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Chisholm K, Schirmbeck F, Pinkham AE, Sasson NJ, Simons CJP, de Haan L, Harvey PD, Penn DL, Ziermans T. A Cross-sectional Conceptual Replication and Longitudinal Evaluation of the PANSS-Autism-Severity-Score Measure Suggests it Does Not Capture Autistic Traits in Individuals With Psychosis. Schizophr Bull 2023:sbad161. [PMID: 37992238 DOI: 10.1093/schbul/sbad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Autism and psychosis co-occur at elevated rates, with implications for clinical outcomes, functioning, and suicidality. The PANSS-Autism-Severity-Score (PAUSS) is a measure of autism trait severity which has not yet been validated externally or longitudinally. STUDY DESIGN Participants were derived from the GROUP and SCOPE datasets. Participants included 1448 adults with schizophrenia spectrum disorder (SSD), 800 SSD-siblings, 103 adults diagnosed with an autistic spectrum condition (ASC), and 409 typically-developing controls (TC). Analyses from the original validation study were conducted with SSD participants, and extended into ASC, SSD-sibling, and TC participants. Test-retest reliability of the PAUSS at 2-weeks and long-term stability 3 and 6-years was also examined. STUDY RESULTS Results differed in important ways from the original validation. SSD participants reported higher PAUSS scores than other groups, with only a fraction of ASC participants scoring as "PAUSS-Autistic." Cronbach's alpha was acceptable for the SSD cohort only. Two-week stability of the PAUSS was fair to good for all PAUSS scores. Long-term stability was poor for most PAUSS items but fair for total PAUSS score. CONCLUSIONS Results suggest that the PAUSS does not appear appropriate for assessing autism, with the low rate of PAUSS-Autistic in the ASC population suggesting the PAUSS may not accurately reflect characteristics of autism. The relative lack of long-term stability is cause for concern and suggestive that the PAUSS is capturing features of psychosis rather than autism traits.
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Affiliation(s)
- Katharine Chisholm
- School of Psychology, Institute of Health and Neurodevelopment, Aston University, Aston St, Birmingham, B4 7ET, UK
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam University Medical Center, Meibergdreef, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Amy E Pinkham
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Noah J Sasson
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Claudia J P Simons
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands
- GGzE Institute for Mental Health Care, Eindhoven, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Meibergdreef, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Research Service, Miami VA Healthcare System, Miami, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Tim Ziermans
- Department of Psychology, Dutch Autism & ADHD Research Center, University of Amsterdam, Amsterdam, The Netherlands
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Yeh TC, Chen MH, Bai YM, Tsai SJ, Hsu JW, Huang KL, Su TP, Chen TJ, Liang CS. Longitudinal follow-up of subsequent psychiatric comorbidities among children and adolescents with autism spectrum disorder. J Affect Disord 2023; 331:245-250. [PMID: 36965622 DOI: 10.1016/j.jad.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND The mental health of children and adolescents with autism spectrum disorder (ASD) is a concern of recent years. However, a large-scale longitudinal study investigating the risk and the time course of subsequent psychiatric comorbidities is still lacking. METHODS Using the Taiwan National Health Insurance Research Database, 13,382 children and adolescents with ASD, and 53,528 age- and sex-matched non-ASD controls were enrolled between 2001 and 2009, and followed to the end of 2011. The adjusted hazard ratio (HR) with a corresponding 95 % confidence interval for psychiatric comorbidities among children and adolescents with ASD vs matched controls was estimated. The subjects who developed schizophrenia, bipolar disorder, depressive disorder, anxiety disorder, and obsessive-compulsive disorder (OCD) were identified during the follow-up. RESULTS Children and adolescents with ASD compared with controls were more likely to be diagnosed with schizophrenia (19.21; 13.74, 26.88), bipolar disorder (17.59; 12.66, 24.44), depressive disorder (5.56; 4.72, 6.56), anxiety disorder (5.01; 4.49, 5.59), and OCD (16.12; 11.66, 22.30) later in life. The time course of subsequent psychiatric comorbidity showed that anxiety disorder occurred first, usually in late childhood, with psychotic and affective disorders proceeding in adolescence. Those with ASD and anxiety disorder had an additionally increased likelihood of developing subsequent psychiatric comorbidity compared with those with ASD only. LIMITATION In claims data analysis, clinical parameters or possible confounders may not be fully captured. CONCLUSION Patients with ASD are predisposed to the development of anxiety disorder in late childhood, as well as schizophrenia, bipolar disorder, depressive disorder, and OCD in adolescence.
