AUTISM Spectrum Disorders and Suicidality

Michele Raja

doi:10.2174/1745017901107010097

Abstract

The paper describes the suicidal ideation and behavior in a series of 26 adult psychiatric patients affected by Autism Spectrum Disorders (ASDs), the clinical features and the psychiatric comorbidity of patients presenting suicidal behavior, and the history of suicide or suicide attempt in their relatives. Two (7,7%) patients committed suicide. One (3.8%) patient attempted suicide twice, and one (3.8%) patient self-harmed by cutting his face and one finger of his hand with a razor. Eight (30.8%) patients presented suicidal ideation. Two (7.7%) patients had one relative who had attempted suicide, and two (7.7%) patients had one or more relatives who had committed suicide. Most patients with suicidal behavior or ideation presented psychotic symptoms. Although it is not clear whether the high suicidal risk is related with ASDs per se or with psychotic symptoms, a high index of suspicion is warranted in evaluating suicidal risk in patients affected by ASDs, whatever is their age, psychiatric comorbidity, and setting of visit.

Highlights

There are few reports on suicidal behavior among patients with Autism Spectrum Disorders (ASDs)
In order to compare patients with ASDs and patients with other diagnoses, we considered only the 11 patients admitted to the Psychiatric Intensive Care Unit (PICU), because patients visited in the private practice were not always assessed using rating scales
Compared with patients admitted to the PICU who received other diagnoses, patients with ASDs were younger, mostly males, more frequently without children; They were more severely affected at the CGI score, and they had lower current GAF score and best GAF score in the last year, more severe negative symptoms, more retire/retard, and higher vulnerability to motor side effects of treatment with antipsychotics. They had never attempted suicide in the past but had more frequently suicidal ideation (5 out of 10 vs 622 of 1502), even in a not statistically significant way. This is the first study on suicidal behavior in adult patients affected by ASDs

Summary

Introduction

There are few reports on suicidal behavior among patients with Autism Spectrum Disorders (ASDs). Causes of under-reporting may be the low rate of suicidal behavior among children and pre-adolescents and the underdiagnosing of ASDs in the adult psychiatric setting. A systematic review of the literature [2] on the prevalence of suicidal phenomena in adolescents (128 studies, comprising 513,188 adolescents), found that the mean proportion of adolescents reporting having attempted suicide at some point in their lives was 9.7% (95% CI, 8.5-10.9), whilst 29.9% (95% CI, 26.1-33.8) of adolescents said they had thought about suicide at some point. Few studies examined suicidal behavior of children and adolescents affected by ASDs. In a study [3] on 126 children referred to a child psychiatric ward because of suicidal behavior, 123 (97%) were diagnosed as having at least one definite psychiatric diagnosis. Children with suicidal behavior made out 6% of all referred male and females children. 7 boys suffered from psychoses and Pervasive Developmental Disorders (PDDs), whilst the rest of the boys suffered from attention deficit and hyperactivity disorders or mixed disorders of conduct and emotions

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