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Gesi C, Giacovelli L, Reibman YL, Dell'Osso B. Beyond imagination: Sorting out and treating psychosis in the context of autism spectrum disorder. J Psychiatr Res 2024; 173:363-366. [PMID: 38593694 DOI: 10.1016/j.jpsychires.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
In the last decades, growing caseness for Autism Spectrum Disorder (ASD) has been observed, owing to the diagnostic accretion of low-impairment forms, over and above other possible causes. Unrecognized ASD is likely to be mislabeled as a psychotic disorder (PD), as people in the spectrum may show 'pseudopsychotic' symptoms, resembling both negative and positive symptoms. On the other hand, PDs are likely to be overlooked when they arise in people with ASD, due to the 'diagnostic overshadowing' of new-onset conditions by lifelong core autistic symptoms. The three available metanalyses on the occurrence of psychosis in adults with ASD convergently reported a rate of PDs that is at least ten times higher than in the general population. Therefore, the lack of literature addressing risk factors, outcomes, and treatment options for psychosis in the context of ASD is utterly concerning. The present review aims to summarize up-to-date knowledge of PDs with comorbid ASD in terms of clinical features, course, and treatment.
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Affiliation(s)
- Camilla Gesi
- Department of Psychiatry and Addiction ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Luca Giacovelli
- Psychiatry 2 Unit, Luigi Sacco University Hospital, University of Milan, Milan, Italy.
| | - Yacob Levin Reibman
- Department of Psychiatry and Addiction ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Bernardo Dell'Osso
- Psychiatry 2 Unit, Luigi Sacco University Hospital, University of Milan, Milan, Italy; "Aldo Ravelli" Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; "Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche", University of Milan, Milan, Italy
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Bakken TL, Askeland Hellerud JM, Kildahl AN, Solheim-Inderberg AM, Hove O, Berge Helverschou S. Schizophrenia in Autistic People with Intellectual Disabilities. Treatment and Interventions. J Autism Dev Disord 2024:10.1007/s10803-024-06286-6. [PMID: 38393435 DOI: 10.1007/s10803-024-06286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
Autistic people with intellectual disabilities appear to be at increased risk of schizophrenia. While current recommendations emphasize adapting interventions used for people with schizophrenia in general, few studies to date have investigated treatment of co-occurring schizophrenia in this specific population. To explore what interventions are provided to autistic people with intellectual disabilities and co-occurring schizophrenia in specialized mental health services, and to investigate whether changes in mental health symptoms and challenging behavior occurred during treatment. Using data from a longitudinal, national multicenter study, interventions provided to 26 autistic individuals with intellectual disabilities and co-occurring schizophrenia were explored. Symptoms were measured using the Psychopathology in Autism Checklist (PAC) and the Aberrant Behavior Checklist ABC) at referral (T1), at the end of treatment (T2), and at follow-up 12 months after T2 (T3). A broad range of interventions were provided to the participants, including inpatient admission, psychopharmacological treatment, various psychosocial interventions, and supportive interventions. Scores on the PAC and ABC were significantly lower at T2 than T1 for most scales, and no significant change was found from T2 to T3.Treatment of co-occurring schizophrenia appears feasible and effective in autistic people with intellectual disabilities.
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Landgren V, Hedman E, Lindblad I, Gillberg C, Fernell E. Adult psychiatric and psychosocial outcomes of children with mild intellectual disability: a register follow-up of a population-based cohort. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:34-44. [PMID: 37699865 DOI: 10.1111/jir.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Very few longitudinal psychiatric and psychosocial outcome studies of children with mild intellectual disability (MID) have been performed. METHODS The study group was population based and consisted of 82 individuals, born in 1979-1985 and diagnosed in childhood at ages between 3 and 15 years with MID. In the present study, register data regarding school attendance, employment, economic situation, psychiatric diagnoses and criminal sentences were retrieved for the years 1997-2018, when the individuals were up to 39 years old. RESULTS At follow-up, data were obtained for 78 of the 82 individuals (47 male and 31 female). Mean age at follow-up was 36 years. Of the 78 individuals, 57 (73%) had exclusively received education for pupils with MID, but 21 (27%) had graduated from regular education of some sort (at least 9 years). Forty-four (56%) had never been employed, and 34 (44%) had been registered as employed for at least a shorter period. Forty-seven (60%) had received a sick pension at some point in adulthood. Of the 78 individuals, 44 (56%) had any psychiatric disorder recorded and about half of these (n = 21) had had inpatient treatment. A total of 31 of the 44 individuals in psychiatric care (70%) had ID noted as one of their diagnoses. Of the 78 individuals, 48 (62%) had support from the Act concerning Support and Service for Persons with Certain Functional Impairments (Swedish LSS law) as adults. Twenty-one individuals (27%) had had a criminal conviction, of whom five male individuals had been incarcerated. CONCLUSIONS Individuals with MID constitute a heterogeneous group with regard to severity of functional impairment, co-occurring psychiatric disorders and need of support from society. Primary health care, psychiatry and habilitation services need to work together in order to meet the multiple needs of this group.
