Catatonia in Autism: A Case Study

Background: Catatonia is being increasingly reported in individuals with autism. Despite the relative increase in the number of published reports in coexistence of autism and catatonia, still there is a lack of awareness on comorbidity of these two important clinical entities.

Objectives: In this case study we presented clinical features and treatment of a pediatric case with autism and catatonia. Methods: Case: An 11 year-old boy with autism referred to our out-patient unit by his mother due to mutism, slowness in his movements, posturing, toilet refusal because of his immobility and loss of appetite.  During his psychiatric evaluation, he was mute, had no interest in surrounding, had no response to questions, showed posturing and waxy flexibility. After clinical evaluation, the diagnosis of autistic disorder was confirmed and he also received additional diagnosis of catatonia. He was given Lorazepam 1 mg / day to test the response. The symptoms of catatonia resolved dramatically within hours; his movements increased and he started talking to his mother and the other people around him. He began to go to toilet and his sleeplessness during this period ameliorated. Therefore, we continued with lorazepam in a dose of 1mg/d. In addition, reviewing his family history proved the presence of depression in his mother. He also had lost his father when he was 8. The bereavement caused him have some crying spells which continued till catatonic symptoms.

Results: The pediatric case with autism represented catatonic symptoms and was treated with Lorazepam successfully. Conclusions: The case reported here shows some differences from previous reported cases in terms of age of onset and showing all characteristics of catatonia as defined in DSM-IV. In addition although it was stated that catatonia in this group is commonly associated with impaired language and social passivity, our case was an active verbal autistic.  Moreover it seems that lack of awareness of mental health professionals about life events such as bereavement in autistic individuals have a deep negative influence in their quality of life. Lack of enough support and appropriate treatment for treatable disorders such grief reaction and depression may contribute to life threatening conditions such as catatonia.