Rethinking Catatonia: New Insights from the Autism Spectrum

Abstract

Initially conceptualized as a subtype of schizophrenia, catatonia has progressively been recognized to occur in a broad variety of conditions, as a kind of final common pathway for many severe men-tal disorders. There is a significant overlap between the fundamental symptoms of Autism Spectrum Disorder (ASD) and catatonia, and ASD can frequently complicate with catatonic states. While provocative, the hypothesis that neuroatypicality may represent the submerged structural piece un-derlying catatonic states is intriguing. Yet, the multifaced relationship between catatonia and ASD may provide new insights in the etiology and treatment of both disorders.

Investigating the relationship between autistic traits and symptoms and Catatonia Spectrum

“…Numerous clinical features are shared by ASD and catatonia, such as mutism and echolalia, stereotyped movements and repetitive behaviors, and negativism and arousal. This clinical overlap could be responsible, on one hand, for a propensity to overestimate subthreshold catatonia among autistic subjects and, on the other, for a failure to recognize catatonic symptoms that first appear in patients with ASD [ 11 ]. Indeed, although anecdotal, previous descriptions have indicated that catatonia may slowly develop over the course of autism, often preceded by isolated manifestations and a slow deterioration in functioning, until it assumes a chronic character [ 12 ].…”

Rumination and altered reactivity to sensory input as vulnerability factors for developing post-traumatic stress symptoms among adults with autistic traits

“…22,31,42,57,58,62,63 In particular, the presence of AT, which results in reduced coping strategies and difficulties in processing stressful experiences, may lead to an increased vulnerability to a wide range of trauma or stress-related symptom. 22,42,44,57,58,61,63 Considering that subjects with AT may have difficulties also in emotional expression and impairment in peer relationships, the lack of ability to request and obtain social support may enhance the negative impact of the stressors. 22,29,39,42,57,58,61,63 Noticeably, the autism spectrum group reported higher scores also on TALS domain, investigating the wide spectrum of loss events and potentially traumatic events.…”

“…22,42,44,57,58,61,63 Considering that subjects with AT may have difficulties also in emotional expression and impairment in peer relationships, the lack of ability to request and obtain social support may enhance the negative impact of the stressors. 22,29,39,42,57,58,61,63 Noticeably, the autism spectrum group reported higher scores also on TALS domain, investigating the wide spectrum of loss events and potentially traumatic events. These domains do not assess only major traumatic or loss events but also minor ones for which the subject experienced distress (such as changes in home or school, school or work failures, etc.).…”

“…Finally, it is important to underline that, according to our vision, PTSD would not represent the end point of the disease pathway but the first step of a psychopathology trajectory that, starting from a neurodevelopmental impairment, may evolve toward mood disorders and catatonia, another condition often associated with both autism spectrum and PTSD. 42,[61][62][63] Our main hypothesis is that there is a correlation between elevated AT and post-traumatic stress symptoms and that, in this relationship, some symptom domains of autism, such as ruminative thinking and altered responsiveness to sensory stimuli, may play an important role.…”

“…Furthermore, the authors suggested that traumatic experiences and the subsequent development of PTSD-like symptoms may on the development of mood condition. Finally, it is important to underline that, according to our vision, PTSD would not represent the end point of the disease pathway but the first step of a psychopathology trajectory that, starting from a neurodevelopmental impairment, may evolve toward mood disorders and catatonia, another condition often associated with both autism spectrum and PTSD 42 , 61 – 63 …”