The relationship between psychosis and autism spectrum disorder was present since the first definition of “autism” itself. Indeed, Kanner, in his description of the . The goal of this session is to explore the diverse challenges in assessing and formulating the occurrence of psychotic symptoms in individuals with autism. Despite the fact that people with an autism spectrum condition (ASD) association with genetic risk factors for psychosis than restricted and.
Psychosis Treatment Failure More Common in Patients With ASD
The patient often contacts the old psychiatrist who was in charge of his therapy when he was in the hospital, the psychiatrist remembers him clearly because the patient, since he left the hospital, calls him every day until now and tells him about the same philosophical political topic. So the old psychiatrist recognized a clinical difference in this patient compared with others schizophrenic inpatients During our clinical examination, from the patient do not emerge any perceptive problems or delusions and these symptoms were never even present in the patient history.
We decided, together with his personal doctor, to suspend his neuroleptic therapy and we did not find, in the year after this suspension, any change in his psychic symptoms.
However, his general health conditions were significantly better. This case represents an emblematic misdiagnosis of schizophrenia because the nosographic definition of the Asperger syndrome, described in by Hans Asperger, was not yet diffused in Europe since its translation made by Lorna Wing [ 6 - 8 ]. Thus, patients who received a diagnosis from psychiatrists before this last period were frequently considered part of other diagnostic categories other than ASD and, in primis, schizophrenia.
Autistic pseudo-psychosis In this second case, we describe a patient who, during one examination, started describing us an episode from his life, happened in the December ofwhen he was 17 years old. When he came back home, he became suddenly aggressive toward his parents, taking a knife in his hand and accusing them of mocking him. Because of this realistic reading, he was very angry toward his parents, accusing them of not telling them of this news and also for being responsible of telling him to study, when this activity would not be important i.
After having clarified to the patient the meaning of the movie and the difference between real news on the TV and their representation in the movie, it was possible to observe the sudden disappearing of his aggressive ideas toward his family.
Psychosis Treatment Failure More Common in Patients With ASD
In this case we can observe a typical ASD modality which is represented by the literal and concrete reading of a written story or a fictive event. Reactive paranoid psychosis A 24 years old patient, with a master degree and a brilliant academic history was studying in a specialization course.
In the college where she studied, however, she has rigid and apparently bizarre behaviours. For instance, she used specific colours of her clothes to match specific arguments that she was studying: Since she had different lessons with different arguments during the day, she changed her dresses accordingly i.
Also, in the library she had to sit always in the same place. In the past, students as well as professors made fun of this behaviour until the patient felt a persecutory hyperactivity toward the college and had to go to the psychiatric ward where she received a diagnosis of paranoid schizophrenia.
In patients affected by ASD, and in particular in the Asperger syndrome, the scholastic or work discrimination, is a frequent event and represents a stressful trigger that in turn elicits anxiety, depressive and transient psychotic episodes.
During stressful moments in his life, especially because of his job, his psychiatrist of the CSM had also to admit him to a psychiatric ward because of his persecutory ideas.
From the test evaluation it emerged an MMPI2 profile adherent to the paranoid disorder. From the Rorschach test it emerged a profile adherent to the narcissistic-paranoid classification. From the clinical exam no persecutory delirious idea were observed.
The intellective level was above the norm as observed with the WAIS scale the patient had a master degree [ 10 ].
Interestingly, during the diagnostic evaluation and when the Asperger syndrome and the narcissistic-paranoid personality were explained to the patient, he contested a few single words in the 14 pages that composed the written explanation. In particular, he contested some words related to his relationship with sexuality. However, it also emerges the ingenuity of the Asperger syndrome, along with is high intellect level, when he describes to unknown people his sexual activity.
The presence of these comorbidities rendered really complex the treatment of Asperger syndrome because the narcissistic-paranoid aspects are amplified when he is under the stress of a relationship and when he has to work with other people, and difficulties in relationship are strictly related to Asperger syndrome.
He showed significant schizophrenic symptoms with disorganized-hebephrenic characteristics. He presented yellow fingers from chronic smoke abuse, a language composed by few associative links between concepts, an incongruous affectivity, a sever behavioral disorganization and he also had an history of aggressive episodes e. The diagnosis was of a chronic schizophrenic disorder.
In the patient history, however, it has been described that, since early childhood, he had difficulties in creating relationships with his peers and in the social communication but an early language acquisition 1 year old with fluid and complex words along with clumsiness in his movements, and the need for a fixed and immutable environment. Also, he showed a high intellective level for his age with selective interests, already during childhood, like history and trains and he preferred to play alone than with his peers.
These symptoms were not recognized as a disorder since his adolescence when he began to experience episodes of agitation and persecutory ideas. The patient characteristics during his childhood are the typical ASD characteristics and they were confirmed by the ADI-r test, while the current diagnosis describes a schizophrenic disorder [ 12 ]. Affective psychosis In adolescence a psychotic episode may represent the onset of a bipolar disorder. We describe the case of an ASD with intellectual disabilities and non-verbal communication that in adolescence began to show definite and severe episodes with aggressive behavior, insomnia, sexual hyperactivy with assault against social workers.
He frequently was carried to emergency room of the psychiatric hospital and a several neuroleptic treatment was used.
But after few months the episodes appeared again, in the same way. The improvement of functioning was clearly relevant and the patient began to come back to home during the week-end. It is important to consider the possibility that even in intellectual disabilities a bipolar disorder could be in comorbidity with ASD and that mood stabilizers could improve the disorder.
First, psychotic and autistic disorders where often overlapped. Clinically speaking, in the schizophrenic patients it is possible to often observe autistic-like traits [ 16 ]. For genetic reasons or because of diagnostic confusion, we hypothesise that in individuals with ASD—P both conditions would take a recognisably distinct form, different from the manifestations of either ASD or psychotic illness as it manifests in singly affected populations. Method Written informed consent was obtained from all participants prior to study procedures taking place.
Individuals aged 16 or older were considered eligible to give consent for themselves. Where participants were found to lack capacity to consent to participate in research, advice from an informant who knew them well, such as a family member, was obtained in accordance with UK law.
They were initially identified and referred to the study by clinicians in services across the UK, through charities and by self-referral. The sample size in this study represents the maximum number of eligible individuals recruited within a constrained time period and was not determined by formal sample-size calculation.
Recruitment was undertaken by a number of different agencies, and it was not possible to know the number of individuals invited to take part but who did not respond.
None of those who consented to participate withdrew. A maximum of one point below threshold on any one of three ADI-R diagnostic scales was accepted as indicative of ASD for individuals with no clinical diagnosis of ASD, as in all cases of referral ASD was suspected by the person's clinical team. Details of the participants' age at administration of the ADI-R was obtained; in all but one individual the ADI-R was conducted on enrolment in the study.
History of a comorbid psychotic illness was determined in two stages. Participants were initially included if they had a prior clinical diagnosis of psychotic illness or gave an account of an episode that was clearly psychotic.
Their participation was subsequently confirmed if psychotic symptoms were elicited by F. In two cases, neither the participant nor an informant was available. L or by a trained member of a research network. Participants were considered to have research-significant psychosis if they met criteria for a disorder with features of psychosis ICD FF39 diagnoses that include psychosis in the description on any one of the three algorithms.
In practice, there was little confusion between symptoms of ASD and of psychosis in our participants. Psychosis was always associated with a change from previous functioning and rarely involved a person's special interests or repetitive behaviours. Additionally, the psychotic illnesses described had all been treated by experienced mental health professionals.
It comprised individuals with clinically relevant psychosis.