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Maintenance Electroconvulsive Therapy for Aggression and Self-Injurious Behavior in Two Adolescents With Autism and Catatonia
Aazaz U. Haq, M.D.; Neera Ghaziuddin, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:64-72. doi:10.1176/appi.neuropsych.12110284
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From the Dept. of Psychiatry, University of Michigan Hospitals and Health Systems, Ann Arbor, MI.

Send correspondence to Dr. Ghaziuddin; e-mail neerag@med.umich.edu

Copyright © 2014 by the American Psychiatric Association

Received November 21, 2012; Revised January 29, 2013; Accepted February 12, 2013.

Abstract

Frequent aggression toward others and repetitive self-injurious behaviors (SIB) can be features of catatonia in patients with autism. Similar to catatonia secondary to other etiologies, catatonia associated with autism responds well to treatment with benzodiazepines and/or electroconvulsive therapy (ECT). The authors report here on two adolescent patients with autism who presented with severe aggression, one of whom also engaged in repetitive SIB. With ongoing treatment with maintenance ECT, dramatic reduction in aggression and SIB were noted, allowing both patients a reasonable quality of life in their own homes. Attempts to taper off ECT coincided with return of aggression symptoms, although not SIB.

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FIGURE 1. Number of Electroconvulsive Therapy (ECT) Treatments and Episodes of Aggression per Month for “Patient CE”

Month 1 indicates when the patient was first admitted to the hospital. An episode of aggression was defined as any incidence of spontaneously biting, hitting, kicking, punching, or throwing objects across the room.

aAsterisks represent data-points that are estimated because of lack of exact data.

FIGURE 2. Number of Electroconvulsive Therapy (ECT) Treatments and Episodes of Aggression per Month for “Patient DS”

Month 1 indicates when the patient was first admitted to the hospital. An episode of aggression was defined as any incidence of spontaneously biting, hitting, kicking, punching, or throwing objects across the room.

aAsterisks represent data-points that are estimated because of lack of exact data.

Anchor for Jump
TABLE 1.Medication Trials for Patient “CE”
Table Footer Note

Month 1 indicates when the patient was first admitted to the hospital.

Anchor for Jump
TABLE 2.Medication Trials for Patient “DS”
Table Footer Note

Month 1 indicates when the patient was first admitted to the hospital.

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References

Taylor  MA;  Fink  M:  Catatonia in psychiatric classification: a home of its own.  Am J Psychiatry 2003; 160:1233–1241
[CrossRef] | [PubMed]
 
Francis  A:  Catatonia: diagnosis, classification, and treatment.  Curr Psychiatry Rep 2010; 12:180–185
[CrossRef] | [PubMed]
 
Ghaziuddin  M;  Quinlan  P;  Ghaziuddin  N:  Catatonia in autism: a distinct subtype? J Intellect Disabil Res 2005; 49:102–105
[CrossRef] | [PubMed]
 
Wing  L;  Shah  A:  Catatonia in autistic spectrum disorders.  Br J Psychiatry 2000; 176:357–362
[CrossRef] | [PubMed]
 
Billstedt  E;  Gillberg  IC;  Gillberg  C:  Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood.  J Autism Dev Disord 2005; 35:351–360
[CrossRef] | [PubMed]
 
Ghaziuddin  N;  Dhossche  D;  Marcotte  K:  Retrospective chart review of catatonia in child and adolescent psychiatric patients.  Acta Psychiatr Scand 2012; 125:33–38
[CrossRef] | [PubMed]
 
Wachtel  LE;  Dhossche  DM:  Self-injury in autism as an alternate sign of catatonia: implications for electroconvulsive therapy.  Med Hypotheses 2010; 75:111–114
[CrossRef] | [PubMed]
 
Dhossche  DM;  Carroll  BT;  Carroll  TD:  Is there a common neuronal basis for autism and catatonia? Int Rev Neurobiol 2006; 72:151–164
[PubMed]
 
Dhossche  DM;  Rout  U:  Are autistic and catatonic regression related? a few working hypotheses involving GABA, Purkinje cell survival, neurogenesis, and ECT.  Int Rev Neurobiol 2006; 72:55–79
[PubMed]
 
Zaw  FK;  Bates  GD;  Murali  V  et al:  Catatonia, autism, and ECT.  Dev Med Child Neurol 1999; 41:843–845
[CrossRef] | [PubMed]
 
Fink  M;  Taylor  MA;  Ghaziuddin  N:  Catatonia in autistic spectrum disorders: a medical treatment algorithm.  Int Rev Neurobiol 2006; 72:233–244
[PubMed]
 
Bailine  SH;  Petraviciute  S:  Catatonia in autistic twins: role of electroconvulsive therapy.  J ECT 2007; 23:21–22
[CrossRef] | [PubMed]
 
