Abstract
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. 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). 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. 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.
Highlights
Since the concept of ‘autism’ was conceived by Bleuler in 1911 (Bleuler, 1950), it has been intertwined with the diagnosis of schizophrenia and evolved from a central feature of severe psychotic disorders (PD) to a separate spectrum of clinical disorders
The literature suggests that autism spectrum disorders (ASD) and PD still co-occur more frequently than one would expect based on the prevalence rates in the general population, which gravitate around 1% for both (Chisholm, Lin, Abu-Akel, & Wood, 2015)
The primary aim of the current study was to establish the prevalence of autistic traits in a substantial group of PD individuals compared to their unaffected siblings with a familial risk for PD (FR) and a typical comparison (TC) group
Summary
Since the concept of ‘autism’ was conceived by Bleuler in 1911 (Bleuler, 1950), it has been intertwined with the diagnosis of schizophrenia and evolved from a central feature of severe psychotic disorders (PD) to a separate spectrum of clinical disorders. Recent efforts have focused more on dimensional rather than categorical approaches, under the assumption that both conditions represent extremes on a continuum of symptomatic severity, and that even isolated or low-intensity traits may affect clinical outcomes Such studies have provided further evidence that autistic and psychotic traits co-occur at an elevated behavioral level in clinical samples 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 It is unknown whether the presence of comorbid autism traits disproportionally affects the cognitive and behavioral aspects of social functioning in PD.
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