Electroconvulsive Therapy for Catatonia in Autistic and Non‐Autistic Patients: An Observational Study on Course, Efficacy, Aggression, and Self‐Injury Outcomes

Catatonia occurs disproportionately in autistic individuals and may respond to electroconvulsive therapy (ECT), yet prior reports suggest greater treatment burden in this population. We compared longitudinal ECT utilization, safety, and clinical outcomes between autistic and non-autistic patients with catatonia. This single-center observational cohort included 110 patients treated from May 2022 through April 2026, comprising 43 autistic and 67 non-autistic patients. Bush-Francis Catatonia Rating Scale (BFCRS), Clinical Global Impression-Improvement (CGI-I), Clinical Global Impression-Severity (CGI-S), and Kanner Catatonia Severity and Examination scores were recorded across acute and maintenance treatment. Because the cohorts differed in age, biologic sex, and intellectual disability, treatment burden was evaluated using covariate-adjusted, censoring-aware models with a three-level clinical-group variable comprising non-autism, autism with intellectual disability, and autism without intellectual disability. Autistic patients received more ECT sessions than non-autistic patients (median, 35 vs. 14) over longer observed treatment courses (median, 342 vs. 97 days). After adjustment, this difference reflected longer retention in maintenance ECT rather than a higher treatment rate and was concentrated among autistic patients with intellectual disability (Cox hazard ratio, 0.21). Clinical improvement was observed in both cohorts: CGI-I response occurred in 100.0% of autistic and 89.1% of non-autistic patients, BFCRS reduction of at least 50% occurred in 76.9% and 75.4%, and CGI-S improvement of at least 1 point occurred in 85.0% and 70.8%, respectively. Kanner total scores decreased significantly, and self-injury prevalence declined from 42.9% to 17.1% among autistic patients. Combativeness improved in both cohorts, and documented adverse events were uncommon. ECT was associated with substantial clinical improvement in autistic and non-autistic patients with catatonia. Autistic patients, particularly those with intellectual disability, experienced longer maintenance courses rather than more intensive treatment, underscoring the importance of sustained treatment access.