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Affiliation(s)
- V Landgren
- Department of Psychiatry, Skaraborg Hospital, Skövde, Sweden
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
| | - E Hedman
- Department of Psychiatry, Skaraborg Hospital, Skövde, Sweden
| | - I Lindblad
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
| | - C Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
| | - E Fernell
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgren's Academy, Gothenburg University, Gothenburg, Sweden
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Nordgaard J, Nielsen KM, Rasmussen AR, Henriksen MG. Psychiatric comorbidity: a concept in need of a theory. Psychol Med 2023; 53:5902-5908. [PMID: 37264812 PMCID: PMC10520580 DOI: 10.1017/s0033291723001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023]
Abstract
Despite being a relatively new concept, psychiatric comorbidity, i.e. the co-occurrence of two or more mental disorders, has become widespread in clinical practice and psychiatric research. In this article, we trace the origin of the concept of psychiatric comorbidity, discuss the conceptual literature and point to basic problems concerning inadequate definition of the concept, differential diagnostic issues, and reification of mental disorders. We illustrate how these problems may have consequences for diagnostic assessment in current clinical practice and psychiatric research. To address some of the problems related to psychiatric comorbidity, we discuss potential principles for assessing psychiatric comorbidity. Inspired by Feinstein's original concept of comorbidity in general medicine and his differential diagnostic principles, we emphasize the importance of independence of mental disorders when assessing psychiatric comorbidity. We suggest that knowledge of trait v. state conditions and of the multitudinous clinical manifestations beyond what is captured in the diagnostic manuals may be helpful for assessing the independence of mental disorders and thus psychiatric comorbidity. We further argue that a more hierarchical diagnostic system and explicit exclusionary rules could improve clinical practice and research by reducing informational complexity and combating unwarranted psychiatric comorbidity.
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Affiliation(s)
- Julie Nordgaard
- Mental Health Center Amager, University Hospital Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | | | - Andreas Rosén Rasmussen
- Mental Health Center Amager, University Hospital Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
- Center for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mads Gram Henriksen
- Mental Health Center Amager, University Hospital Copenhagen, Denmark
- Department of Communication, Center for Subjectivity Research, University of Copenhagen, Denmark
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5
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Gupta N, Gupta M, Esang M. Lost in Translation: Challenges in the Diagnosis and Treatment of Early-Onset Schizophrenia. Cureus 2023; 15:e39488. [PMID: 37362509 PMCID: PMC10290525 DOI: 10.7759/cureus.39488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Early-onset schizophrenia (EOS) is a heterogeneous condition that has a serious, insidious clinical course and poor long-term mental health outcomes. The clinical presentations are highly complex due to the overlapping symptomatology with other illnesses, which contributes to a delay in the diagnosis. The objective of the review is to study if an earlier age of onset (AAO) of EOS has poor clinical outcomes, the diagnostic challenges of EOS, and effective treatment strategies. The review provides a comprehensive literature search of 5966 articles and summarizes 126 selected for empirical evidence to methodically consider challenges in diagnosing and treating EOS for practicing clinicians. The risk factors of EOS are unique but have been shared with many other neuropsychiatric illnesses. Most of the risk factors, including genetics and obstetric complications, are nonmodifiable. The role of early diagnosis in reducing the duration of untreated psychosis (DUP) remains critical to reducing overall morbidity. Many specific issues contribute to the risk and clinical outcomes. Therefore, issues around diagnostic ambiguity, treatment resistance, nonadherence, and rehospitalizations further extend the DUP. There is hesitancy to initiate clozapine early, even though the empirical evidence strongly supports its use. There is a growing body of research that suggests the use of long-acting injectables to address nonadherence, and these measures are largely underutilized in acute settings. The clinical presentations of EOS are complex. In addition to the presence of specific risk factors, patients with an early onset of illness are also at a higher risk for treatment resistance. While there is a need to develop tools for early diagnosis, established evidence-based measures to address nonadherence, psychoeducation, and resistance must be incorporated into the treatment planning.