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Affiliation(s)
- Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
| | - Ya-Mei Bai
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Fusar-Poli L, Brondino N, Politi P, Aguglia E. Missed diagnoses and misdiagnoses of adults with autism spectrum disorder. Eur Arch Psychiatry Clin Neurosci 2022; 272:187-198. [PMID: 32892291 PMCID: PMC8866369 DOI: 10.1007/s00406-020-01189-w] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022]
Abstract
Autism spectrum disorder (ASD) is a group of life-long neurodevelopmental disorders affecting 1.5% of the general population. The present study aimed to evaluate the psychiatric history of a group of adults who received the first diagnosis of ASD in two Italian university centers. Diagnoses of ASD were confirmed by a team of psychiatrists with wide expertise in the field, after the administration of standardized tools (i.e., ADOS-2, ADI-R). The sample comprised 161 participants, of which 114 (79.5%) were males. The median age of diagnosis was 23 years (range 18-55), with a median IQ of 100 (range 30-145). The first evaluation by a mental health professional was performed at a median age of 13 years, with a gap of 11 years between the first evaluation and the diagnosis of ASD. 33.5% of participants had never received a psychiatric diagnosis, while the rest of the sample had received one or more diagnoses different from ASD. The most common past diagnoses were intellectual disability, psychoses, personality disorders, and depression. Sex differences were detected in the age of diagnosis and ADOS-2 scores. Our results provide important information for both child and adult psychiatrists. Given the prevalence of autism and the high rates of co-occurrent psychiatric conditions, it is important for clinicians to consider ASD in the differential diagnostic process.
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Affiliation(s)
- Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, via Santa Sofia 78, 95123 Catania, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100 Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, via Bassi 21, 27100 Pavia, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, via Santa Sofia 78, 95123 Catania, Italy
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4
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Zheng S, Chua YC, Tang C, Tan GMY, Abdin E, Lim VWQ, Koh AS, Verma S, Magiati I. Autistic traits in first-episode psychosis: Rates and association with 1-year recovery outcomes. Early Interv Psychiatry 2021; 15:849-855. [PMID: 32710521 PMCID: PMC8366507 DOI: 10.1111/eip.13021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/31/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
AIM There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in Singaporean patients with first-episode psychosis and their association with 1-year psychosis recovery. METHODS The relationship between baseline patient characteristics, autistic traits (measured with autism screening questionnaires) and psychosis recovery outcomes at 1-year were examined in 180 adults in the Early Intervention Psychosis Programme in Singapore. RESULTS Out of 180 participants, 50 (27.8%) had clinically elevated above screening-cut off levels of autistic traits on the self-reported 10-item Autism Spectrum Quotient and 8 (4.4%) on the staff-rated Autism Spectrum Disorder in Adults Screening Questionnaire. At baseline, those with more autistic traits were more likely to be unemployed, economically inactive (ie, students or homemakers); and to have diagnoses of mood disorder with psychotic features, brief psychotic disorder or psychotic disorder not otherwise specified as compared to schizophrenia spectrum and delusional disorder diagnoses. Although most participants showed improvements in their clinical outcomes at 1-year, those with higher autistic traits improved less in the Positive and Negative Syndrome Scale general psychopathology scale and in Global Assessment of Functioning symptomatology. CONCLUSIONS Autistic traits are common in those with first-episode psychosis and may be associated with poorer clinical outcomes. Validated screening tools should be developed in this population to support earlier reporting.
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Affiliation(s)
- Shushan Zheng
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
| | - Yi Chian Chua
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
| | - Charmaine Tang
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
| | - Giles Ming-Yee Tan
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | | | - Vicki Wei Qi Lim
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore.,Department of Psychology, National University of Singapore, Singapore
| | - Astelle Shiyun Koh
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
| | - Swapna Verma
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore
| | - Iliana Magiati
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore.,Department of Psychology, National University of Singapore, Singapore
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5
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Ziermans TB, Schirmbeck F, Oosterwijk F, Geurts HM, de Haan L. Autistic traits in psychotic disorders: prevalence, familial risk, and impact on social functioning. Psychol Med 2021; 51:1704-1713. [PMID: 32151297 PMCID: PMC8327624 DOI: 10.1017/s0033291720000458] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prevalence estimates of autistic traits in individuals with psychotic disorders (PD) vary greatly and it is unclear whether individuals with a familial risk (FR) for psychosis have an increased propensity to display autistic traits. Furthermore, it is unknown whether the presence of comorbid autism traits disproportionally affects the cognitive and behavioral aspects of social functioning in PD. METHODS In total, 504 individuals with PD, 587 unaffected siblings with FR, and 337 typical comparison (TC) individuals (16-50 years) were included. Autistic and psychotic traits were measured with the Autism Spectrum Quotient (AQ) and the Community Assessment of Psychic Experiences (CAPE). Social cognition was assessed with the Picture Sequencing Task (PST) and social behavior with the Social Functioning Scale (SFS). RESULTS For PD 6.5% scored above AQ clinical cut-off (⩾32), 1.0% for FR, and 1.2% for TC. After accounting for age, sex, and IQ, the PD group showed significantly more autistic traits and alterations in social behavior and cognition, while FR and TC only displayed marginal differences. Within the PD group autistic traits were a robust predictor of social behavior and there were no interactions with positive psychotic symptoms. CONCLUSIONS Levels of autistic traits are substantially elevated in PD and have a profoundly negative association with social functioning. In contrast, autistic traits above the clinical cut-off are not elevated in those with FR, and only marginally on a dimensional level. These findings warrant specific clinical guidelines for psychotic patients who present themselves with autistic comorbidity to help address their social needs.
