepines and psychosocial
interventions. Use of specific tools for diagnosis of catatonia in autism spectrum
disorder, such as Wing and Shah's criteria, can help with diagnostic accuracy.
Date 2025
Language eng
Short Title Catatonia in Autistic Adults in a Tertiary Inpatient and Outpatient
Neurodevelopmental Service
Library Catalog librarysearch.library.utoronto.ca
Extra Place: United States
Publication Journal of autism and developmental disorders
DOI 10.1007/s10803-025-06837-5
ISSN 0162-3257
Date Added 7/2/2025, 2:48:07 PM
Modified 7/2/2025, 2:48:07 PM
Catatonia in neurodevelopmental disorders: assessing catatonic deterioration
from baseline
Item Type Journal Article
Author Aaron J. Hauptman
Author David Cohen
Author Dirk Dhossche
Author Marie Raffin
Author Lee Wachtel
Author Vladimir Ferrafiat
Abstract SummaryDespite the inclusion of catatonia as a specifier of autism spectrum
disorder in DSM-5, we—a team of child and adolescent neuropsychiatrists who
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specialise in paediatric catatonia and neurodevelopmental disorders—have
identified a number of issues with the diagnosis and clinical management of
catatonia in our patients. In this Personal View, we summarise the literature
regarding catatonia in people with neurodevelopmental disorders, including
autism spectrum disorder, describe our concerns, and offer a novel approach to
addressing important issues with current diagnostic and treatment paradigms.
We emphasise the need for a measure to diagnose and monitor people with
catatonia and their history of neurodevelopmental disorders. This measure
should consider previous complex and underlying motor, medical, functional,
and neurobehavioural symptoms. We propose two concepts for understanding
catatonia that relate to the baseline status of an individual: the personalised
score at baseline, an estimate of premorbid neurobehavioral and motor
symptoms, and the catatonic deterioration from baseline, an estimate of current
features that are due to catatonia rather than an underlying neurodevelopmental
disorder. We hope this measure will provide a practical tool for clinicians and
researchers working with this underserved and high-risk population.
Date 2023
Language eng
Short Title Catatonia in neurodevelopmental disorders
Library Catalog librarysearch.library.utoronto.ca
Extra Place: England Publisher: Elsevier Ltd
Volume 10
Pages 228–234
Publication The Lancet. Psychiatry
DOI 10.1016/S2215-0366(22)00436-9
Issue 3
ISSN 2215-0366
Date Added 8/23/2025, 5:40:23 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
Adolescent, Autism Spectrum Disorder - complications, Autism Spectrum Disorder - diagnosis,
autistic catatonia, catatonia, Catatonia - diagnosis, Child, Diagnostic and Statistical Manual of
Mental Disorders, Humans, Psychiatric/Mental Health, Risk Factors
Catatonia: A Common Cause of Late Regression in Autism
Item Type Journal Article
Author Mohammad Ghaziuddin
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Abstract <p>Autism spectrum disorder (ASD) is a neurodevelopmental disorder
characterized by social communication deficits and restricted interests and
behaviors which begin very early in life. In about a quarter of cases, the
symptoms emerge about 18–24 months after a period of normal development, a
phenomenon commonly described as early regression. However, marked
functional decline can also occur in persons with autism after a relatively stable
childhood. As opposed to early regression, which occurs in normally
developing children, late regression occurs typically in adolescents with an
established diagnosis of autism. Apart from their occasional mention in the
literature, these individuals have not been examined systematically. This Brief
Report describes the presentation, comorbidity and short-term outcome of 20
persons with ASD who developed late regression. The mean age of onset of
regression was 13 years. One of the earliest symptoms was an increase in
obsessive slowing and compulsive rituals. Other symptoms included motor
abnormalities, aggression and mood disturbance. The most common comorbid
disorder was catatonia occurring in 17 patients. Despite treatment with several
modalities, the outcome was often suboptimal. These findings suggest that
catatonia is a common cause of late regression in persons with autism. Clinical
and research implications are discussed.</p>
Date 2021-10-28
Language English
Short Title Catatonia
Library Catalog Frontiers
URL https://www.frontiersin.org/journals/psychiatry/articles/10.3389
/fpsyt.2021.674009/full
Accessed 11/4/2024, 3:03:06 PM
Extra Publisher: Frontiers
Volume 12
Publication Frontiers in Psychiatry
DOI 10.3389/fpsyt.2021.674009
Journal Abbr Front. Psychiatry
ISSN 1664-0640
Date Added 11/4/2024, 3:03:06 PM
Modified 11/4/2024, 3:03:06 PM
Tags:
Catatonia, adolescence, autism, Comorbidity, late regression
Catatonia: American Psychiatric Association Resource Document
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Item Type Journal Article
Author Jo Ellen Wilson
Author Mark A. Oldham
Author Andrew Francis
Author Dina Perkey
Author Eric Kramer
Author Shixie Jiang
Author Jennifer Yoon
Author Scott Beach
Author Gregory Fricchione
Author Matthew Gunther
Author Jihoon Ha
Author James Luccarelli
Author Jordan Rosen
Author Dallas Hamlin
Author Joseph D. Dragonetti
Author Avi Gerstenblith
Author Anne Louise Stewart
Author Jon Sole
Author James A. Bourgeois
Abstract The American Psychiatric Association Resource Document for Catatonia was
prepared by the Catatonia Work Group of the Council on Consultation-Liaison
Psychiatry, with the goal of supporting psychiatrists, trainees, and other mental
healthcare workers and to provide a useful framework for understanding
catatonia. In 2023, the American Psychiatric Association Council on
Consultation-Liaison Psychiatry convened a work group to develop a resource
document on Catatonia. A draft of this document was reviewed by the Council
in December 2024, and a revised version was approved by this Council in
January 2025. The accepted version was subsequently reviewed by the
American Psychiatric Association Council on Women's Mental Health, Council
on Geriatric Psychiatry, Council on Research, Council on Quality Care,
Committee on Practice Guidelines, and Committee on Ethics in December
2024. The final version was approved by the Joint Reference Committee on
March 12, 2025, and posted to the American Psychological Association
website. In this resource document, we review the history of the catatonia and
its epidemiology including prevalence and risk factors. We review the common
evaluation methods including rating scales, diagnostic criteria, and clinical
evaluation of medical causes of catatonia and its complications, with a focus on
the physical examination, laboratory studies, neuroimaging, and
electroencephalography. We review the differential diagnosis of catatonia
across the medical and psychiatric context of care including abulia/akinetic
mutism, delirium, major neurocognitive disorders, locked-in syndrome, late-
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stage Parkinsons disease, stiff-person syndrome, akathisia, mania, malignant
catatonia/neuroleptic malignant syndrome, autoimmune encephalitis, and
serotonin syndrome. In this resource document, we additionally review the
pathophysiology of catatonia and highlight common interventions and treatment
recommendations, with a focus on benzodiazepines and electroconvulsive
therapy. We additionally highlight considerations in specific populations
including pediatrics, the medically complex, pregnancy and postpartum period,
and dementia. We conclude the document with a review of ethical and legal
considerations and provide some suggestions for educational resources.