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Affiliation(s)
- Nihit Gupta
- Psychiatry, Dayton Children's Hospital, Dayton, USA
| | - Mayank Gupta
- Psychiatry and Behavioral Sciences, Southwood Psychiatric Hospital, Pittsburgh, USA
| | - Michael Esang
- Psychiatry and Behavioral Sciences, Clarion Psychiatric Center, Clarion, USA
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6
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Mollon J, Almasy L, Jacquemont S, Glahn DC. The contribution of copy number variants to psychiatric symptoms and cognitive ability. Mol Psychiatry 2023; 28:1480-1493. [PMID: 36737482 PMCID: PMC10213133 DOI: 10.1038/s41380-023-01978-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
Copy number variants (CNVs) are deletions and duplications of DNA sequence. The most frequently studied CNVs, which are described in this review, are recurrent CNVs that occur in the same locations on the genome. These CNVs have been strongly implicated in neurodevelopmental disorders, namely autism spectrum disorder (ASD), intellectual disability (ID), and developmental delay (DD), but also in schizophrenia. More recent work has also shown that CNVs increase risk for other psychiatric disorders, namely, depression, bipolar disorder, and post-traumatic stress disorder. Many of the same CNVs are implicated across all of these disorders, and these neuropsychiatric CNVs are also associated with cognitive ability in the general population, as well as with structural and functional brain alterations. Neuropsychiatric CNVs also show incomplete penetrance, such that carriers do not always develop any psychiatric disorder, and may show only mild symptoms, if any. Variable expressivity, whereby the same CNVs are associated with many different phenotypes of varied severity, also points to highly complex mechanisms underlying disease risk in CNV carriers. Comprehensive and longitudinal phenotyping studies of individual CNVs have provided initial insights into these mechanisms. However, more work is needed to estimate and predict the effect of non-recurrent, ultra-rare CNVs, which also contribute to psychiatric and cognitive outcomes. Moreover, delineating the broader phenotypic landscape of neuropsychiatric CNVs in both clinical and general population cohorts may also offer important mechanistic insights.
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Affiliation(s)
- Josephine Mollon
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Laura Almasy
- Department of Genetics, Perelman School of Medicine, Penn-CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Sebastien Jacquemont
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
- Center Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada
| | - David C Glahn
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT, USA
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7
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Aripiprazole Used to Treat Capgras Syndrome in an Adolescent Diagnosed With Autism. Clin Neuropharmacol 2023; 46:85-86. [PMID: 36728844 DOI: 10.1097/wnf.0000000000000536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This report discusses the emergence, clinical appearance, and treatment of the rare entity Capgras syndrome (CS) in an adolescent diagnosed with autism. METHODS After a brief introduction to the CS, we conduct a detailed description of the case and review, after a search on the PubMed database, the known pathophysiology, psychiatric disorders associated with the onset of this syndrome, and the management of CS. RESULTS Capgras syndrome generally emerges during the course of delusional disorder, schizophrenia, or mood disorders, and for reasons such as neurological, infectious, or endocrinological diseases, drug intoxications, or deprivation. We encountered no previous reports of CS developing during the course of autism. There are no prospective studies concerning the treatment of the syndrome. However, antipsychotic drug use is primarily recommended in treatment. Antipsychotic drug therapy was therefore planned for the treatment of delusion, a psychotic symptom, in this case. The atypical antipsychotic aripiprazole was used based on the presence of accompanying diagnosis of autism, and the patient's body mass index and age. A relatively high dose of aripiprazole was required for the first psychotic attack in our patient. However, a good level of response was achieved within the expected time frame. In addition, no marked adverse effects were observed. CONCLUSIONS Aripiprazole seems to be an effective and well-tolerated antipsychotic drug in the treatment of CS accompanying autism.