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Affiliation(s)
- Tim B. Ziermans
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
| | | | - Hilde M. Geurts
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Dr. Leo Kannerhuis, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Institute for Mental Health, Amsterdam, The Netherlands
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6
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Cornwall PL, Simpson S, Gibbs C, Morfee V. Evaluation of radically open dialectical behaviour therapy in an adult community mental health team: effectiveness in people with autism spectrum disorders. BJPsych Bull 2021; 45:146-153. [PMID: 33261708 PMCID: PMC9059310 DOI: 10.1192/bjb.2020.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
AIMS AND METHOD Radically open dialectical behaviour therapy (RO DBT) is a transdiagnostic treatment designed to address disorders associated with overcontrol, including autism spectrum disorders (ASD). To date, no studies have reported on the effectiveness of RO DBT for people with ASD. Forty-eight patients were referred to a RO DBT programme, of whom 23 had a diagnosis of ASD. Outcome was measured using the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE) and the Questionnaire about the Process of Recovery. RESULTS The intervention was effective, with a medium effect size of 0.53 for improvement in CORE global distress. End-point CORE global distress score was predicted from initial severity and a diagnosis of ASD. Participants with a diagnosis of ASD who completed the therapy had significantly better outcomes than completing participants without an ASD diagnosis. CLINICAL IMPLICATIONS These findings provide preliminary support for RO DBT as an effective intervention for ASD in routine settings.
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Affiliation(s)
- Peter L Cornwall
- Redcar & Cleveland Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Susan Simpson
- Redcar & Cleveland Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Claire Gibbs
- Redcar & Cleveland Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Valerie Morfee
- Redcar & Cleveland Mental Health Services, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
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7
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Vaquerizo-Serrano J, Salazar de Pablo G, Singh J, Santosh P. Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis. J Autism Dev Disord 2021; 52:1568-1586. [PMID: 33993403 PMCID: PMC8938385 DOI: 10.1007/s10803-021-05046-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 12/12/2022]
Abstract
Psychotic experiences can occur in autism spectrum disorders (ASD). Some of the ASD individuals with these experiences may fulfil Clinical High-Risk for Psychosis (CHR-P) criteria. A systematic literature search was performed to review the information on ASD and CHR-P. A meta-analysis of the proportion of CHR-P in ASD was conducted. The systematic review included 13 studies. The mean age of ASD individuals across the included studies was 11.09 years. The Attenuated Psychosis Syndrome subgroup was the most frequently reported. Four studies were meta-analysed, showing that 11.6% of CHR-P individuals have an ASD diagnosis. Symptoms of prodromal psychosis may be present in individuals with ASD. The transition from CHR-P to psychosis is not affected by ASD.
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Affiliation(s)
- Julio Vaquerizo-Serrano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK.,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Institute of Psychiatry and Mental Health, Department of Psychiatry, Hospital General Universitario Gregorio Marañón Instituto de Investigación Sanitaria Gregorio Maranón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK. .,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK.
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8
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Bechi M, Abu-Akel A, Agostoni G, Bosia M, Cocchi F, Spangaro M, Cavallaro R. Functional benefits of co-occurring autistic symptoms in schizophrenia is delimited by symptom severity. J Psychiatr Res 2021; 137:48-54. [PMID: 33652326 DOI: 10.1016/j.jpsychires.2021.02.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Impairments in daily functioning characterize both autism spectrum disorder and schizophrenia. Research has shown that a subsample of schizophrenia patients presents autistic symptoms, leading to the hypothesis that their co-occurrence would be associated with a 'double dose' of deficit. A growing body of research examined this hypothesis by looking at the joint effect of autistic and positive psychotic symptoms, and yielded contrasting results, ranging from benefits to adverse effects. We hypothesized that the interactive effect of autistic and positive symptoms on functioning in schizophrenia might depend on the patients' symptom severity. METHOD In 170 schizophrenia patients, a two-step cluster analysis identified two groups of patients with different levels of autistic and positive symptom severity. Using general linear models, we examined the interactions of groups, autistic and positive symptoms on functioning. RESULTS Autistic and positive symptoms were interactively associated with better functioning, but only in the symptomatically less severe patients. In contrast, autistic and positive symptoms were independently associated with worse functioning in the symptomatically more severe patients. These associations were observed above and beyond the effects of I.Q. and illness duration. CONCLUSIONS The findings highlight the complex role played by co-occurring autistic symptoms in schizophrenia, whose beneficial effects on functioning appear to depend on patients' psychopathological severity. Our findings may help to reconcile the seemingly contrasting results from previous studies, and to understand the heterogeneity of behavior and functional outcomes in schizophrenia. This study underscores the potential utility of routinely assessing autism in schizophrenia, in order to better formulate individualized rehabilitative programs.