Date 2025
Language eng
Short Title Catatonia
Library Catalog librarysearch.library.utoronto.ca
Extra Place: Netherlands Publisher: Elsevier Inc
Publication Journal of the Academy of Consultation-Liaison Psychiatry
DOI 10.1016/j.jaclp.2025.05.001
ISSN 2667-2960
Date Added 8/23/2025, 5:15:00 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
autistic catatonia, catatonia, electroconvulsive therapy, epidemiology, rating scales, risk factors,
treatment
Diagnostic and Therapeutic Challenges of Catatonia in an Adolescent With
High Functioning Autism Spectrum Disorder: A Case Report
Item Type Journal Article
Author Annalisa Traverso
Author Caterina Ancora
Author Silvia Zanato
Author Alessia Raffagnato
Author Michela Gatta
Abstract Catatonia is a psychomotor syndrome with specific clusters of speech,
behavioral and motor features. Although potentially life-threatening, especially
in its malignant form accompanied with autonomic dysregulation and medical
complications, it is a treatable condition, when promptly identified. For a long
time catatonia was considered a marker of schizophrenia, thus limiting the
possibility of diagnosis and treatment. Due to growing awareness and studies on
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the subject, it is now known that catatonia can occur in the context of a number
of diseases, including psychotic, affective and neurodevelopmental disorders. In
recent years, there's been a renewed interest in the recognition and definition of
catatonia in neurodevelopmental disorders, such as Autism Spectrum Disorder
(ASD), where the differential diagnosis poses great challenges, given the
considerable overlapping of signs and symptoms between the conditions. We
present the case of a 15 year old boy with High Functioning ASD with a sudden
onset of severe catatonic symptoms and the co-existence of psychotic
symptoms, whose complex clinical course raises many questions on the
differentiation and relation of said disorders.
Date 2021
Language eng
Short Title Diagnostic and Therapeutic Challenges of Catatonia in an Adolescent With
High Functioning Autism Spectrum Disorder
Library Catalog librarysearch.library.utoronto.ca
Extra Publisher: Frontiers Media S.A
Volume 12
Pages 644727-
Publication Frontiers in psychiatry
DOI 10.3389/fpsyt.2021.644727
ISSN 1664-0640
Date Added 8/23/2025, 5:11:50 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
adolescent psychiatry, autism spectrum disorder, autistic catatonia, catatonia, ECT, high functioning
autism, Psychiatry
Electroconvulsive Therapy-Resistant Catatonia: Case Report and Literature
Review
Item Type Journal Article
Author Tuna Hasoglu
Author Andrew Francis
Author Charles Mormando
Abstract Untreated catatonia is associated with serious medical complications that can
necessitate urgent medical attention. Lorazepam and electroconvulsive therapy
(ECT) are effective for catatonia across various psychiatric or medical
diagnoses. In rare cases, ECT fails to achieve full response in catatonic
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symptoms, particularly in patients with chronic catatonia or primary psychotic
disorder. Evidence on treating catatonia that does not respond to ECT is
lacking. Conduct a literature review on treatment of ECT-resistant catatonia
which is defined as that reported lack of full response to ECT treatments. We
present a case of a 52-year-old male with schizophrenia where catatonia did not
respond to lorazepam and robust ECT but resolved after memantine titration. A
literature review was performed using Medline/PubMed with the following
keywords: treatment-resistant, catatonia, electroconvulsive therapy. References
in eligible articles and most recent systematic reviews on catatonia treatment
were reviewed. Seventeen patients in 12 case reports were identified where the
treatment of catatonia was described after failed ECT trials. Most had chronic
catatonia and a diagnosis of schizophrenia. ECT parameters and ictal outcome
measures were not consistently reported. Treatment modalities for ECTresistant
catatonia included amantadine, memantine, lorazepam augmentation to
ECT, and antiepileptic and antipsychotic medications such as aripiprazole and
clozapine. The literature review and new case suggest reconsideration of
catatonia diagnosis, optimizing ECT treatments, cautious use of antipsychotics,
consideration of lorazepam augmentation to ECT treatments, and/or use of
N-methyl-D-aspartate receptor antagonists.
Date 2022
Language eng
Short Title Electroconvulsive Therapy-Resistant Catatonia
Library Catalog librarysearch.library.utoronto.ca
Extra Place: Netherlands Publisher: Elsevier Inc
Volume 63
Pages 607–618
Publication Journal of the Academy of Consultation-Liaison Psychiatry
DOI 10.1016/j.jaclp.2022.07.003
Issue 6
ISSN 2667-2960
Date Added 8/23/2025, 5:32:11 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
autistic catatonia, catatonia, Catatonia - drug therapy, electroconvulsive therapy, Electroconvulsive
Therapy - adverse effects, Humans, Lorazepam - therapeutic use, Male, memantine, Memantine -
therapeutic use, Middle Aged, NMDA receptor antagonists, Schizophrenia, Catatonic -
complications, Schizophrenia, Catatonic - drug therapy, treatment resistant
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Evidence-based consensus guidelines for the management of catatonia:
Recommendations from the British Association for Psychopharmacology
Item Type Journal Article
Author Jonathan P. Rogers
Author Mark A. Oldham
Author Gregory Fricchione
Author Georg Northoff
Author Jo Ellen Wilson
Author Stephan C. Mann
Author Andrew Francis
Author Angelika Wieck
Author Lee Elizabeth Wachtel
Author Glyn Lewis
Author Sandeep Grover
Author Dusan Hirjak
Author Niraj Ahuja
Author Michael S. Zandi
Author Allan H. Young
Author Kevin Fone
Author Simon Andrews
Author David Kessler
Author Tabish Saifee
Author Siobhan Gee
Author David S. Baldwin
Author Anthony S. David
Abstract The British Association for Psychopharmacology developed an evidence-based
consensus guideline on the management of catatonia. A group of international
experts from a wide range of disciplines was assembled. Evidence was gathered
from existing systematic reviews and the primary literature. Recommendations
were made on the basis of this evidence and were graded in terms of their
strength. The guideline initially covers the diagnosis, aetiology, clinical features
and descriptive epidemiology of catatonia. Clinical assessments, including
history, physical examination and investigations are then considered. Treatment
with benzodiazepines, electroconvulsive therapy and other pharmacological and
neuromodulatory therapies is covered. Special regard is given to periodic
catatonia, malignant catatonia, neuroleptic malignant syndrome and
antipsychotic-induced catatonia. There is attention to the needs of particular
groups, namely children and adolescents, older adults, women in the perinatal
period, people with autism spectrum disorder and those with certain medical
conditions. Clinical trials were uncommon, and the recommendations in this
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guideline are mainly informed by small observational studies, case series and
case reports, which highlights the need for randomised controlled trials and
prospective cohort studies in this area.