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8
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Srichawla BS, Telles CC, Schweitzer M, Darwish B. Attention Deficit Hyperactivity Disorder and Substance Use Disorder: A Narrative Review. Cureus 2022; 14:e24068. [PMID: 35573587 PMCID: PMC9097465 DOI: 10.7759/cureus.24068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) has a growing incidence and prevalence in the United States and throughout the world, much of which is contributed to increased awareness of the condition and solidified diagnostic criteria. Substance use disorder (SUD) similarly has seen a sharp increase, particularly with the rising cases of opioid abuse. Management of ADHD is done primarily with pharmacologic therapy, often stimulants and with psychosocial interventions (i.e., exercise, meditation, peer-to-peer intervention, etc.) for adjunctive management. Management of SUD involves cessation and treatment based on the underlying drug of abuse. Many clinicians are uncomfortable treating ADHD in patients with SUD based on concerns the intervention may lead to an adverse event, including drug relapse, and the development of other psychiatric comorbidities. Concerns also arise about stimulants acting as a gateway drug in adolescents leading to the onset of SUD. Thus, in this narrative review, we aim to shed light on ADHD in relation to SUD and to provide clinical insight based on the current scientific literature on the topic. ADHD causes lesions in subcortical structures in the basal ganglia and limbic system. Treatment of ADHD with stimulants has been shown to normalize malformed neuroanatomical variations and lead to improved long-term outcomes compared to non-treatment of ADHD. Based on current scientific literature, it is recommended to treat ADHD with guideline-directed pharmacologic agents including stimulants along with non-pharmacologic interventions primarily exercise. There may be some improvement in reducing risky behavior, such as substance abuse, and may even help prevent the development of SUD.
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Affiliation(s)
| | - Chloe C Telles
- Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Melanie Schweitzer
- Medicine, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Bilal Darwish
- Medicine, Idaho College of Osteopathic Medicine, Meridian, USA
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Jutla A, Foss-Feig J, Veenstra-VanderWeele J. Autism spectrum disorder and schizophrenia: An updated conceptual review. Autism Res 2022; 15:384-412. [PMID: 34967130 PMCID: PMC8931527 DOI: 10.1002/aur.2659] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/08/2021] [Accepted: 12/12/2021] [Indexed: 12/19/2022]
Abstract
Autism spectrum disorder (ASD) and schizophrenia (SCZ) are separate disorders, with distinct clinical profiles and natural histories. ASD, typically diagnosed in childhood, is characterized by restricted or repetitive interests or behaviors and impaired social communication, and it tends to have a stable course. SCZ, typically diagnosed in adolescence or adulthood, is characterized by hallucinations and delusions, and tends to be associated with declining function. However, youth with ASD are three to six times more likely to develop SCZ than their neurotypical counterparts, and increasingly, research has shown that ASD and SCZ converge at several levels. We conducted a systematic review of studies since 2013 relevant to understanding this convergence, and present here a narrative synthesis of key findings, which we have organized into four broad categories: symptoms and behavior, perception and cognition, biomarkers, and genetic and environmental risk. We then discuss opportunities for future research into the phenomenology and neurobiology of overlap between ASD and SCZ. Understanding this overlap will allow for researchers, and eventually clinicians, to understand the factors that may make a child with ASD vulnerable to developing SCZ. LAY SUMMARY: Autism spectrum disorder and schizophrenia are distinct diagnoses, but people with autism and people with schizophrena share several characteristics. We review recent studies that have examined these areas of overlap, and discuss the kinds of studies we will need to better understand how these disorders are related. Understanding this will be important to help us identify which autistic children are at risk of developing schizophrenia.