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Affiliation(s)
- Margherita Bechi
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ahmad Abu-Akel
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Giulia Agostoni
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy.
| | - Marta Bosia
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Cocchi
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Spangaro
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Cavallaro
- Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
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9
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Treise C, Simmons C, Marshall N, Painter M, Perez J. Autism Spectrum Disorder in Early Intervention in Psychosis Services: Implementation and Findings of a 3-step Screening and Diagnostic Protocol. J Psychiatr Pract 2021; 27:23-32. [PMID: 33438864 DOI: 10.1097/pra.0000000000000525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence indicates that autism spectrum disorder (ASD) is underidentified in populations with psychosis, but that clinical presentations of comorbid ASD and psychosis (ASD-P) and specific treatment needs that may relate to this group are not well understood. In fact, recent studies of ASD in first-episode psychosis suggest that there may be a specific clinical presentation of ASD-P. In response, the Cambridgeshire and Peterborough Early Intervention in Psychosis (EIP) service in the UK implemented and evaluated a 3-step ASD screening and diagnostic protocol, using the Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ), case note review, and the Autism Diagnostic Observation Schedule (ADOS-2) and the Childhood Autism Spectrum Test (CAST). As a quality improvement project, the evaluation aimed to (1) establish the prevalence of patients with ASD-P, (2) describe characteristics of the clinical presentation of ASD-P and compare them to those of patients suffering from psychosis but no ASD, and (3) determine any differences in treatment between psychosis patients with and without ASD. Notably, at least 9% of the EIP service caseload met the criteria for a diagnosis of ASD-P, with half identified via the implementation of this protocol. The patients with ASD-P had specific clinical presentations and treatment needs that differed from those of patients with psychosis but no ASD. Thus, the findings from this study supported existing evidence concerning the underdetection of ASD in EIP populations. Our findings also added to emerging evidence for a clinical presentation of ASD-P with specific treatment needs. Our protocol has now been established as routine practice, and its implementation has improved the detection and treatment of patients with ASD-P within our EIP service.
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10
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Poletti M, Raballo A. Childhood schizotypal features vs. high-functioning autism spectrum disorder: Developmental overlaps and phenomenological differences. Schizophr Res 2020; 223:53-58. [PMID: 33046336 DOI: 10.1016/j.schres.2020.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/18/2020] [Accepted: 09/26/2020] [Indexed: 12/27/2022]
Abstract
Although autism spectrum disorder and schizophrenia have allegedly different onset timelines (e.g. in early years of life vs adolescence/early adulthood), there is nonetheless a diagnostic grey-zone along developmental stages, in which overlapping clinical features related to social impairment and oddity could impact on the differential diagnosis between childhood schizotypal features and high-functioning autism spectrum disorder. A phenomenological perspective may be helpful for the purpose of timely differential diagnosis also in developmental years.
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Affiliation(s)
- Michele Poletti
- Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy
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11
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Sunwoo M, O'Connell J, Brown E, Lin A, Wood SJ, McGorry P, O'Donoghue B. Prevalence and outcomes of young people with concurrent autism spectrum disorder and first episode of psychosis. Schizophr Res 2020; 216:310-315. [PMID: 31787480 DOI: 10.1016/j.schres.2019.11.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/05/2019] [Accepted: 11/22/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The intersect and blurring of boundaries between schizophrenia spectrum disorders and autism spectrum disorder (ASD) has long been an area of confusion, in both nosology and clinical practice. Individuals with a comorbid presentation of the two spectra can present with a distinct phenomenological profile to those with psychosis or ASD alone. AIMS To examine the prevalence rates of ASD in a cohort of young people presenting with a first episode of psychosis (FEP) and compare the demographic and clinical characteristics and functional outcomes between individuals with concurrent FEP and ASD, and individuals with FEP only. METHODS Young people aged 15 to 24 who presented with FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1st January 2011 and 31st December 2013 were included in the study. RESULTS Of the 544 individuals presenting with a FEP, 3.7% (N = 20) had a diagnosis of ASD. Individuals with a concurrent diagnosis of FEP and ASD were more likely to be male and less likely to have comorbid substance use issues. There was no difference found in the severity of psychotic symptoms or diagnoses between groups. Those with FEP and ASD were more likely to experience impairments in interpersonal skills and be more likely to be engaged in employment or education at time of discharge from service. CONCLUSIONS Individuals with concurrent FEP and ASD can present with distinct clinical characteristics that require specialised assessment and treatment. Further large-scale studies with control groups could help to better understand the phenomenological specificity of this subgroup.
