{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T10:56:08Z","timestamp":1776164168893,"version":"3.50.1"},"posted":{"date-parts":[[2024,9,6]]},"group-title":"Psychiatry and Clinical Psychology","reference-count":70,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,9,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Catatonia is a highly morbid psychomotor and affective disorder which can affect autistic individuals with and without profound impairment. Catatonic symptoms are treatable with pharmacotherapy and electroconvulsive therapy, but the longitudinal effectiveness of these treatments has not been described.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    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\n                    <jats:sup>st<\/jats:sup>\n                    , 2021 to May 31\n                    <jats:sup>st<\/jats:sup>\n                    , 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 \u2013 Improvement (CGI-I) were collected.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Forty-five patients were identified with 39 (86.7%) meeting criteria for profound autism. All patients received pharmacotherapy. 44 (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. Fourteen patients (31.1%) attempted to taper off benzodiazepines 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 symptomatic over the study period.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Lay Summary<\/jats:title>\n                  <jats:p>Catatonia is a condition which can significantly impact the quality of life for autistic individuals with and without profound impairment. Symptoms of catatonia such as aggression and self-injury can improve with treatment. However, over the three-year period of this study, most patients experienced residual symptoms, and few could discontinue psychotropic medication.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2024.09.05.24312724","type":"posted-content","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T13:40:53Z","timestamp":1725630053000},"source":"Crossref","is-referenced-by-count":5,"title":["Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism with and without Profound Impairment: An Observational Study"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7008-165X","authenticated-orcid":false,"given":"Joshua Ryan","family":"Smith","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0716-0695","authenticated-orcid":false,"given":"Seri","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8865-4249","authenticated-orcid":false,"given":"Snehal","family":"Bindra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8663-357X","authenticated-orcid":false,"given":"Sarah","family":"Marler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bavani","family":"Rajah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7646-423X","authenticated-orcid":false,"given":"Zachary J.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-0836","authenticated-orcid":false,"given":"Isaac","family":"Baldwin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nausheen","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo Ellen","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1387-4092","authenticated-orcid":false,"given":"D. Catherine","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1606-3917","authenticated-orcid":false,"given":"James","family":"Luccarelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2024090903350567000_2024.09.05.24312724v1.1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"2024090903350567000_2024.09.05.24312724v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01541-5"},{"key":"2024090903350567000_2024.09.05.24312724v1.3","doi-asserted-by":"publisher","DOI":"10.3390\/educsci13020106"},{"key":"2024090903350567000_2024.09.05.24312724v1.4","doi-asserted-by":"publisher","DOI":"10.1002\/aur.3201"},{"key":"2024090903350567000_2024.09.05.24312724v1.5","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-020-04402-w"},{"key":"2024090903350567000_2024.09.05.24312724v1.6","doi-asserted-by":"publisher","DOI":"10.1177\/00333549231163551"},{"key":"2024090903350567000_2024.09.05.24312724v1.7","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2020.135"},{"key":"2024090903350567000_2024.09.05.24312724v1.8","doi-asserted-by":"publisher","DOI":"10.1186\/s13229-015-0054-8"},{"key":"2024090903350567000_2024.09.05.24312724v1.9","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-024-06451-x"},{"key":"2024090903350567000_2024.09.05.24312724v1.10","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2021.2259"},{"key":"2024090903350567000_2024.09.05.24312724v1.11","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2022.0067"},{"key":"2024090903350567000_2024.09.05.24312724v1.12","doi-asserted-by":"publisher","DOI":"10.1177\/02698811231158232"},{"key":"2024090903350567000_2024.09.05.24312724v1.13","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2024.61"},{"key":"2024090903350567000_2024.09.05.24312724v1.14","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-024-00534-w"},{"key":"2024090903350567000_2024.09.05.24312724v1.15","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0000000000000393"},{"key":"2024090903350567000_2024.09.05.24312724v1.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2034954"},{"key":"2024090903350567000_2024.09.05.24312724v1.17","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-022-05868-6"},{"key":"2024090903350567000_2024.09.05.24312724v1.18","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000000993"},{"key":"2024090903350567000_2024.09.05.24312724v1.19","doi-asserted-by":"publisher","DOI":"10.1101\/2024.06.06.24308554"},{"key":"2024090903350567000_2024.09.05.24312724v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2023.12.019"},{"key":"2024090903350567000_2024.09.05.24312724v1.21","doi-asserted-by":"publisher","DOI":"10.3389\/frcha.2023.1208926"},{"key":"2024090903350567000_2024.09.05.24312724v1.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2017.06.011"},{"key":"2024090903350567000_2024.09.05.24312724v1.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"2024090903350567000_2024.09.05.24312724v1.24","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000001020"},{"key":"2024090903350567000_2024.09.05.24312724v1.25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1996.tb09814.x"},{"issue":"12","key":"2024090903350567000_2024.09.05.24312724v1.26","first-page":"42","article-title":"Katatonia","volume":"5","year":"2008","journal-title":"Psychiatry Edgmont"},{"key":"2024090903350567000_2024.09.05.24312724v1.27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1996.tb09814.x"},{"key":"2024090903350567000_2024.09.05.24312724v1.