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Affiliation(s)
- Amandeep Jutla
- Columbia University Vagelos College of Physicians and
Surgeons, 630 W 168th St, New York, NY 10032, United States
- New York State Psychiatric Institute, 1051 Riverside
Drive, Mail Unit 78, New York, NY 10032, United States
| | - Jennifer Foss-Feig
- Seaver Autism Center for Research and Treatment, Icahn
School of Medicine at Mount Sinai, Department of Psychiatry, 1 Gustave L. Levy
Place, Box 1230, New York, NY 10029, United States
| | - Jeremy Veenstra-VanderWeele
- Columbia University Vagelos College of Physicians and
Surgeons, 630 W 168th St, New York, NY 10032, United States
- New York State Psychiatric Institute, 1051 Riverside
Drive, Mail Unit 78, New York, NY 10032, United States
- Center for Autism and the Developing Brain, New
York-Presbyterian Westchester Behavioral Health Center, 21 Bloomingdale Road, White
Plains, NY 10605, United States
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10
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Abu-Akel A, Wood SJ, Upthegrove R, Chisholm K, Lin A, Hansen PC, Gillespie SM, Apperly IA, Montag C. Psychosocial functioning in the balance between autism and psychosis: evidence from three populations. Mol Psychiatry 2022; 27:2976-2984. [PMID: 35422471 PMCID: PMC9205777 DOI: 10.1038/s41380-022-01543-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/09/2022]
Abstract
Functional impairment is a core feature of both autism and schizophrenia spectrum disorders. While diagnostically independent, they can co-occur in the same individual at both the trait and diagnostic levels. The effect of such co-occurrence is hypothesized to worsen functional impairment. The diametric model, however, suggests that the disorders are etiologically and phenotypically diametrical, representing the extreme of a unidimensional continuum of cognition and behavior. A central prediction of this model is that functional impairment would be attenuated in individuals with mixed symptom expressions or genetic liability to both disorders. We tested this hypothesis in two clinical populations and one healthy population. In individuals with chronic schizophrenia and in individuals with first episode psychosis we evaluated the combined effect of autistic traits and positive psychotic symptoms on psychosocial functioning. In healthy carriers of alleles of copy number variants (CNVs) that confer risk for both autism and schizophrenia, we also evaluated whether variation in psychosocial functioning depended on the combined risk conferred by each CNV. Relative to individuals with biased symptom/CNV risk profiles, results show that functional impairments are attenuated in individuals with relatively equal levels of positive symptoms and autistic traits-and specifically stereotypic behaviors-, and in carriers of CNVs with relatively equal risks for either disorder. However, the pattern of effects along the "balance axis" varied across the groups, with this attenuation being generally less pronounced in individuals with high-high symptom/risk profile in the schizophrenia and CNV groups, and relatively similar for low-low and high-high individuals in the first episode psychosis group. Lower levels of functional impairments in individuals with "balanced" symptom profile or genetic risks would suggest compensation across mechanisms associated with autism and schizophrenia. CNVs that confer equal risks for both disorders may provide an entry point for investigations into such compensatory mechanisms. The co-assessment of autism and schizophrenia may contribute to personalized prognosis and stratification strategies.
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Affiliation(s)
- Ahmad Abu-Akel
- Institute of Psychology, University of Lausanne, 1015, Lausanne, Switzerland. .,School of Psychological Sciences, University of Haifa, 31905, Haifa, Israel.
| | - Stephen J. Wood
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, VIC 3052 Australia ,grid.488501.00000 0004 8032 6923Orygen, Parkville, VIC 3052 Australia
| | - Rachel Upthegrove
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.6572.60000 0004 1936 7486Institute of Clinical Sciences, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,Forward Thinking Birmingham and Birmingham and Solihull Mental Health Foundation Trust, 1 Printing House Street, Birmingham, B4 6DF UK
| | - Katharine Chisholm
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK ,grid.7273.10000 0004 0376 4727Department of Psychology, Aston University, Birmingham, B4 7ET UK
| | - Ashleigh Lin
- grid.1012.20000 0004 1936 7910Telethon Kids Institute, The University of Western Australia, 15 Hospital Avenue, Perth, WA 6009 Australia
| | - Peter C. Hansen
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Steven M. Gillespie
- grid.10025.360000 0004 1936 8470Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, L69 3GB UK
| | - Ian A. Apperly
- grid.6572.60000 0004 1936 7486School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Christiane Montag
- grid.6363.00000 0001 2218 4662Charité University Medicine Berlin (Charité Universitätsmedizin Berlin), Department of Psychiatry and Psychotherapy, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