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Affiliation(s)
| | - Jessica O'Connell
- Orygen Youth Health, Melbourne, Australia; Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Ellie Brown
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, WA 6008, Australia
| | - Stephen J Wood
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; School of Psychology, University of Birmingham, UK
| | - Patrick McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Brian O'Donoghue
- Orygen Youth Health, Melbourne, Australia; Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
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12
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Maat A, Therman S, Swaab H, Ziermans T. The Attenuated Psychosis Syndrome and Facial Affect Processing in Adolescents With and Without Autism. Front Psychiatry 2020; 11:759. [PMID: 32848934 PMCID: PMC7416636 DOI: 10.3389/fpsyt.2020.00759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Autism and schizophrenia spectrum disorders both represent severely disabling neurodevelopmental disorders with marked impairments in social functioning. Despite an increased incidence of psychosis in autism, and substantial overlap in symptoms and cognitive markers, it is unclear whether such phenotypes are specifically related to risk for psychosis or perhaps reflect more general, idiosyncratic autism traits. The attenuated psychosis syndrome (APS) is primarily defined by the presence of attenuated psychotic symptoms, which currently constitute the best and most-replicated clinical predictors of psychosis, and are common in clinical youth with and without autism. The aims of this study were to test the hypothesis that facial affect processing is impaired in adolescents with APS and to explore whether such deficits are more indicative of psychotic or autistic phenotypes on a categorical and dimensional level. MATERIALS AND METHOD Fifty-three adolescents with APS and 81 typically developing controls (aged 12-18) were included. The APS group consisted of adolescents with (n = 21) and without (n = 32) a diagnosis of autism spectrum disorder. Facial affect recognition was assessed with the Amsterdam Neuropsychological Tasks using a cascade model of cognitive processing, in which disturbances in "lower-level" cognitive abilities (pattern recognition), affect "higher-level" cognitive processes (face recognition and facial affect recognition). For associations with schizotypal and autistic-like traits the Schizotypal Personality Questionnaire and Social Communication Questionnaire were used in a confirmatory item factor analysis framework. RESULTS Contrary to expectation, APS in adolescents was not associated with impairments in pattern, face, or facial affect recognition. However, the APS group with autism spectrum disorder showed a general latency in response time to social and non-social stimuli. Dimensionally assessed schizotypal and autistic-like traits did not predict the accuracy or the speed of face or facial affect recognition. CONCLUSION Facial affect processing performance was not associated with APS in adolescence and represents an unlikely early vulnerability marker for psychosis. APS individuals with a more autistic-like profile were characterized by slower responses to social- and non-social stimuli, suggesting that the combined effect of APS and autism spectrum disorder on cognition is larger than for APS alone.
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Affiliation(s)
- Arija Maat
- Department of Psychiatry, UMC Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Sebastian Therman
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Swaab
- Clinical Child & Adolescent Studies, Leiden University, Leiden, Netherlands
| | - Tim Ziermans
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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13
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Chisholm K, Pelton M, Duncan N, Kidd K, Wardenaar KJ, Upthegrove R, Broome MR, Lin A, Wood SJ. A cross-sectional examination of the clinical significance of autistic traits in individuals experiencing a first episode of psychosis. Psychiatry Res 2019; 282:112623. [PMID: 31685288 DOI: 10.1016/j.psychres.2019.112623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/28/2022]
Abstract
Autism traits are found at elevated rates in individuals with schizophrenia spectrum disorders, however, there is a lack of evidence regarding potential clinical impact. The current research aimed to examine potential associations between autism traits and symptoms of psychosis, social and role functioning, and quality of life. 99 individuals experiencing a first episode of psychosis took part in a cross-sectional interview and self-report questionnaire which assessed current symptoms of psychosis, autism traits, functioning, and quality of life. Participants were found to have a high level of autism traits. Higher autism traits were associated with poorer quality of life, functioning, and current psychotic symptoms. Receiver operating characteristic curve (ROC) analyses indicated that optimal AQ cut-off scores to predict severity of psychosis symptoms, functioning, and quality of life were lower than those used to suggest likely autism-spectrum diagnosis. Results suggest that autism traits are associated with poorer clinical presentation in first-episode psychosis populations, even in those whose traits fall below potentially diagnostic thresholds for autism. Psychosis services should be prepared to adequately address the needs of individuals with higher autism traits.
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Affiliation(s)
- Katharine Chisholm
- Department of Psychology, Aston University, United Kingdom; School of Psychology and Institute for Mental Health, University of Birmingham, United Kingdom.
| | - Mirabel Pelton
- School of Psychology and Institute for Mental Health, University of Birmingham, United Kingdom; Centre for Innovative Research Across the Life course (CIRAL), Coventry University, United Kingdom
| | - Nikita Duncan
- School of Psychology and Institute for Mental Health, University of Birmingham, United Kingdom
| | - Katherine Kidd
- School of Psychology and Institute for Mental Health, University of Birmingham, United Kingdom
| | - Klaas J Wardenaar
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Netherlands
| | - Rachel Upthegrove
- School of Psychiatry, Institute of Clinical Sciences, and Institute for Mental Health, University of Birmingham. Forward Thinking Birmingham and Birmingham and Solihull Mental Health Foundation Trust, United Kingdom
| | - Matthew R Broome
- School of Psychology and Institute for Mental Health, University of Birmingham, United Kingdom; Department of Psychiatry, University of Oxford, UK; Faculty of Philosophy, University of Oxford, UK, Oxford Health NHS Foundation Trust, United Kingdom
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Stephen J Wood
