Burns Nora Kathleen, Grissett Kathleen, Macaluso Marc, Raza Mohsin, Gracious Barbara
GME Psychiatry, Orange Park Medical Center, Orange Park, FL, United States.
Front Psychiatry. 2021 May 11;12:674335. doi: 10.3389/fpsyt.2021.674335. eCollection 2021.
Autistic catatonia is an under-recognized debilitating syndrome with long-lasting negative effects for families, healthcare workers, and high-cost to the healthcare system. In this report, we describe two cases of excited catatonia in young men diagnosed with autism. Both endured a delay to diagnosis and difficulty to obtain appropriate treatment. Each patient had a change in behavior from their baseline but with differences in severity and onset. The diagnosis in the first patient was made after only 3 months as the change was dramatic and sudden. Yet, despite a confirmed diagnosis, it was difficult to treat as the importance of M-ECT was not recognized by the clinicians. The second patient had been suffering for more than 5 years with a slow progression of worsening aggressive symptoms. The aggression was so uncontrollable that the patient required sedation, intubation and daily ECT. Both suffered from agitation, unprovoked aggression, urinary incontinence, stereotypic, and OCD behaviors and compulsive masturbation. Both patients were diagnosed with autism, one high-functioning, attending high school and working a part-time job, the second low-functioning, nearly non-verbal, isolated to home and ABA school. The first patient's diagnosis of catatonia was only suspected after five psychiatric admissions and more than 20 medication trials. Lorazepam challenge was effective, he was treated with a short series of ECT but each time the treatments were tapered, the aggression returned. Ultimately, stabilized on weekly ECT. The second patient's behavior was escalating over a 5 month period, to the point, the aggression was uncontrollable. He presented to the ED under involuntary hold and the behavior could not be stabilized to the point that emergent ECT was initiated. Two cases of autistic catatonia diagnosed and treated within a year time span at a small community hospital indicates that this diagnosis is more common than previously recognized. We propose screening all patients with neurodevelopmental disorders with the Bush-Francis and Kanner scales to diagnose and treat them appropriately.
自闭症性紧张症是一种未得到充分认识的致残综合征，对家庭、医护人员具有长期负面影响，且给医疗系统带来高昂成本。在本报告中，我们描述了两名被诊断为自闭症的年轻男性的激越性紧张症病例。两人都经历了诊断延误和难以获得适当治疗的情况。每位患者的行为都与其基线水平有所变化，但在严重程度和发作方面存在差异。第一名患者在仅3个月后就被确诊，因为变化剧烈且突然。然而，尽管确诊了，但由于临床医生未认识到改良电休克治疗（M-ECT）的重要性，治疗起来很困难。第二名患者已经患病5年多，攻击症状逐渐加重。攻击行为如此难以控制，以至于患者需要镇静、插管和每日进行电休克治疗。两人都有激动、无端攻击、尿失禁、刻板行为、强迫行为和强迫性自慰。两名患者均被诊断为自闭症，一名为高功能，正在上高中并做兼职工作，另一名为低功能，几乎无法言语，居家和接受应用行为分析（ABA）学校教育。第一名患者在五次精神科住院和二十多次药物试验后才怀疑患有紧张症。劳拉西泮激发试验有效，他接受了短期的电休克治疗系列，但每次治疗逐渐减少时，攻击行为又会复发。最终，通过每周进行电休克治疗得以稳定。第二名患者的行为在5个月内不断升级，到了攻击行为无法控制的程度。他在非自愿约束下被送往急诊室，其行为无法稳定到需要紧急进行电休克治疗的程度。在一家小型社区医院一年内诊断和治疗的两例自闭症性紧张症病例表明，这种诊断比以前认为的更为常见。我们建议用布什-弗朗西斯量表和坎纳量表对所有神经发育障碍患者进行筛查，以便进行适当的诊断和治疗。