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaclp.2022.07.002"},{"issue":"7","key":"2024090903350567000_2024.09.05.24312724v1.29","first-page":"28","article-title":"The Clinical Global Impressions Scale","volume":"4","year":"2007","journal-title":"Psychiatry Edgmont"},{"key":"2024090903350567000_2024.09.05.24312724v1.30","unstructured":"Benzodiazepine Conversion Calculator. MDCalc. Accessed August 20, 2024. https:\/\/www.mdcalc.com\/calc\/10091\/benzodiazepine-conversion-calculator"},{"key":"2024090903350567000_2024.09.05.24312724v1.31","unstructured":"Benzodiazepine Equivalents Conversion Calculator - ClinCalc.com. Accessed August 20, 2024. https:\/\/clincalc.com\/Benzodiazepine\/"},{"key":"2024090903350567000_2024.09.05.24312724v1.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaclp.2022.07.002"},{"key":"2024090903350567000_2024.09.05.24312724v1.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2022.12.019"},{"key":"2024090903350567000_2024.09.05.24312724v1.34","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v067.i01"},{"key":"2024090903350567000_2024.09.05.24312724v1.35","doi-asserted-by":"publisher","DOI":"10.1177\/2515245918823199"},{"key":"2024090903350567000_2024.09.05.24312724v1.36","unstructured":"Christensen RHB . ordinal: Regression Models for Ordinal Data. Published online August 19, 2024. Accessed August 20, 2024. https:\/\/cran.r-project.org\/web\/packages\/ordinal\/index.html"},{"key":"2024090903350567000_2024.09.05.24312724v1.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2022.09.021"},{"key":"2024090903350567000_2024.09.05.24312724v1.38","doi-asserted-by":"publisher","DOI":"10.1080\/17512433.2023.2243820"},{"key":"2024090903350567000_2024.09.05.24312724v1.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2009.04.021"},{"key":"2024090903350567000_2024.09.05.24312724v1.40","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.114.160192"},{"key":"2024090903350567000_2024.09.05.24312724v1.41","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13744"},{"key":"2024090903350567000_2024.09.05.24312724v1.42","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.176.4.357"},{"key":"2024090903350567000_2024.09.05.24312724v1.43","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12980"},{"key":"2024090903350567000_2024.09.05.24312724v1.44","doi-asserted-by":"publisher","DOI":"10.1016\/S0074-7742(05)72002-X"},{"key":"2024090903350567000_2024.09.05.24312724v1.45","doi-asserted-by":"publisher","DOI":"10.1016\/S0074-7742(05)72003-1"},{"key":"2024090903350567000_2024.09.05.24312724v1.46","unstructured":"Shah A. Catatonia, Shutdown and Breakdown in Autism: A Psycho-Ecological Approach . Jessica Kingsley Publishers; 2019."},{"key":"2024090903350567000_2024.09.05.24312724v1.47","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00508"},{"key":"2024090903350567000_2024.09.05.24312724v1.48","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2018.03.020"},{"key":"2024090903350567000_2024.09.05.24312724v1.49","doi-asserted-by":"publisher","DOI":"10.1038\/s44184-022-00012-9"},{"key":"2024090903350567000_2024.09.05.24312724v1.50","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.63379"},{"key":"2024090903350567000_2024.09.05.24312724v1.51","unstructured":"Fink M , Taylor MA . Catatonia: A Clinician\u2019s Guide to Diagnosis and Treatment . Cambridge University Press; 2006."},{"key":"2024090903350567000_2024.09.05.24312724v1.52","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2011.01779.x"},{"key":"2024090903350567000_2024.09.05.24312724v1.53","doi-asserted-by":"publisher","DOI":"10.1002\/aur.2898"},{"key":"2024090903350567000_2024.09.05.24312724v1.54","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-018-3844-y"},{"key":"2024090903350567000_2024.09.05.24312724v1.55","doi-asserted-by":"publisher","DOI":"10.1515\/sjpain-2019-0160"},{"issue":"2","key":"2024090903350567000_2024.09.05.24312724v1.56","first-page":"214","article-title":"Benzodiazepine Pharmacology and Central Nervous System\u2013Mediated Effects","volume":"13","year":"2013","journal-title":"Ochsner J"},{"key":"2024090903350567000_2024.09.05.24312724v1.57","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci10070423"},{"key":"2024090903350567000_2024.09.05.24312724v1.58","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-014-1216-0"},{"key":"2024090903350567000_2024.09.05.24312724v1.59","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-022-09564-1"},{"key":"2024090903350567000_2024.09.05.24312724v1.60","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000784"},{"key":"2024090903350567000_2024.09.05.24312724v1.61","doi-asserted-by":"publisher","DOI":"10.1186\/s13229-022-00498-2"},{"key":"2024090903350567000_2024.09.05.24312724v1.62","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(18)30474-7"},{"key":"2024090903350567000_2024.09.05.24312724v1.63","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2022.07.850"},{"key":"2024090903350567000_2024.09.05.24312724v1.64","doi-asserted-by":"publisher","DOI":"10.1177\/08850666221114303"},{"key":"2024090903350567000_2024.09.05.24312724v1.65","doi-asserted-by":"publisher","DOI":"10.1097\/HRP.0000000000000381"},{"key":"2024090903350567000_2024.09.05.24312724v1.66","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2024.07.004"},{"key":"2024090903350567000_2024.09.05.24312724v1.67","doi-asserted-by":"publisher","DOI":"10.1177\/0004867420968915"},{"key":"2024090903350567000_2024.09.05.24312724v1.68","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2022.01.038"},{"key":"2024090903350567000_2024.09.05.24312724v1.69","doi-asserted-by":"publisher","DOI":"10.5080\/u27064"},{"key":"2024090903350567000_2024.09.05.24312724v1.70","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2014.12.036"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2024.09.05.24312724","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T20:11:11Z","timestamp":1768507871000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2024.09.05.24312724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,6]]},"references-count":70,"URL":"https:\/\/doi.org\/10.1101\/2024.09.05.24312724","relation":{},"subject":[],"published":{"date-parts":[[2024,9,6]]},"subtype":"preprint"}}