- School of Psychology and Institute for Mental Health, University of Birmingham, United Kingdom; Orygen, The National Centre of Excellence for Youth Mental Health, Melbourne, Australia, & the Centre for Youth Mental Health, University of Melbourne, Australia, & School of Psychology, University of Birmingham, United Kingdom
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14
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[ADI-R and ADOS and the differential diagnosis of autism spectrum disorders: Interests, limits and openings]. Encephale 2019; 45:441-448. [PMID: 31495549 DOI: 10.1016/j.encep.2019.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Current developments in international public health are leading qualified authorities to release clinical practice guidelines for Autism Spectrum Disorders (ASD) assessment and diagnosis. Such documents incorporate procedures that rely on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) which are considered to be the "gold standard" assessment measures in the evaluation of ASD. Although these tools do prove their effectiveness in the evaluation of autistic symptomatology, they nevertheless stumble whenever the situation becomes more complex and reveal differential diagnostic issues in infantile and adult autism cases. This differential diagnostic issue remains significant in the clinical practice of daily life and has strong implications for the course of therapeutic treatment. OBJECTIVES Our objective is to underline and nuance the metrological qualities of the ADI-R and the ADOS in the differential diagnosis of autistic disorders by presenting a synthesis of recent studies, thus supporting the interest of maintaining an open debate on diagnostic practices. METHODS Our selective review of the recent literature focuses on studies that confront the ADI-R and the ADOS - used either independently or in a combination - with various differential issues in adulthood and childhood autism in order to highlight their qualities and limits. RESULTS The ADI-R is a semi-structured interview applied by trained examiners and applied to relatives and/or caregivers who collect developmental information about the patient's first years of life on a variety of behaviors and skills. It is therefore relatively dependent on the availability and personal bias of the interviewed third parties. Metric features highlighted by the reviewed studies straightforwardly reveal a certain effectiveness of the tool and a good discrimination of childhood disorders. At the same time, the tool's discriminatory capacity seems insufficient when applied to toddlers, very young children, and adults alike. The latter seems particularly true when it comes to differentiating between autistic and schizophrenic spectrum disorders. The ADOS is a semi-structured standardized observation assessment tool that has experienced several successive developments, such as optimizations concerning the sensitivity of its cutoffs. Many works have contributed to building such a tool with reliable and solid metric qualities which nevertheless retain important biases such as the subjectivity of the caregiver or the evaluator during the scoring process. For assessments of autistic children the tool still has a good diagnostic validity but seems to retain cases of incorrect diagnosis of ASD (false positives). In other words, disorders or developmental disabilities of some children and adolescents could not be distinguished from ASD when relying on this test alone. The ADOS Module 4, designed for the diagnosis of adolescents and adults with fluent speech, has undergone less updating. This revisited algorithm has metrological qualities useful for clinicians and remains one of the few available tools for this population. Unfortunately, its diagnostic accuracy is lower when applied to women, the elderly, people with personality disorders or higher intellectual abilities, or for the discrimination between ASD and schizophrenia. Overall, scores from these two instruments bring strong evidence of their usefulness in the diagnostic process of ASD, provided that they are used with caution and a critical clinical perspective, and only as a secondary technical support. Their use in combination is effective since they are complementary and compensate for each other's limitations. However, their globalized hegemony as "gold-standard" tools constitutes a setback insofar as it constrains the diagnosis of ASD to a set of stereotyped items. The latter in turn sets a normative model of autism that excludes other phenotypic forms, especially in the case of women and the elderly. Finally, the discrimination between autism and psychosis for children seems to remain an insoluble task even for the ADI-R/ADOS combination. CONCLUSIONS The problematics of differential diagnosis remain critical for clinical approaches to autism. Therefore, formalizations of the diagnostic procedures must be able to remain open-minded and accompanied by a creative clinical approach, especially in the case of complex situations that are not soluble by means of conventional diagnostic tools. One possibility may lie in the deepening of the phenomenological approach to autism as an attempt to model the subjective phenomena of autistic subjects and thus operationalize elements that serve the diagnostic process. In the same way, a psychodynamic epistemology could help clinicians to go beyond the consideration of observable behaviors and scores, introducing a psychoanalytic point of view that interfaces objective behaviors with the individual's dynamic intrapsychic functioning. This project could be articulated with projective methodologies - notably the Rorschach test - which respects the needs for standardization and quantification of conventionally used diagnostic tools.
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15
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Assessing Autism in Adults: An Evaluation of the Developmental, Dimensional and Diagnostic Interview-Adult Version (3Di-Adult). J Autism Dev Disord 2019; 48:549-560. [PMID: 29116420 PMCID: PMC5807495 DOI: 10.1007/s10803-017-3321-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We developed a brief, informant-report interview for assessing autism spectrum conditions (ASC) in adults, called the Developmental, Dimensional and Diagnostic Interview-Adult Version (3Di-Adult); and completed a preliminary evaluation. Informant reports were collected for participants with ASC (n = 39), a non-clinical comparison group (n = 29) and a clinical comparison group (n = 20) who had non-autistic mental health conditions. Mean administration time was 38 min (50 min for ASC). Internal consistency (αs ≥ 0.93) and inter-rater agreement (ICCs ≥ 0.99) were high. When discriminating ASC from non-ASC, the 3Di-Adult showed excellent sensitivity (95%) and specificity (92%). The 3Di-Adult shows promise as a psychometrically sound and time-efficient interview for collecting standardised informant reports for DSM-5 assessments of ASC in adults, in research and clinical practice.
