Smith Joshua Ryan, Lim Seri, Bindra Snehal, Marler Sarah, Rajah Bavani, Williams Zachary J, Baldwin Isaac, Hossain Nausheen, Wilson Jo Ellen, Fuchs D Catherine, Luccarelli James
Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, Nashville, Tennessee, USA.
Vanderbilt Kennedy Center, Vanderbilt University, Nashville, Tennessee, USA.
Autism Res. 2025 Feb;18(2):449-462. doi: 10.1002/aur.3315. Epub 2025 Jan 27.
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 taper and discontinue benzodiazepine treatment. Notably, the open label design of this study is a limiting factor when interpreting the results.
紧张症是一种高度病态的精神运动和情感障碍，可影响有无智力障碍的自闭症个体。紧张症症状可用药物治疗和电休克治疗，但这些治疗方法对自闭症个体的长期有效性尚未得到描述。我们对2021年7月1日至2024年5月31日在一家专门门诊接受门诊治疗的自闭症合并紧张症患者进行了一项前瞻性观察队列研究。收集了调查药物干预的数据以及包括布什-弗朗西斯紧张症评定量表（BFCRS）、坎纳紧张症严重程度量表（KCS）、坎纳紧张症检查（KCE）和临床总体印象改善量表（CGI-I）在内的临床测量数据。在研究期间，对45名自闭症合并紧张症患者进行了治疗。平均年龄为15.6（标准差=7.9）岁[中位数=16.0，范围6.0-31.0]。41名患者（91.1%）符合自闭症合并智力障碍的标准。所有患者均接受了药物治疗。44名（97.8%）患者接受了苯二氮䓬类药物治疗，平均最大日剂量为17.4毫克（标准差=15.8）劳拉西泮等效剂量。35名患者（77.8%）需要不止一类药物进行治疗。16名（35.6%）患者接受了电休克治疗。14名患者（31.1%）在研究期间临床改善后试图逐渐减少苯二氮䓬类药物的用量；其中，5名患者（11.1%）成功减量，其余9名（17.8%）因紧张症症状复发而停止减量。除KCS外，所有临床领域均观察到统计学上的显著改善。然而，在研究期间，大多数患者仍至少有部分症状。3名患者（6.7%）在研究期间死亡。尽管在接受紧张症精神药物管理的金标准治疗时临床症状有所改善，但在研究期间，大多数紧张症患者仍有慢性症状，很少有人能够逐渐减少并停止苯二氮䓬类药物治疗。值得注意的是，本研究的开放标签设计在解释结果时是一个限制因素。