Wachtel  LE;  Kahng  S;  Dhossche  DM  et al:  ECT for catatonia in an autistic girl.  Am J Psychiatry 2008; 165:329–333
[CrossRef] | [PubMed]
 
Wachtel  LE;  Contrucci-Kuhn  SA;  Griffin  M  et al:  ECT for self-injury in an autistic boy.  Eur Child Adolesc Psychiatry 2009; 18:458–463
[CrossRef] | [PubMed]
 
Wachtel  LE;  Griffin  M;  Reti  IM:  Electroconvulsive therapy in a man with autism experiencing severe depression, catatonia, and self-injury.  J ECT 2010; 26:70–73
[CrossRef] | [PubMed]
 
Wachtel  LE;  Jaffe  R;  Kellner  CH:  Electroconvulsive therapy for psychotropic-refractory bipolar affective disorder and severe self-injury and aggression in an 11-year-old autistic boy.  Eur Child Adolesc Psychiatry 2011; 20:147–152
[CrossRef] | [PubMed]
 
Consoli  A;  Cohen  J;  Bodeau  N  et al:  Electroconvulsive therapy in adolescents with intellectual disability and severe self-injurious behavior and aggression: a retrospective study.  Eur Child Adolesc Psychiatry 2013; 22:55–62
[CrossRef] | [PubMed]
 
Wachtel  LE;  Hermida  A;  Dhossche  DM:  Maintenance electroconvulsive therapy in autistic catatonia: a case series review.  Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:581–587
[CrossRef] | [PubMed]
 
Wachtel  LE;  Reti  IM;  Dhossche  DM  et al:  Stability of neuropsychological testing during two years of maintenance electroconvulsive therapy in an autistic man.  Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:301–302
[CrossRef] | [PubMed]
 
Huuhka  K;  Viikki  M;  Tammentie  T  et al:  One-year follow-up after discontinuing maintenance electroconvulsive therapy.  J ECT 2012; 28:225–228
[CrossRef] | [PubMed]
 
Ghaziuddin  N;  Gih  D;  Barbosa  V  et al:  Onset of catatonia at puberty: electroconvulsive therapy response in two autistic adolescents.  J ECT 2010; 26:274–277
[CrossRef] | [PubMed]
 
Ghaziuddin  N;  Kutcher  SP;  Knapp  P  et al; Work Group on Quality Issues; AACAP:  Practice parameter for use of electroconvulsive therapy with adolescents.  J Am Acad Child Adolesc Psychiatry 2004; 43:1521–1539
[CrossRef] | [PubMed]
 
McKinney  P;  Kellner  C:  Multiple ECT late in the course of neuroleptic malignant syndrome.  Convuls Ther 1997; 13:269–273
[PubMed]
 
Kellner  CH;  Popeo  DM;  Aloysi  AS:  Electroconvulsive therapy for catatonia.  Am J Psychiatry 2010; 167:1127–1128, author reply 1128
[CrossRef] | [PubMed]
 
Lucenko  BA;  Mancuso  D;  Janssen-Timmen  B:  Predictors of Out-of-Home Placement Among Children with Developmental Disabilities .  Olympia, WA,  Washington State Dept. of Social and Health Services, Research and Data Analysis Division, 2008
 
Fink  M:  Electroconvulsive Therapy: A Guide for Professionals and Their Patients .  Oxford,  Oxford University Press, 2009
 
Kutcher  S;  Robinson  HA:  Electroconvulsive therapy in treatment-resistant bipolar youth.  J Child Adolesc Psychopharmacol 1995; 5:167–175
[CrossRef]
 
Ghaziuddin  N;  King  CA;  Naylor  MW  et al:  Electroconvulsive treatment in adolescents with pharmacotherapy-refractory depression.  J Child Adolesc Psychopharmacol 1996; 6:259–271
[CrossRef] | [PubMed]
 
Cohen  D;  Taieb  O;  Flament  M  et al:  Absence of cognitive impairment at long-term follow-up in adolescents treated with ECT for severe mood disorder.  Am J Psychiatry 2000; 157:460–462
[CrossRef] | [PubMed]
 
Ghaziuddin  N;  Laughrin  D;  Giordani  B:  Cognitive side effects of electroconvulsive therapy in adolescents.  J Child Adolesc Psychopharmacol 2000; 10:269–276
[CrossRef] | [PubMed]
 
Ghaziuddin  N;  Kaza  M;  Ghazi  N  et al:  Electroconvulsive therapy for minors: experiences and attitudes of child psychiatrists and psychologists.  J ECT 2001; 17:109–117
[CrossRef] | [PubMed]
 
Ghaziuddin  N;  Dumas  S;  Hodges  E:  Use of continuation or maintenance electroconvulsive therapy in adolescents with severe treatment-resistant depression.  J ECT 2011; 27:168–174
[CrossRef] | [PubMed]
 
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