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11
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Predicting adolescent alcohol and other drug problems using electronic health records data. J Subst Abuse Treat 2021; 132:108487. [PMID: 34098206 DOI: 10.1016/j.jsat.2021.108487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/18/2020] [Accepted: 05/15/2021] [Indexed: 11/22/2022]
Abstract
IMPORTANCE Alcohol and other drug (AOD) use problems may cause significant burden on affected adolescents and their families, yet treatment providers often do not identify these problems early enough. OBJECTIVE To develop, and internally and externally validate a multivariable prediction model of adolescent AOD problems using child- and maternal-level predictors before age 12, and child-level predictors between ages 12 to 18, as recorded in the electronic health records (EHR). DESIGN A retrospective cohort study conducted time-to-event analyses using Cox proportional hazards models. SETTING AND PARTICIPANTS 41,172 children born between 1997 and 2000 at four health plans (Kaiser Permanente Hawaii, KPHI; Kaiser Permanente Northern California, KPNC; Geisinger Clinic, GC; and Henry Ford Health System, HFHS) who had continuous membership since birth and linkable maternal records in the health plan. OUTCOMES AOD use problems between ages 12 to 18, defined as either: 1) having a contact with the AOD treatment program or 2) receiving a non-tobacco AOD diagnosis in an inpatient or outpatient encounter. EXPOSURES Candidate predictor variables include demographics, socioeconomic status, and clinical diagnoses of the children and the mothers. RESULTS Overall, 1400 (3.4%) adolescents had an AOD disorder between ages 12 to 18; the median follow-up time post-age 12 was 5.3 years. The research team developed two final prediction models: a "baseline" model of 10 child-level and 7 maternal-level predictors before age 12, and a more comprehensive "time-varying" model, which incorporated child risk factors after age 12 as time-varying covariates in addition to the baseline model predictors. Model performance evaluation showed good discrimination performance of the models, with the concordance index improved for the time-varying model, especially for prediction of AOD events in late adolescence. CONCLUSIONS AND RELEVANCE This study identified a number of child and maternal characteristics and diagnoses routinely available in EHR data as predictive of risk for developing AOD problems in adolescence. Further, we found that risk of developing problems varies significantly by the timing and persistence of the risk factors. Findings may have potential clinical implications for prevention and identification of adolescent AOD problems, but more research is needed, especially across additional health systems.
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12
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[ADHD during childhood and subsequent psychotic disorder: A link?]. Encephale 2021; 47:484-490. [PMID: 33994156 DOI: 10.1016/j.encep.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/21/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Attention Deficit with/without Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with frequent comorbid psychiatric disorders. Several studies have underlined the increased risk of developing a psychotic disorder subsequent to a childhood ADHD. The aim of our review is not only to clarify this association and the related physiopathology but also to understand the consequences for therapeutic management. METHODS We processed a narrative review of available literature based on a research of the PubMed database. Articles related to ADHD and psychotic disorder on a genetical, clinical or biological level were selected by one of the authors. RESULTS ADHD and psychotic disorders share neonatal, environmental, and genetic risk factors. On a neurobiological level, both disorders are concerned by a dysfunction of the dopaminergic system with an abnormal regulation of dopaminergic neurons' phasic and tonic activity. Our review aims to explain the « dynamic » model of dopaminergic dysfunctions and propose some guidance for pharmacological treatment of ADHD, with or without psychotic disorder. This model offers a better understanding of why methylphenidate is not associated to an increased risk of psychotic disorder and could act as a protective factor. Association between ADHD and psychotic disorders could be explained by some comorbidities such as substance use disorders which are frequently associated with both conditions and could act as mediator in the genesis of psychotic disorders following ADHD during childhood. Our review also focuses on an epidemiological bias that could be found in some studies such as possible diagnostic errors, as some non-specific clinical signs could be found in both late diagnosed ADHD and in "at risk mental state" of psychosis. CONCLUSION ADHD and psychotic disorders share common risk factors, neurobiological pathways and clinical symptoms. Perspectives for future studies are proposed considering a dimensional aspect of psychiatric disorders using, for example, Research Domain Criteria and exploring the link between the two conditions.