Date 2023-04
Language eng
Short Title Evidence-based consensus guidelines for the management of catatonia
Library Catalog PubMed
Extra PMID: 37039129 PMCID: PMC10101189
Volume 37
Pages 327-369
Publication Journal of Psychopharmacology (Oxford, England)
DOI 10.1177/02698811231158232
Issue 4
Journal Abbr J Psychopharmacol
ISSN 1461-7285
Date Added 6/24/2025, 10:06:18 PM
Modified 6/24/2025, 10:06:18 PM
Tags:
Adolescent, Autism Spectrum Disorder, Catatonia, Child, Female, Humans, Aged, Antipsychotic
Agents, benzodiazepine, catatonic schizophrenia, electroconvulsive therapy, guideline, neuroleptic
malignant syndrome, Psychopharmacology, treatment
Attachments
Full Text
PubMed entry
Increasing Verbal Behavior in a Young Adolescent Girl with Catatonia and
Autism Spectrum Disorder
Item Type Journal Article
Author Susan M. Vener
Author Alison M. Gillis
Author Claire L. Poulson
Abstract Catatonia is a syndrome characterized as a cluster of difficulties in verbal and
motor behavior that interferes with everyday function. This study analyzed the
effects of a prompt-fading behavioral treatment package on the verbal behavior
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of an adolescent girl with autism and catatonia. Data were collected on three
verbal responses previously observed in the participant’s repertoire, including
“Hi,” “That sounds great,” and “Excuse me.” Instructors provided full manual
guidance, in conjunction with a verbal model, when needed, to assist the
participant in emitting the verbal responses. A functional relation was
demonstrated between the prompt-fading package and the three verbal
responses, and independent verbal responding emerged as manual prompts were
faded. Responding was displayed across unfamiliar adults and maintained over
time.
Date 2021
Language eng
Library Catalog librarysearch.library.utoronto.ca
Extra Place: New York Publisher: Springer US
Volume 51
Pages 3857–3867
Publication Journal of autism and developmental disorders
DOI 10.1007/s10803-020-04843-3
Issue 11
ISSN 0162-3257
Date Added 9/27/2024, 8:53:29 PM
Modified 9/27/2024, 8:53:29 PM
Tags:
Psychological aspects, Psychology, Autism, Catatonia, Diagnosis, Adolescent girls, Autistic
adolescents, Behavior modification, Behavioral Science and Psychology, Child and School
Psychology, Demographic aspects, Early Adolescents, Females, Health aspects, Intervention,
Management, Mental Disorders, Neurosciences, Original Paper, Pediatrics, Pervasive
Developmental Disorders, Program Effectiveness, Prompting, Public Health, Teenage girls,
Teenagers, Verbal behavior, Verbal behaviour, Verbal Communication
Intrinsic neural network dynamics in catatonia
Item Type Journal Article
Author Fabio Sambataro
Author Dusan Hirjak
Author Stefan Fritze
Author Katharina M. Kubera
Author Georg Northoff
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Author Vince D. Calhoun
Author Andreas Meyer-Lindenberg
Author Robert C. Wolf
Abstract Catatonia is a transnosologic psychomotor syndrome with high prevalence in
schizophrenia spectrum disorders (SSD). There is mounting neuroimaging
evidence that catatonia is associated with aberrant frontoparietal, thalamic and
cerebellar regions. Large-scale brain network dynamics in catatonia have not
been investigated so far. In this study, resting-state fMRI data from 58 righthanded
SSD patients were considered. Catatonic symptoms were examined on
the Northoff Catatonia Rating Scale (NCRS). Group spatial independent
component analysis was carried out with a multiple analysis of covariance
(MANCOVA) approach to estimate and test the underlying intrinsic
components (ICs) in SSD patients with (NCRS total score ≥ 3; n = 30) and
without (NCRS total score = 0; n = 28) catatonia. Functional network
connectivity (FNC) during rest was calculated between pairs of ICs and
transient changes in connectivity were estimated using sliding windowing and
clustering (to capture both static and dynamic FNC). Catatonic patients showed
increased static FNC in cerebellar networks along with decreased low frequency
oscillations in basal ganglia (BG) networks. Catatonic patients had reduced state
changes and dwelled more in a state characterized by high within-network
correlation of the sensorimotor, visual, and default-mode network with respect
to noncatatonic patients. Finally, in catatonic patients according to DSM-IVTR
(n = 44), there was a significant correlation between increased within FNC
in cortico-striatal state and NCRS motor scores. The data support a
neuromechanistic model of catatonia that emphasizes a key role of disrupted
sensorimotor network control during distinct functional states. The data support
a neuromechanistic model of catatonia that emphasizes a key role of disrupted
sensorimotor network control during distinct functional states.