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16
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De Crescenzo F, Postorino V, Siracusano M, Riccioni A, Armando M, Curatolo P, Mazzone L. Autistic Symptoms in Schizophrenia Spectrum Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2019; 10:78. [PMID: 30846948 PMCID: PMC6393379 DOI: 10.3389/fpsyt.2019.00078] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/04/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Recent studies have examined the association between autism spectrum disorder and schizophrenia spectrum disorders, describing a number of cognitive features common to both conditions (e.g., weak central coherence, difficulties in set-shifting, impairment in theory of mind). Several studies have reported high levels of autistic symptoms in population with schizophrenia spectrum disorders. Our study systematically reviews and quantitatively synthetizes the current evidence on the presence of autistic symptoms in individuals with schizophrenia spectrum disorders. Methods: A comprehensive literature search of the PubMed/MEDLINE, Cochrane Library, CINHAL, and Embase databases was performed from the date of their inceptions until March 2018. The primary outcome measure was the Autism Spectrum Quotient (AQ). As secondary outcome measures, we analyzed the AQ subscales. Data were extracted and analyzed by using a conservative model and expressed by standardized mean difference (SMD). Results: Thirteen studies comprising a total of 1,958 individuals were included in the analysis. Results showed that individuals with schizophrenia spectrum disorders have higher levels of autistic symptoms compared to healthy controls [SMD: 1.39, 95% confidence interval (CI): 1.11 to 1.68] and lower levels of autistic symptoms compared to individuals with autism (SMD: -1.27, 95% CI: -1.77 to -0.76). Conclusions: Current findings support that individuals with schizophrenia spectrum disorders have higher autistic symptoms than healthy controls. Therefore, further studies are needed in order to shed light on the association between these two conditions.
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Affiliation(s)
- Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Pediatric University Hospital-Department, Bambino Gesù Children's Hospital, Rome, Italy.,Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Valentina Postorino
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, JFK, Aurora, CO, United States.,Brain and Body Integration - Mental Health Clinic, Denver, CO, United States
| | - Martina Siracusano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Assia Riccioni
- Child Neurology and Psychiatry Unit, System Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Marco Armando
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, System Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, System Medicine Department, University of Rome Tor Vergata, Rome, Italy
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17
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Barlati S, Deste G, Gregorelli M, Vita A. Autistic traits in a sample of adult patients with schizophrenia: prevalence and correlates. Psychol Med 2019; 49:140-148. [PMID: 29554995 DOI: 10.1017/s0033291718000600] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Schizophrenia and autism spectrum disorder (ASD) are currently conceptualized as distinct disorders. However, the relationship between these two disorders has been revisited in recent years due to evidence that they share phenotypic and genotypic expressions. This study aimed to identify ASD traits in patients with schizophrenia, and to define their demographic, psychopathological, cognitive and functional correlates. METHOD Seventy-five schizophrenia patients (20 females, mean age 42 ± 12) were evaluated with the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). Participants were also assessed with clinical, neuropsychological, and psychosocial functioning measures. RESULTS Of the 75 patients, 47 were negative to all the autism scales administered (ADOS-TOT-NEG), 21 patients were positive to the ADOS Language sub-domain (ADOS-L-POS), 21 patients were positive to the ADOS Reciprocal Social Interaction (RSI) sub-domain (ADOS-RSI-POS), 14 patients were positive to the ADOS Total scale (ADOS-TOT-POS), and nine patients were positive to the ADI-R scale (ADI-R-POS). Demographic (duration of illness), psychopathological (negative symptoms and general psychopathology), and cognitive (working memory and processing speed) differences emerged between schizophrenic patients with and without ASD traits, while no differences in psychosocial functioning were detected. Results of this study indicate the existence, in a sample of patients with a diagnosis of schizophrenia, of a distinct group of subjects with ASD features, characterized by specific symptomatological and cognitive profile. CONCLUSIONS These findings may contribute to better characterize patients with schizophrenia in order to develop new procedures and therapeutic tools in a more personalized perspective.
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Affiliation(s)
- S Barlati
- Department of Mental Health,ASST Spedali Civili of Brescia,Italy
| | - G Deste
- Department of Mental Health,ASST Spedali Civili of Brescia,Italy
| | - M Gregorelli
- Center Diagnosis Care and Autism Research (CDRA),ULSS 9 Scaligera,Verona Italy; "Luna" Association Onlus,Brescia,Italy
| | - A Vita
- Department of Mental Health,ASST Spedali Civili of Brescia,Italy
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18
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Zheng Z, Zheng P, Zou X. Association between schizophrenia and autism spectrum disorder: A systematic review and meta-analysis. Autism Res 2018; 11:1110-1119. [PMID: 30284394 DOI: 10.1002/aur.1977] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/27/2018] [Accepted: 05/28/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Zhen Zheng
- Department of Pediatrics, The Third Affiliated Hospital; Sun Yat-sen University; Guangzhou Guangdong 510630 China
| | - Peng Zheng
- Department of Science and Technology; South China Agricultural University; Guangzhou Guangdong 510642 China
| | - Xiaobing Zou
- Department of Pediatrics, The Third Affiliated Hospital; Sun Yat-sen University; Guangzhou Guangdong 510630 China
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19
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Naguy A, Naguy CA. Autism/schizophrenia spectrum disorder interface-the nosological limbo. Asian J Psychiatr 2018; 37:78-79. [PMID: 30149284 DOI: 10.1016/j.ajp.2018.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/29/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Ahmed Naguy
- Al-Manara CAP Centre, Kuwait Centre of Mental Health, Jamal Abdul-Nassir St, Shuwaikh, State of Kuwait.
