Catatonia in individuals with Autism Spectrum Disorder and intellectual disability: a discussion of four cases
| Date | 21 August 2019 |
| Pages | 182-193 |
| Published date | 21 August 2019 |
| DOI | https://doi.org/10.1108/AMHID-07-2018-0034 |
| Author | Huw Morgan Dunstall,Catherine Walton,Lance Vincent Watkins,Andrew Bhasker Isaac,Mohamed El Tahir |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Catatonia in individuals with
Autism Spectrum Disorder and
intellectual disability: a discussion
of four cases
Huw Morgan Dunstall, Catherine Walton, Lance Vincent Watkins, Andrew Bhasker Isaac and
Mohamed El Tahir
Abstract
Purpose –Catatonia is increasingly recognised as a comorbid syndrome of Autism Spectrum Disorder
(ASDs). The assessment and management of individuals with comorbid ASD and intellectual disability (ID)
adds a further dimension to this already complex presentation, with few cases identified in the literature. The
paper aims to discuss these issues.
Design/methodology/approach –This paper presents four cases of catatonia in individuals with comorbid
ASD and ID. The diagnostic challenges, response to treatment and prognosis are discussed whilst
comparing with the existing literature.
Findings –A high index of suspicion is required to recognise the subtle catatonic features seen in patients
with ASD and ID. Clinicians should be particularly vigilant following stressful events in young adults. The
assessment of catatonia in ASDs and ID requires a pragmatic approach given the lack of suitable diagnostic
tools and difficulties completing investigations. Caution is advised when using rating scales as they are not
validated in ID. The mainstay of treatment is lorazepam, although responses vary.
Originality/value –The discussion of these four cases strengthens the existing literature, and highlights the
implications a comorbid diagnosis of ID has on the assessment and management of catatonia in ASDs.
Keywords Intellectual disability, Diagnosis, Treatment, Autism Spectrum Disorder, Case report, Catatonia
Paper type Case study
Introduction
Catatoniais a psychomotor syndrome characterised by rigidity,posturing, mutism, stereotypyand
echophenomena. Catatonia is increasingly recognised as a comorbid syndrome of Autism
Spectrum Disorder (ASDs). Two systematic studies using the same diagnostic criteria reported
the prevalence of catatonia in community patients with ASD as 12 per cent (n¼506, age
range ¼15–50 years; Wing and Shah,2000) and 17 per cent (n¼120, age range ¼17–40 years;
Billstedt et al., 2005). Prevalence estimates within the general population are limited to inpatient
settings, where one would expect more psychopathology. These range from 8 to 15 per cent
(Rosebush et al., 1990;Bush et al.,1996;Leeet al., 2000; Ungvari et al.,2001). The assessment
and management of individuals with comorbid ASD and intellectual disability (ID) add a further
dimension to this already complex presentation, with few cases identified in the literature.
This paper presents four cases of catatonia in individuals with ASD presenting to their local ID
Community Support Teams in South Wales. The aim is to discuss the diagnostic challenges,
response to treatment and prognosis, whilst comparing with the existing literature. All names
have been changed and patient identifiable information has been omitted in order to
maintain confidentiality.
Received 12 July 2018
Revised 4 February 2019
Accepted 5 April 2019
Huw Morgan Dunstall,
Catherine Walton, Lance
Vincent Watkins, Andrew
Bhasker Isaac and
Mohamed El Tahir are all based
at the Department of Intellectual
Disability Psychiatry, Swansea
Bay University Health Board,
Bridgend, UK.
PAGE182
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ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
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VOL. 13 NO. 5 2019, pp.182-193, © Emerald Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-07-2018-0034
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