Date 2021
Language eng
Library Catalog librarysearch.library.utoronto.ca
Extra Place: Hoboken, USA Publisher: John Wiley & Sons, Inc
Volume 42
Pages 6087–6098
Publication Human brain mapping
DOI 10.1002/hbm.25671
Issue 18
ISSN 1065-9471
Date Added 8/23/2025, 5:15:40 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
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Adult, autistic catatonia, Basal ganglia, Brain - diagnostic imaging, Brain - physiopathology, Brain
mapping, catatonia, Catatonia, Catatonia - diagnostic imaging, Catatonia - physiopathology,
Cerebellum, Clustering, Connectome, dynamic functional network connectivity, Female, Functional
magnetic resonance imaging, Ganglia, Humans, Independent component analysis, Magnetic
Resonance Imaging, Male, Medical imaging, Mental disorders, Middle Aged, MRI, Neostriatum,
Nerve Net - diagnostic imaging, Nerve Net - physiopathology, Network control, Neural networks,
Neuroimaging, Oscillations, Schizophrenia, sensorimotor neuroscience, Sensorimotor system, Signs
and symptoms, Spatial analysis, static functional network connectivity, Thalamus
Investigating the relationship between autistic traits and symptoms and
Catatonia Spectrum
Item Type Journal Article
Author L. Dell’Osso
Author G. Amatori
Author G. Massimetti
Author B. Nardi
Author D. Gravina
Author F. Benedetti
Author C. Bonelli
Author M. Luciano
Author I. Berardelli
Author N. Brondino
Author M. De Gregorio
Author G. Deste
Author M. Nola
Author A. Reitano
Author M. R. A. Muscatello
Author M. Pompili
Author P. Politi
Author A. Vita
Author C. Carmassi
Author M. Maj
Abstract In recent years, numerous studies have highlighted the overlap between autism
spectrum disorder (ASD) and catatonia, both from a clinical and
pathophysiological perspective. This study aimed to investigate the relationship
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between the autism spectrum (autistic traits and ASD signs, symptoms, and
behavioral manifestation) and Catatonia Spectrum (CS). A total sample of 376
subjects was distributed in four diagnostic groups. Subjects were assessed with
the Structured Clinical Interview for DSM-5, Research Version, the Adult
Autism Subthreshold Spectrum (AdAS Spectrum), and CS. In the statistical
analyses, the total sample was also divided into three groups according to the
degree of autism severity, based on the AdAS Spectrum total score. A
statistically significant positive correlation was found between AdAS Spectrum
and CS total score within the total sample, the gender subgroups, and the
diagnostic categories. The AdAS Spectrum domains found to be significantly
and strongly correlated with the total CS score were hyper-hypo reactivity to
sensory input, verbal communication, nonverbal communication, restricted
interests and rumination, and inflexibility and adherence to routine. The three
groups of different autistic severity were found to be distributed across all
diagnostic groups and the CS score increased significantly from the group
without autistic traits to the group with ASD. Our study reports a strong
correlation between autism spectrum and CS.
Date 2022
Language eng
Library Catalog librarysearch.library.utoronto.ca
Extra Place: England Publisher: Cambridge University Press
Volume 65
Pages e81-
Publication European psychiatry
DOI 10.1192/j.eurpsy.2022.2334
Issue 1
ISSN 0924-9338
Date Added 8/23/2025, 5:13:49 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
AdAS Spectrum, Adult, Autism, autism spectrum, Autism Spectrum Disorder - diagnosis, autistic
catatonia, Autistic Disorder - diagnosis, catatonia, Catatonia, Catatonia - diagnosis, Catatonia
Spectrum, Child development, Communication, Echolalia, Humans, Mental disorders,
Questionnaires, Regression analysis, Stereotypes, Validation studies, Young adults
Attachments
Full Text
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Longitudinal Symptom Burden and Pharmacologic Management of
Catatonia in Autism With Intellectual Disability: An Observational Study
Item Type Journal Article
Author Joshua Ryan Smith
Author Seri Lim
Author Snehal Bindra
Author Sarah Marler
Author Bavani Rajah
Author Zachary J. Williams
Author Isaac Baldwin
Author Nausheen Hossain
Author Jo Ellen Wilson
Author D. Catherine Fuchs
Author James Luccarelli
Abstract ABSTRACT Catatonia is a highly morbid psychomotor and affective disorder,
which can affect autistic individuals with and without intellectual disability.
Catatonic symptoms are treatable with pharmacotherapy and electroconvulsive
therapy, but the longitudinal effectiveness of these treatments in autistic
individuals has not been described. We conducted a prospective observational
cohort study of patients with autism and co-morbid catatonia who received
outpatient care in a specialized outpatient clinic from July 1, 2021 to May 31,
2024. Data investigating pharmacologic interventions, and clinical measures
including the Bush Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia
Severity Scale (KCS), Kanner Catatonia Examination (KCE), and Clinical
Global Impression—Improvement (CGI-I) were collected. Forty-five autistic
patients with co-morbid catatonia were treated during the study period. The
mean age was 15.6 (SD = 7.9) years [Mdn = 16.0, range 6.0–31.0]. Forty-one
patients (91.1%) met criteria for autism with co-occurring intellectual
disability. All patients received pharmacotherapy. Forty-four (97.8%) were
treated with benzodiazepines with a mean maximal daily dose of 17.4 mg (SD
= 15.8) lorazepam equivalents. Thirty-five patients (77.8%) required more than
one medication class for treatment. Sixteen (35.6%) patients received
electroconvulsive therapy. Fourteen patients (31.1%) attempted to taper off
benzodiazepines after achieving clinical improvement during the study period;
of these, 5 patients (11.1%) were successfully tapered off, and the remaining 9
(17.8%) discontinued the taper due to a return of catatonic symptoms.
Statistically significant improvement was observed across all clinical domains
except the KCS. However, the majority remained at least partially symptomatic
over the study period. Three patients (6.7%) died over the study period. Despite
clinical improvements while receiving the gold standard for
psychopharmacologic management of catatonia, chronic symptoms remained
for the majority of catatonia patients over the study period, and few were able to
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taper and discontinue benzodiazepine treatment. Notably, the open label design
of this study is a limiting factor when interpreting the results.