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20
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[Asperger Syndrome and/or Clinical High Risk of Psychosis? A Differential Diagnostic Challenge]. Prax Kinderpsychol Kinderpsychiatr 2018; 67:274-293. [PMID: 29546821 DOI: 10.13109/prkk.2018.67.3.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Asperger Syndrome and/or Clinical High Risk of Psychosis? A Differential Diagnostic Challenge This case-study deals with the often difficult differential diagnosis of Asperger syndrome and a clinical high risk state of psychosis, in particular as indicated by attenuated psychotic symptoms, as well as with its therapeutic implications. The presented case is a 10-year old girl, who has not been diagnosed with an autism spectrum disorder before being referred to a specialized center for early detection of psychosis due to possible hallucinatory experiences and delusional ideas. We demonstrate how to perform a context-sensitive differential diagnosis to distinguish between specific interests as well as related behaviors and unusual thought content as well as perceptive abnormalities, between paranoid ideas and biased interpretations of the behaviors of others typical for autism, and between disorganized symptoms and autistic unusual communication and social behavior. The resulting dual diagnoses in our case-study formed the basis for a complex differential indication, which considered both the increased stress vulnerability associated with an increased risk for the development of psychosis as well as the rigid thinking style associated with autism. Our case-report shows that such a precise differential indication can lead to stabilization over the long-term, even in patients with dual diagnoses.
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21
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Lugo Marín J, Alviani Rodríguez-Franco M, Mahtani Chugani V, Magán Maganto M, Díez Villoria E, Canal Bedia R. Prevalence of Schizophrenia Spectrum Disorders in Average-IQ Adults with Autism Spectrum Disorders: A Meta-analysis. J Autism Dev Disord 2017; 48:239-250. [DOI: 10.1007/s10803-017-3328-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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22
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What is the prevalence of autism spectrum disorder and ASD traits in psychosis? A systematic review. Psychiatry Res 2017; 250:99-105. [PMID: 28152400 DOI: 10.1016/j.psychres.2017.01.017] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/15/2016] [Accepted: 01/06/2017] [Indexed: 11/24/2022]
Abstract
There is increasing evidence to suggest both a symptomatic overlap and a clinically significant degree of co-occurrence between Autism Spectrum Disorders (ASD) and psychotic disorders such as schizophrenia but the nature of such relationships remain unclear. We reviewed the literature reporting prevalence rates of Autistic-like Traits (ALTs) and ASD in populations with a diagnosis of schizophrenia or other psychotic disorder. A search of three large databases was conducted and from this seven studies met the criteria for inclusion. The point prevalence rates for ALTs ranged from 9.6% to 61%, whilst the prevalence rates for diagnosed ASD ranged from <1% to 52% across outpatient and inpatient populations. This suggests that prevalence rates of ALTs and ASD in psychosis populations are much higher than in the general population. This has important implications regarding future research, and clinical implications in terms of ensuring that patients receive the most appropriate diagnosis and treatment.
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Davidson CJ, Kam A, Needham F, Stansfield AJ. No exclusions – developing an autism diagnostic service for adults irrespective of intellectual ability. ADVANCES IN AUTISM 2015. [DOI: 10.1108/aia-08-2015-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Autism is a spectrum condition, yet many autism services limit access based on IQ score. The Department of Health 2009 enabled enthusiastic clinicians in Leeds with a strong interest in autism to apply for funding to develop an all IQ adult autism diagnostic service and here we present the experience. The paper aims to discuss this issue.
Design/methodology/approach
– The process of establishing and then expanding the service is described. Details of the diagnostic pathway and tools used are provided.
Findings
– The number of referrals was higher than expected – a baseline of 20 per year rose to 150 per year as soon as the service opened. Other unexpected findings include relatively low diagnosis rates (32 per cent), high rates of past trauma and patient dissatisfaction when a diagnosis of autism is not given.
Originality/value
– To date, the service has assessed 517 patients, and plans are underway to collaborate with the local adult ADHD team to form a unified adult neurodevelopmental disorders service.
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Chisholm K, Lin A, Abu-Akel A, Wood SJ. The association between autism and schizophrenia spectrum disorders: A review of eight alternate models of co-occurrence. Neurosci Biobehav Rev 2015; 55:173-83. [PMID: 25956249 DOI: 10.1016/j.neubiorev.2015.04.012] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/30/2015] [Accepted: 04/25/2015] [Indexed: 01/06/2023]
Abstract
Although now believed to be two distinct disorders, autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD) share multiple phenotypic similarities and risk factors, and have been reported to co-occur at elevated rates. In this narrative review, we give a brief overview of the phenomenological, genetic, environmental, and imaging evidence for the overlap between ASD and SSD, highlighting similarities and areas of distinction. We examine eight possible alternate models of explanation for the association and comorbidity between the disorders, and set out a research agenda to test these models. Understanding how and why these disorders co-occur has important implications for diagnosis, treatment, and prognosis, as well as for developing fundamental aetiological models of the disorders.
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Affiliation(s)
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Rd, Subiaco, WA, 6008, Australia
| | - Ahmad Abu-Akel
- School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Stephen J Wood
- School of Psychology, University of Birmingham, Edgbaston, B15 2TT, UK; Melbourne Neuropsychiatry Centre, National Neuroscience Facility, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Vic, 3053, Australia
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