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Strålin P, Hetta J. First episode psychosis: register-based study of comorbid psychiatric disorders and medications before and after. Eur Arch Psychiatry Clin Neurosci 2021; 271:303-313. [PMID: 32458108 PMCID: PMC7960599 DOI: 10.1007/s00406-020-01139-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/04/2020] [Indexed: 01/02/2023]
Abstract
Comorbid psychiatric disorders are common in first episode psychosis. We investigated comorbid disorders before, at, and after a first hospital-treated psychosis in a naturalistic nation-wide cohort (n = 2091) with a first psychosis hospitalization between 2007 and 2011, and at ages between 16 and 25. Swedish population registers were used to identify the cohort and to collect data on diagnoses at hospitalizations and medications. The proportions of cases with hospitalizations or medications increased year by year before and decreased in the years after the first psychosis hospitalization. In the 2 years before, 30% had hospitalizations with other psychiatric diagnoses and 60% had psychiatric medications. At the first psychosis hospitalization, 46% had other comorbid psychiatric diagnoses or self-harm. In the 2 years before or at the first psychosis hospitalization, 17% had anxiety or stress disorders at hospitalizations, 12% depressive disorders, 5.4% manic or bipolar disorders, 8.6% personality disorders, 26% substance use disorders, and 15% neurodevelopmental disorders. 8.2% had hospitalizations for self-harm. At most, around 30% of the cases were estimated not to have had any comorbid psychiatric disorders before or at the first psychosis presentation. Early comorbid affective, anxiety or personality disorders or self-harm were associated with a worse outcome, as measured by new psychiatric hospitalizations. The outcome was worst for personality disorders with 73% re-hospitalizations within 1 year and for patients with self-harm with 70% re-hospitalizations. In conclusion, most cases with a first psychosis hospitalization had clinical presentations indicating comorbid psychiatric disorders. Cases with comorbidity had a higher risk for re-hospitalizations.
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Affiliation(s)
- Pontus Strålin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jerker Hetta
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
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Corbeil O, Bérubé FA, Artaud L, Roy MA. Détecter et traiter les troubles comorbides aux premiers épisodes psychotiques : un levier pour le rétablissement. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088187ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Pehlivanidis A, Papanikolaou K, Mantas V, Kalantzi E, Korobili K, Xenaki LA, Vassiliou G, Papageorgiou C. Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD). BMC Psychiatry 2020; 20:423. [PMID: 32847520 PMCID: PMC7449076 DOI: 10.1186/s12888-020-02828-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Co-occurring psychiatric disorders in adults with Attention Deficit Hyperactivity Disorder (ADHD) and/or Autism Spectrum Disorder (ASD) contribute to the burden of the healthcare and possibly to the delay of diagnosis. Aim of the study was to clinically assess the prevalence and compare lifetime co-occurring psychopathology in a sample of newly diagnosed ADHD and/or ASD adults and discuss the diagnostic challenges they pose. METHODS The lifetime prevalence rates of ten of the most frequently co-occurring psychiatric diagnoses was registered in 336 adults of normal intelligence who underwent a thorough clinical evaluation for the diagnosis of ADHD and/or ASD for the first time in their lives. Four study groups were formed: the ADHD (n = 151), the ASD (n = 58), the ADHD+ASD (n = 28) and the nonADHD/nonASD (NN) (n = 88) group. RESULTS At least one co-occurring psychopathology was found in 72.8% of the ADHD group, in 50% of the ASD group, in 72.4% of the ADHD+ASD group and in 76.1% of the NN group (p = 0.004). In all groups the most frequent psychiatric disorder was depressive disorder. The only significant difference regarding the patterns of psychiatric co-occurrence between the ADHD and the nonADHD groups (ASD and NN groups) was found for SUD (p = 0.001). Also, the proportion of subjects with Bipolar Disorder was significantly greater in the NN group as compared to those with ASD (p = 0.025). CONCLUSIONS Our results support the high prevalence of co-occurring psychiatric disorders in adults with ADHD and/or ASD with the ASD group presenting the lowest rate. The most marked difference between the ADHD and the nonADHD groups was found for SUD. Moreover, our findings highlight the need for a thorough clinical assessment of all referred patients both in the presence and absence of ADHD and/or ASD.