Date 2025
Language eng
Short Title Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in
Autism With Intellectual Disability
Library Catalog librarysearch.library.utoronto.ca
Extra Place: Hoboken, USA Publisher: John Wiley & Sons, Inc
Volume 18
Pages 449–462
Publication Autism research
DOI 10.1002/aur.3315
Issue 2
ISSN 1939-3792
Date Added 8/23/2025, 5:17:29 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
Adolescent, Adult, aggression, Autism, autistic catatonia, Autistic Disorder - complications,
Benzodiazepines, Benzodiazepines - therapeutic use, catatonia, Catatonia, Catatonia -
complications, Catatonia - drug therapy, Catatonia - therapy, Child, Design factors, Drug therapy,
Electroconvulsive therapy, Female, Humans, Intellectual disabilities, Intellectual Disability -
complications, Longitudinal Studies, Lorazepam, Lorazepam - therapeutic use, Male, Observational
studies, Patients, Pharmacology, Prospective Studies, psychopharmacology, self-injurious behavior,
Severity of Illness Index, Statistical analysis, Symptom Burden, Tapering, TREATMENT,
Treatment Outcome, Young Adult
N-methyl-d-aspartate (NMDA) receptor antagonists for treatment of
catatonia in adults: Narrative review
Item Type Journal Article
Author Jeong Hoo Lee
Author Joji Suzuki
Abstract While the majority of patients with catatonia fully respond to benzodiazepines
or ECT, some have a partial or no response. Benzodiazepines may be
contraindicated such as when delirium co-exists. This review discusses the
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utility of NMDA receptor antagonists as alternatives to benzodiazepines in the
treatment of catatonia in adults. A PubMed search adhering to PRISMA
guidelines was conducted for articles on NMDA receptor antagonists in
catatonia treatment. Thirty-seven articles, including case reports and case series
were identified. Amantadine (27 cases in 13 articles) and memantine (20 cases
in 14 articles) were the most commonly reported agents. Amantadine, typically
used as monotherapy or adjunctive therapy with benzodiazepines, showed quick
responses. Memantine, used alone or with lorazepam, demonstrated rapid
responses. A small number of cases (5 cases in 4 articles) reported successful
use of ketamine and esketamine, highlighting their potential role in catatonia
treatment. Despite limitations, NMDA receptor antagonists may be viable
options when the patient is partially or not responsive to benzodiazepine, ECT
is not available or may not be well tolerated, there is a concern for co-morbid
delirium where benzodiazepines may be contraindicated. Further research is
needed.
Date 2024
Language eng
Short Title N-methyl-d-aspartate (NMDA) receptor antagonists for treatment of catatonia
in adults
Library Catalog librarysearch.library.utoronto.ca
Extra Place: United States Publisher: Elsevier Inc
Volume 91
Pages 60–65
Publication General hospital psychiatry
DOI 10.1016/j.genhosppsych.2024.09.005
ISSN 0163-8343
Date Added 8/23/2025, 5:33:42 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
Adult, Amantadine, Amantadine - therapeutic use, autistic catatonia, Benzodiazepines - therapeutic
use, catatonia, Catatonia, Catatonia - drug therapy, Esketamine, Excitatory Amino Acid Antagonists
- administration & dosage, Excitatory Amino Acid Antagonists - pharmacology, Excitatory Amino
Acid Antagonists - therapeutic use, Humans, Ketamine, Memantine, Memantine - therapeutic use,
NMDA receptor antagonists, Receptors, N-Methyl-D-Aspartate - antagonists & inhibitors
Neurodevelopmental Disorders Including Autism Spectrum Disorder and
Intellectual Disability as a Risk Factor for Delayed Diagnosis of Catatonia
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Item Type Journal Article
Author Katherine J. Zappia
Author Amelle Shillington
Author Cara Fosdick
Author Craig A. Erickson
Author Martine Lamy
Author Kelli C. Dominick
Abstract Objective:Catatonia is a distinct and severe medical syndrome comprising
motor, somatic, and psychiatric symptoms that is reported in upwards of 17% of
young patients with autism spectrum disorders. Clinical experience indicates
catatonia is often under-recognized in this clinical population. Here we
characterize the clinical presentation of catatonia in patients with and without
neurodevelopmental disorders (NDDs) including autism, including the time
from symptom onset to diagnosis of catatonia.Method:Retrospective chart
review of electronic medical records at a large, academic pediatric medical
center identified 113 pediatric and young adult patients with a charted history of
catatonia, as identified by an encounter diagnosis or problem list entry between
September 2017 and September 2021. Workup, treatments, and diagnoses
(psychiatric, neurodevelopmental, and genetic) were identified.Results:We
observed a clear and substantial delay in identification of catatonia in those with
NDDs (diagnosis after 330 days for those without psychosis) compared with
neurotypical patients (~16 days). Psychiatry involvement was associated with
shorter delays.Conclusion:Intellectual disability and autism are risk factors for
significantly delayed diagnosis of catatonia. It is unknown whether delayed
diagnosis contributes to the difficulty in treating catatonia in this patient
population or whether the treatment difficulties relate instead to differential and
ongoing biological mechanisms and underlying encephalopathy. Overall, these
findings highlight the importance of increased recognition of catatonia
symptoms in patients with NDDs and suggest early referral to psychiatric
specialists may shorten the delay to diagnosis.
Date 2024
Language eng
Library Catalog librarysearch.library.utoronto.ca
Extra Place: United States Publisher: Lippincott Williams & Wilkins
Volume 45
Pages e137–e142
Publication Journal of developmental and behavioral pediatrics
DOI 10.1097/DBP.0000000000001252
Issue 2
ISSN 0196-206X
Date Added 7/9/2025, 7:42:33 PM
Modified 7/9/2025, 7:42:33 PM
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Tags:
Autism, Catatonia, Intellectual disabilities, Neurodevelopmental disorders, Pediatrics
Prevalence of Autism Spectrum Disorder and Co-morbidities in Children
and Adolescents: A Systematic Literature Review
Item Type Journal Article
Author Clémence Bougeard
Author Françoise Picarel-Blanchot
Author Ramona Schmid
Author Rosanne Campbell
Author Jan Buitelaar
Abstract Objective: Individuals with autism spectrum disorder often present somatic
and/or psychiatric co-morbid disorders. The DSM-5 allows for consideration of
additional diagnoses besides ASD and may have impacted the prevalence of comorbidities
as well as being limited in capturing the true differences in
prevalence observed between males and females. We describe the prevalence of
ASD and frequently observed co-morbidities in children and adolescents (<18
years) in the United States and five European countries.Methods: Two
systematic literature reviews were conducted in PubMed and Embase for the
period 2014–2019 and focusing on the prevalence of ASD and nine comorbidities
of interest based on their frequency and/or severity: Attention
Deficit Hyperactivity Disorder (ADHD), anxiety, depressive disorders,
epilepsy, intellectual disability (ID), sleep disorders, sight/hearing
impairment/loss, and gastro-intestinal syndromes (GI).Results: Thirteen studies
on prevalence of ASD and 33 on prevalence of co-morbidities were included.
Prevalence of ASD was 1.70 and 1.85% in US children aged 4 and 8 years
respectively, while prevalence in Europe ranged between 0.38 and 1.55%.
