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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\u2010morbid 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\u2014Improvement (CGI\u2010I) were collected. Forty\u2010five autistic patients with co\u2010morbid catatonia were treated during the study period. The mean age was 15.6 (SD\u2009=\u20097.9) years [Mdn\u2009=\u200916.0, range 6.0\u201331.0]. Forty\u2010one patients (91.1%) met criteria for autism with co\u2010occurring intellectual disability. All patients received pharmacotherapy. Forty\u2010four (97.8%) were treated with benzodiazepines with a mean maximal daily dose of 17.4\u2009mg (SD\u2009=\u200915.8) lorazepam equivalents. Thirty\u2010five 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.<\/jats:p>","DOI":"10.1002\/aur.3315","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T04:13:27Z","timestamp":1737951207000},"page":"449-462","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism With Intellectual Disability: An Observational Study"],"prefix":"10.1002","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7008-165X","authenticated-orcid":false,"given":"Joshua Ryan","family":"Smith","sequence":"first","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center at Village of Vanderbilt  Nashville Tennessee USA"},{"name":"Vanderbilt Kennedy Center Vanderbilt University  Nashville Tennessee USA"},{"name":"Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0716-0695","authenticated-orcid":false,"given":"Seri","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center at Village of Vanderbilt  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8865-4249","authenticated-orcid":false,"given":"Snehal","family":"Bindra","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Marler","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center at Village of Vanderbilt  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bavani","family":"Rajah","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center at Village of Vanderbilt  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7646-423X","authenticated-orcid":false,"given":"Zachary J.","family":"Williams","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-0836","authenticated-orcid":false,"given":"Isaac","family":"Baldwin","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center at Village of Vanderbilt  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nausheen","family":"Hossain","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center at Village of Vanderbilt  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2565-8012","authenticated-orcid":false,"given":"Jo Ellen","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Critical Illness, Brain Dysfunction and Survivorship Center, Center for Health Services Research  Nashville Tennessee USA"},{"name":"Geriatric Research, Education, and Clinical Center Service Veterans Affairs Tennessee Valley Healthcare System  Nashville Tennessee USA"},{"name":"Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1387-4092","authenticated-orcid":false,"given":"D. Catherine","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center at Village of Vanderbilt  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1606-3917","authenticated-orcid":false,"given":"James","family":"Luccarelli","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Psychiatry Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v067.i01"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2017.06.011"},{"key":"e_1_2_10_5_1","unstructured":"Benzodiazepine Conversion Calculator. n.d.\u201cMDCalc.\u201dAugust 20 2024.https:\/\/www.mdcalc.com\/calc\/10091\/benzodiazepine\u2010conversion\u2010calculator."},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00508"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/2515245918823199"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100447.1996.tb09814.x"},{"issue":"7","key":"e_1_2_10_9_1","first-page":"28","article-title":"The Clinical Global Impressions Scale","volume":"4","author":"Busner J.","year":"2007","journal-title":"Psychiatry (Edgmont)"},{"issue":"12","key":"e_1_2_10_10_1","first-page":"42","article-title":"Katatonia","volume":"5","author":"Carroll B. 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