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Affiliation(s)
- Artemios Pehlivanidis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital, 72-74 Vas. Sofias Ave, 11528, Athens, Greece.
| | - Katerina Papanikolaou
- Department of Child Psychiatry, National and Kapodistrian University of Athens, Medical School, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece
| | - Vasilios Mantas
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Eva Kalantzi
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Kalliopi Korobili
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Lida-Alkisti Xenaki
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Georgia Vassiliou
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Charalambos Papageorgiou
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
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Chandrasekhar T, Copeland JN, Spanos M, Sikich L. Autism, Psychosis, or Both? Unraveling Complex Patient Presentations. Child Adolesc Psychiatr Clin N Am 2020; 29:103-113. [PMID: 31708040 DOI: 10.1016/j.chc.2019.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Autism spectrum disorders (ASDs) and schizophrenia spectrum disorders co-occur at elevated rates. Although these conditions are diagnostically distinct, they share multiple clinical features and genetic risk factors. This article describes the epidemiologic features and clinical manifestations of psychosis in individuals with ASDs, while also discussing shared genetic risk factors and affected brain regions. Components of a diagnostic assessment, including a thorough developmental, behavioral, medical, and psychiatric history, will be reviewed. The authors highlight the manifestations of catatonia in this population and note the shared features between catatonia and ASDs. Finally, treatment approaches and areas for future study are suggested.
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Affiliation(s)
- Tara Chandrasekhar
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA.
| | - John Nathan Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - Marina Spanos
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - Linmarie Sikich
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
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Garel N, Joober R. Treatment of first-episode psychosis in patients with autism-spectrum disorder and intellectual deficiency. J Psychiatry Neurosci 2019; 44:E31-E32. [PMID: 31657537 PMCID: PMC6821509 DOI: 10.1503/jpn.190081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nicolas Garel
- From the psychiatry residency program, McGill University (Garel); and McGill University, Douglas Mental Health University Institute (Joober), Montreal, Que., Canada
| | - Ridha Joober
- From the psychiatry residency program, McGill University (Garel); and McGill University, Douglas Mental Health University Institute (Joober), Montreal, Que., Canada
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Wingård L, Brandt L, Bodén R, Kieler H, Andersen M, Reutfors J. Monotherapy vs. combination therapy for post mania maintenance treatment: A population based cohort study. Eur Neuropsychopharmacol 2019; 29:691-700. [PMID: 31078359 DOI: 10.1016/j.euroneuro.2019.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/30/2019] [Accepted: 04/23/2019] [Indexed: 11/29/2022]
Abstract
In recent years, the use of atypical antipsychotics and combination therapy for relapse prevention in bipolar disorder has increased substantially. However, real-world data on the comparative effectiveness of these treatment options are largely non-existent. We conducted a population-based cohort study, using data from Swedish national registers. All patients aged 18-75 years who were hospitalized for mania 2006-2014 and filled at least one prescription of lithium, valproate, olanzapine, quetiapine, aripiprazole or any combination of these drugs were included, and followed for up to one year after hospital discharge, generating follow-up data from 5 713 hospitalizations. We used Cox proportional hazard regression models to study time to treatment failure for each individual drug and combination therapy, using lithium as comparator. Treatment failure was defined as treatment discontinuation, switch, or rehospitalization, and the results were adjusted for clinical and sociodemographic factors. We found that treatment failure occurred in 85% of cases and that the majority of combination therapies were associated with lower risks of treatment failure compared to monotherapies. Patients combining lithium + valproate + quetiapine had the lowest risk of treatment failure (adjusted HR [AHR] 0.40, 95% CI 0.30-0.54), followed by patients on lithium + valproate + olanzapine (AHR 0.55, 95% CI 0.45-0.68). In contrast, monotherapies with antipsychotics were associated with significantly higher risks of treatment failure compared to single use of lithium. In conclusion, our results support experimental findings, suggesting that combination therapy is more effective than monotherapy after a manic episode.
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Affiliation(s)
- Louise Wingård
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, T2, SE-171 76 Stockholm, Sweden.
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, T2, SE-171 76 Stockholm, Sweden
| | - Robert Bodén
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, T2, SE-171 76 Stockholm, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, T2, SE-171 76 Stockholm, Sweden
| | - Morten Andersen
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, T2, SE-171 76 Stockholm, Sweden; Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, T2, SE-171 76 Stockholm, Sweden
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