Additionally, current evidence is supportive of a global increase in ASD
prevalence over the past years. Substantial heterogeneity in prevalence of comorbidities
was observed: ADHD (0.00–86.00%), anxiety (0.00–82.20%),
depressive disorders (0.00–74.80%), epilepsy (2.80–77.50%), ID
(0.00–91.70%), sleep disorders (2.08–72.50%), sight/hearing impairment/loss
(0.00–14.90%/0.00–4.90%), and GI syndromes (0.00–67.80%). Studies were
heterogeneous in terms of design and method to estimate prevalence. Gender
appears to represent a risk factor for co-morbid ADHD (higher in males) and
epilepsy/seizure (higher in females) while age is also associated with ADHD
and anxiety (increasing until adolescence).Conclusion: Our results provide a
descriptive review of the prevalence of ASD and its co-morbidities in children
and adolescents. These insights can be valuable for clinicians and
parents/guardians of autistic children. Prevalence of ASD has increased over
time while co-morbidities bring additional heterogeneity to the clinical
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presentation, which further advocates for personalized approaches to treatment
and support. Having a clear understanding of the prevalence of ASD and its comorbidities
is important to raise awareness among stakeholders.
Date 2021
Language eng
Short Title Prevalence of Autism Spectrum Disorder and Co-morbidities in Children and
Adolescents
Library Catalog librarysearch.library.utoronto.ca
Extra Publisher: Frontiers Media SA
Volume 12
Pages 744709-
Publication Frontiers in Psychiatry
DOI 10.3389/fpsyt.2021.744709
ISSN 1664-0640
Date Added 8/23/2025, 5:38:59 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
autism, Autism Spectrum Disorder, autistic catatonia, catatonia, co-morbidities, pediatric,
prevalence, Psychiatry, review
Prevalence of co-occurring conditions in children and adults with autism
spectrum disorder: A systematic review and meta-analysis
Item Type Journal Article
Author Martina Micai
Author Laura Maria Fatta
Author Letizia Gila
Author Angela Caruso
Author Tommaso Salvitti
Author Francesca Fulceri
Author Antonio Ciaramella
Author Roberto D'Amico
Author Cinzia Del Giovane
Author Marco Bertelli
Author Giovanna Romano
Author Holger Jens Schünemann
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Author Maria Luisa Scattoni
Abstract This systematic review estimates the prevalence of co-occurring conditions
(CCs) in children and adults with autism. A comprehensive search strategy
consulting existing guidelines, diagnostic manuals, experts, carers, and autistic
people was developed. PubMed and PsycInfo databases from inception to May
2022 were searched. PROSPERO registration: CRD42019132347. Two blind
authors screened and extracted the data. Prevalence estimates for different CCs
were summarized by using random effects models. Subgroup analyses were
performed for age groups (children/adolescents vs adults) and study designs
(population/registry-based vs clinical sample-based). Of 19,932 studies, 340
publications with about 590,000 participants were included and meta-analyzed
to estimate the prevalence of 38-point prevalence, 27-lifetime, and 3 without
distinction between point and lifetime prevalence. Point prevalence of
developmental coordination disorder, sleep-wake problem, gastrointestinal
problem, ADHD, anxiety disorder, overweight/obesity, feeding and eating
disorder, elimination disorder, disruptive behavior, and somatic symptoms and
related disorder were the most frequent CCs. Prevalence differed depending on
the age group and study design. Knowing specific CCs linked to autism helps
professional investigations and interventions for improved outcomes. •Cooccurring
conditions (CCs) estimates aid focused interventions.•340 records
with about 590,000 participants were included in the systematic review.•38-
point, 27-lifetime, 3 undifferentiated CCs prevalence (psychiatric and
medical).•Prevalence differed depending on the age group and study design.
Date 2023
Language eng
Short Title Prevalence of co-occurring conditions in children and adults with autism
spectrum disorder
Library Catalog librarysearch.library.utoronto.ca
Extra Place: United States Publisher: Elsevier Ltd
Volume 155
Pages 105436-
Publication Neuroscience and biobehavioral reviews
DOI 10.1016/j.neubiorev.2023.105436
ISSN 0149-7634
Date Added 8/23/2025, 5:38:21 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
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Adolescent, Adult, Autism spectrum disorder, Autism Spectrum Disorder - epidemiology, autistic
catatonia, Autistic Disorder, catatonia, Child, Co-occurring Condition, Comorbidity, Dual
diagnosis, Frequency, Humans, Incidence, Meta-analysis, Multimorbidity, Obesity, Overweight,
Prevalence, Systematic review
Psychiatric Comorbidities in Children and Adolescents with High-
Functioning Autism Spectrum Disorder: A Study on Prevalence, Distribution
and Clinical Features in an Italian Sample
Item Type Journal Article
Author Elisa Fucà
Author Silvia Guerrera
Author Giovanni Valeri
Author Laura Casula
Author Roberta Lucia Novello
Author Deny Menghini
Author Stefano Vicari
Abstract This study investigated the prevalence and distribution of psychiatric
comorbidities in a group of 472 children and adolescents with ASD aged 3–18
years. We examined differences in age, sex, IQ, adaptive skills, and ASD
symptom severity by comparing participants with ASD (ASD group) with
participants with ASD and a psychiatric disorder (ASD/PSY group). Overall,
32.2% of participants had a comorbid psychiatric condition. Attention
deficit/hyperactivity disorder (ADHD) was the most frequent diagnosis among
preschoolers (20.4%); among school-age children, ADHD and
anxiety/obsessive-compulsive disorders were the most frequent conditions (21%
and 10.6%, respectively); finally, adolescents exhibit higher prevalence of
anxiety/obsessive-compulsive disorders (21.8%). The ASD/PSY group showed
a higher percentage of males, they were older and showed lower adaptive skills
than the group with ASD; moreover, their mothers exhibited higher stress levels
than mothers of participants in the ASD group. The comparison between age
groups in participants within ASD/PSY group revealed that preschoolers had
lower IQ than school-age children and adolescents, and worse adaptive skills,
more repetitive behaviors, and restricted interests than adolescents. This study
highlights the importance of an accurate diagnosis of psychiatric comorbidities
in children and adolescents with ASD, also considering individual and family
impairment.
