Insular pathology in young people with high-functioning autism and first-episode psychosis

BACKGROUND

Autism Spectrum Disorders (ASD) and psychosis share deficits in social cognition. The insular region has been associated with awareness of self and reality, which may be basic for proper social interactions.

METHODS

Total and regional insular volume and thickness measurements were obtained from a sample of 30 children and adolescents with ASD, 29 with early onset first-episode psychosis (FEP), and 26 healthy controls (HC). Total, regional, and voxel-level volume and thickness measurements were compared between groups (with correction for multiple comparisons), and the relationship between these measurements and symptom severity was explored.

RESULTS

Compared with HC, a shared volume deficit was observed for the right (but not the left) anterior insula (ASD: p = 0.007, FEP: p = 0.032), and for the bilateral posterior insula: (left, ASD: p = 0.011, FEP: p = 0.033; right, ASD: p = 0.004, FEP: p = 0.028). A voxel-based morphometry (VBM) conjunction analysis showed that ASD and FEP patients shared a gray matter volume and thickness deficit in the left posterior insula. Within patients, right anterior (r = -0.28, p = 0.041) and left posterior (r = -0.29, p = 0.030) insular volumes negatively correlated with the severity of insight deficits, and left posterior insular volume negatively correlated with the severity of 'autistic-like' symptoms (r = -0.30, p = 0.028).

CONCLUSIONS

The shared reduced volume and thickness in the anterior and posterior regions of the insula in ASD and FEP provides the first tentative evidence that these conditions share structural pathology that may be linked to shared symptomatology.

Movie for the Assessment of Social Cognition (MASC): Spanish validation

We present the Spanish validation of the "Movie for the Assessment of Social Cognition" instrument (MASC-SP). We recruited 22 adolescents and young adults with Asperger syndrome and 26 participants with typical development. The MASC-SP and three other social cognition instruments (Ekman Pictures of Facial Affect test, Reading the Mind in the Eyes Test, and Happé's Strange Stories) were administered to both groups. Individuals with Asperger syndrome had significantly lower scores in all measures of social cognition. The MASC-SP showed strong correlations with all three measures and relative independence of general cognitive functions. Internal consistency was optimal (0.86) and the test-retest was good. The MASC-SP is an ecologically valid and useful tool for assessing social cognition in the Spanish population.

Attitude and risk of substance use in adolescents diagnosed with Asperger syndrome

BACKGROUND

Adolescence is a stage of development with increased risk of drug use. Individual personality traits are among those factors that influence the onset of substance use in adolescence and its psychiatric comorbidity. Little research has been done on the comorbidity between substance abuse risk and Asperger syndrome, and none specifically in adolescence. The objective of this study is to assess the risk of drug use by adolescents with Asperger syndrome and compare it with that risk in control subjects. A secondary objective was to analyze the personality factors that may be associated with substance use in the same two groups.

METHODS

We used three self-administered questionnaires, one for drug risk assessment (FRIDA) and the other two for personality trait assessment (MACI and SSS-V).

RESULTS

Adolescents diagnosed with Asperger syndrome are at less risk for drug use derived from family and access to drugs factors. Subjects with Asperger syndrome did score higher on introversive, inhibited, doleful, and borderline tendency prototypes than healthy controls, and scored lower on all sensation-seeking traits. Being male, a diagnosis of Asperger syndrome, and unruly, introversive, and sensation-seeking traits were all independently associated with the risk of drug abuse.

CONCLUSIONS

Both identified personality factors and other variables associated with the Asperger syndrome contribute to the low risk of drug abuse observed in this population. Exploring protective factors for drug use in these subjects may prove useful for interventions with adolescents at risk for consumption.

Autism, the big unkown

Autism is a common disorder of childhood. Yet, it often remains unrecognized and undiagnosed until or after late preschool age because appropriate tools for routine developmental screening and screening specifically for autism have not been available. Paediatricians have an important role in early recognition and evaluation of autism spectrum disorders because they usually are the first point of contact for parents. It is important that paediatricians are able to recognize the signs and symptoms of autism spectrum disorders and have a strategy for assessing them systematically. But paediatricians have also a role in chronic management of these disorders. The objective of this paper is to show a general view of the autism spectrum disorders (ASD) state of knowledge nowadays as well to stress the need of early detection and treatment of these disorders in order to improve better evolution and prognosis.

[Epidemiological research in autism: an integrative view]

INTRODUCTION

Sixty years after the first descriptions of Autism, the same diagnostic criteria based on clinical observation used then are still valid today. Two years ago, the Instituto de Salud Carlos III set up the Grupo de Estudio en los Trastornos del Espectro Autista (Autism Spectrum Disorders Study Group) with the aim of evaluating the current state of research in autism spectrum disorders (ASD) in Spain. This group established collaborative links with different associations and set up a way of working that was more coordinated and closer to the real day-to-day situation experienced by the families involved.

AIMS AND DEVELOPMENT

The aim of this review is to update certain areas of knowledge concerning the distribution of the factors that determine ASD, that is to say, about the epidemiology of these disorders. At the same time, it intends to arouse a greater degree of interest among professionals who are more directly involved in the study of pervasive developmental disorders. The latest diagnostic tools offer a higher degree of certainty in the complicated process of evaluating a case with symptoms of autism. Nevertheless, given the effectiveness of early attention and how it affects the prognosis, population-based ASD screening programmes must be implemented. These would have to include the use of Modified Check List for Autism in Toddlers (M-CHAT)-type questionnaires, followed by several levels of diagnosis, in order to reduce the number of false positives while at the same time increasing the true positives.

[Subtraction scintigraphy with thallium-201 chloride and technetium-99m pertechnetate versus high resolution ultrasonography in the localization of the parathyroid glands in primary hyperparathyroidism]

BACKGROUND

The aim of this study was to evaluate the use of scintigraphy with thallium-201 chloride (201 Tl) and technetium-99m pertechnetate (99mTc) in the diagnosis of the localization of the pathological parathyroid glands in primary hyperparathyroidism and compare the results with those of high resolution ultrasonography.

METHODS

Twelve patients of 56.1 +/- 7.8 years of age diagnosed with primary hyperparathyroidism were studied between March 1987 and June 1990. High resolution ultrasonography with a 7.5 MHz transducer and scintigraphy of digital subtraction with 201Tl-99mTc were carried out preoperatively in all the patients. None of the patients had had previous cervical surgery and diagnosis was proven following surgery by histopathologic study.

RESULTS

Ultrasonography detected 9 out of 11 adenomas and 3 out of 4 hyperplastic glands. Scintigraphy identified 9 adenomas and only 2 of the hyperplastic glands. With this latter technique there was one false positive. The sensitivity of ultrasonography was 80% and that of scintigraphy was 73% with specificity being 100% vs 96.9%, respectively.

CONCLUSIONS

Subtraction 201 Tl-99mTc scintigraphy is useful in the diagnosis of the localization of pathologic parathyroid glands in patients with no previous cervical surgery although in this series this technique did not surpass that of high resolution ultrasonography.