Date 2023
Language eng
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Short Title Psychiatric Comorbidities in Children and Adolescents with High-Functioning
Autism Spectrum Disorder
Library Catalog librarysearch.library.utoronto.ca
Extra Place: Switzerland Publisher: MDPI AG
Volume 12
Pages 677-
Publication Journal of clinical medicine
DOI 10.3390/jcm12020677
Issue 2
ISSN 2077-0383
Date Added 8/23/2025, 5:37:46 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
Autism, autistic catatonia, catatonia, Clinical medicine, Comorbidity, Mental disorders, Teenagers
Systematic Review of Symptoms of Catatonia in Autism Spectrum Disorder
Item Type Journal Article
Author Syeda Hasan
Author Irshad Hussain
Author Laura Chadwick
Author Rachel Moir
Author Ameera Iqbal
Author Rohan Morris
Author Dipti Patil
Abstract Catatonia is a complex neuropsychiatric syndrome characterized by
disturbances in mood, motor function, behavior and speech. It is increasingly
recognized in individuals with autism spectrum disorder (ASD), although its
identification remains challenging due to the overlapping clinical features of the
two conditions. Shared characteristics, such as echophenomena, mannerisms,
social indifference and repetitive behaviors can obscure accurate diagnosis.
Although reports suggest a significant prevalence of catatonia among
individuals with ASD, the condition remains poorly understood and frequently
under recognized, leading to substantial diagnostic and treatment challenges. A
systematic review was conducted to characterize the symptoms of catatonia in
individuals with ASD. The literature search included peer-reviewed journal
articles published in English from 1980 onward, focusing on studies examining
co-occurring catatonia and ASD. A qualitative framework analysis was
implemented to evaluate 45 peer-reviewed studies, with findings interpreted in
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relation to, and extending beyond, the diagnostic criteria for catatonia outlined
in the International Classification of Diseases, 11th revision (ICD-11). The
objective was to identify symptom patterns extending beyond current diagnostic
frameworks and to support improved clinical recognition and diagnostic
precision in ASD populations. The review identified six primary symptom
clusters associated with catatonia in individuals with ASD: (1) psychomotor
activity, (2) speech disturbances, (3) changes in behavior/skills/functions, (4)
mental health symptoms, (5) physiological symptoms, and (6) symptoms related
to arousal and awareness. Notably, several symptoms observed within these
clusters are not currently included in the ICD-11 diagnostic criteria for
catatonia. These additional symptoms include tics, motor compliance,
incoherent speech, self-injury, impaired cognition, and appetite changes,
suggesting a broader clinical presentation of catatonia in ASD populations than
is presently captured in existing diagnostic frameworks. The findings of this
review highlight the significance of enhancing clinicians' awareness and
understanding of how catatonia manifests in individuals with ASD. Most
notably, six symptom clusters, psychomotor changes, speech disturbances,
behavioral and functional regression, affective and psychiatric symptoms,
physiological symptoms, and arousal/awareness disturbances, were observed.
Several symptoms identified in this review are not included in the current
diagnostic criteria, and their recognition may facilitate in earlier identification
and timely intervention, potentially preventing the severe consequences of
untreated catatonia in this population.
Date 2025-05-06
Language eng
Library Catalog PubMed
Extra PMID: 40325288
Publication Journal of Autism and Developmental Disorders
DOI 10.1007/s10803-025-06855-3
Journal Abbr J Autism Dev Disord
ISSN 1573-3432
Date Added 6/24/2025, 9:44:55 PM
Modified 8/23/2025, 5:44:28 PM
Tags:
Autism, Catatonia, Catatonia in autism spectrum disorders, Diagnosis, ICD11, Symptoms
The Development of a Pediatric Catatonia Clinical Roadmap for Clinical
Care at Vanderbilt University Medical Center
Item Type Journal Article
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Author Joshua Ryan Smith
Author Tasia York
Author Sarah Hart
Author Anuj Patel
Author Heather L. Kreth
Author Katherine Spencer
Author Karisa Bree Grizzle
Author Jo Ellen Wilson
Author Lindsay Pagano
Author Nadia Zaim
Author Catherine Fuchs
Abstract BACKGROUND: Pediatric catatonia is associated with a high degree of
morbidity and mortality in children. However, pediatric catatonia is highly
responsive to treatment if rapidly identified and appropriate interventions are
administered. To our knowledge, there are no current publications which
propose a systematic approach for the management of pediatric catatonia.
OBJECTIVE: The aim of our report was to create multidisciplinary clinical care
roadmap for catatonia in the inpatient pediatric setting within Vanderbilt
University Medical Center (VUMC). METHODS: At VUMC, we formed a
team of pediatric providers from child and adolescent psychiatry, rheumatology,
neurology, pediatric hospital medicine, and pediatric psychology. Our team met
on a regular basis over the course of 2022-2024 to review the current literature
on pediatric catatonia and develop a consensus for clinical assessment and
management. RESULTS: We determined consensus recommendations from our
VUMC multidisciplinary team for the following domains of pediatric catatonia
inpatient clinical care: initial assessment of pediatric catatonia in the inpatient
pediatric settings, medical and psychiatric work up for pediatric catatonia, the
lorazepam challenge in pediatric populations, behavioral and environmental
considerations, and the use of electroconvulsive therapy and alternative
psychopharmacologic interventions in pediatric catatonia. CONCLUSION:
Pediatric catatonia is a condition associated with a high degree of morbidity and
mortality but is responsive to treatment if diagnosed and treated early. The
inpatient pediatric medical setting provides a unique opportunity for
identification and treatment. Our clinical care roadmap provides tools for
inpatient clinicians at VUMC to identify pediatric catatonia and initiate an
evidence-based approach to medical workup, management, and clinical care.
This approach has the potential to significantly improve longitudinal outcomes
and quality of life improvements for children at VUMC with catatonia and their
families.
Date 2024
Language eng
Library Catalog PubMed
Extra PMID: 39241984
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Volume 65
Pages 570-578
Publication Journal of the Academy of Consultation-Liaison Psychiatry
DOI 10.1016/j.jaclp.2024.08.003
Issue 6
Journal Abbr J Acad Consult Liaison Psychiatry
ISSN 2667-2960
Date Added 6/24/2025, 9:37:40 PM
Modified 6/24/2025, 9:37:40 PM
Tags:
Adolescent, Catatonia, Child, Humans, Academic Medical Centers, catatonia, child psychiatry,
Consensus, consult-liaison psychiatry, diagnosis, Electroconvulsive Therapy, Lorazepam, pediatric
medicine
The Management of Children and Youth With Pediatric Mental and
Behavioral Health Emergencies
Item Type Journal Article
Author Mohsen Saidinejad
Author Susan Duffy
Author Dina Wallin
Author Jennifer A. Hoffmann
Author Madeline M. Joseph
Author Jennifer Schieferle Uhlenbrock
Author Kathleen Brown
Author Muhammad Waseem
Author Sally Snow
Author Madeline Andrew
Author Alice A. Kuo
Author Carmen Sulton
Author Thomas Chun
Author Lois K. Lee
Author Gregory P. Conners
Author James Callahan
Author Toni Gross
Author Madeline M. Joseph
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Author Lois K. Lee
Author Elizabeth Mack
Author Jennifer Marin
Author Suzan Mazor
Author Ronald Paul
Author Nathan Timm
Author Mark Cicero
Author Ann Dietrich
Author Andrew Eisenberg
Author Mary Fallat
Author Sue Tellez
Author Ann M. Dietrich
Author Kiyetta H. Alade
Author Christopher S. Amato
Author Zaza Atanelov
Author Marc Auerbach
Author Isabel A. Barata
Author Lee S. Benjamin
Author Kathleen T. Berg
Author Kathleen Brown
Author Cindy Chang
Author Jessica Chow
Author Corrie E. Chumpitazi
Author Ilene A. Claudius
Author Joshua Easter
Author Ashley Foster
Author Sean M. Fox
Author Marianne Gausche-Hill
Author Michael J. Gerardi
Author Jeffrey M. Goodloe
Author Melanie Heniff
Author James (Jim) L. Homme
Author Paul T. Ishimine
Author Susan D. John
Author Samuel Hiu-Fung Lam
Author Simone L. Lawson
Author Moon O. Lee
Author Joyce Li
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Author Sophia D. Lin
Author Dyllon Ivy Martini
Author Larry Bruce Mellick
Author Donna Mendez
Author Emory M. Petrack
Author Lauren Rice
Author Emily A. Rose
Author Timothy Ruttan
Author Mohsen Saidinejad
Author Genevieve Santillanes
Author Joelle N. Simpson
Author Shyam M. Sivasankar
Author Daniel Slubowski
Author Annalise Sorrentino
Author Michael J. Stoner
Author Carmen D. Sulton
Author Jonathan H. Valente
Author Samreen Vora
Author Jessica J. Wall
Author Dina Wallin
Author Theresa A. Walls
Author Muhammad Waseem
Author Dale P. Woolridge
Author Sam Shahid
Author Roberta Miller
Author Elyssa Wood
Author Tasha Lowery
Author Julie Cohen
Author Rebecca VanStanton
Author Lisa Hill
Author Elizabeth Stone
Author Domenique Johnson
Abstract Mental and behavioral health (MBH) visits of children and youth to emergency
departments are increasing in the United States. Reasons for these visits range
from suicidal ideation, self-harm, and eating and substance use disorders to
behavioral outbursts, aggression, and psychosis. Despite the increase in
prevalence of these conditions, the capacity of the health care system to screen,
diagnose, and manage these patients continues to decline. Several social
determinants also contribute to great disparities in child and adolescent (youth)
health, which affect MBH outcomes. In addition, resources and space for
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emergency physicians, physician assistants, nurse practitioners, and prehospital
practitioners to manage these patients remain limited and inconsistent
throughout the United States, as is financial compensation and payment for such
services. This technical report discusses the role of physicians, physician
assistants, and nurse practitioners, and provides guidance for the management
of acute MBH emergencies in children and youth. Unintentional ingestions and
substance use disorder are not within the scope of this report and are not
specifically discussed.
Date 2023
Language eng
Library Catalog librarysearch.library.utoronto.ca
Volume 152
Publication Pediatrics (Evanston)
DOI 10.1542/peds.2023-063256
Issue 3
ISSN 0031-4005
Date Added 8/23/2025, 5:21:14 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
autistic catatonia, catatonia
The Triad of Childhood-Onset Schizophrenia, Autism Spectrum Disorder,
and Catatonia: A Case Report
Item Type Journal Article
Author Alison C. Leslie
Author Michael O’Sullivan
Abstract Abstract Childhood-onset schizophrenia (COS) is a rare and severe form of
schizophrenia with an estimated prevalence of 1/10,000. Schizophrenia and
Autism spectrum disorder (ASD) have shared phenotypic features and shared
genetic etiology. There is growing research surrounding the co-occurrence of
psychomotor syndromes like catatonia with neurodevelopmental disorders like
ASD or psychiatric disorders like schizophrenia. In 2013, Shorter and Wachtel
described a phenomenon of the ‘Iron Triangle’ where COS, ASD, and catatonia
often co-occur. The Iron Triangle theory is based on observation of historical
case literature, which showed that all three diagnoses in the Iron Triangle were
routinely assigned to children and adolescents. The pattern of this “Iron
Triangle” suggests there may be a single underlying pathology resulting in a
unique mixed form of catatonia, autism, and psychosis. We describe the case of
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a boy with sequential development of COS, ASD, and catatonia who also has
syndromic facial and musculoskeletal features. This case highlights overlapping
diagnostic features of these three disorders and can help us better understand
how “hidden” features of catatonia may occur in patients with COS or ASD but
go unrecognized, because they are grouped as features under
autism/schizophrenia rather than a distinct diagnosis of catatonia. Further study
is warranted to elucidate if this phenotypic pattern constitutes a new single
diagnosis that is not well understood, an endophenotype of schizophrenia, or if
this is the result of phenomenological overlap between catatonia, ASD, and
COS.
Date 2023
Language eng
Short Title The Triad of Childhood-Onset Schizophrenia, Autism Spectrum Disorder, and
Catatonia
Library Catalog librarysearch.library.utoronto.ca
Extra Place: US Publisher: Oxford University Press
Volume 49
Pages 239–243
Publication Schizophrenia bulletin
DOI 10.1093/schbul/sbac200
Issue 2
ISSN 0586-7614
Date Added 8/23/2025, 5:39:29 PM
Modified 8/23/2025, 5:46:14 PM
Tags:
Adolescent, Autism, Autism Spectrum Disorder - complications, Autism Spectrum Disorder -
genetics, autistic catatonia, Case Report, catatonia, Catatonia, Catatonia - diagnosis, Child, Humans,
Iron, Male, Schizophrenia, Schizophrenia - epidemiology, Schizophrenia, Childhood
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