Abstract
This case report draws attention to the potential relevance of undetected autism spectrum symptoms in a bipolar patient with high work functioning showing a peculiar addictive profile with impulsive and antisocial behaviors. A 23-year-old man with a diagnosis of Bipolar Disorder (BD) and Substance Use Disorder (SUD) was hospitalized at the Psychiatric Clinic of the University of Pisa for diuretics and β-2 adrenergic agonist abuse in a remission phase of benzodiazepines and substance abuse. He reported a history of behavioral addictions in the framework of a global high work functioning with particular skills in computer science. When assessed for adult autism spectrum symptoms, despite not fulfilling a DSM-5 diagnosis of Autism Spectrum Disorder (ASD), he reported a score of 93/240 at the Ritvo Autism and Asperger Diagnostic Scale (RAADS-r) and of 88/160 at the Adult Autism Subthreshold Spectrum (AdAS Spectrum), both indicative of ASD. We argue the possible role of adult subthreshold autism spectrum features, generally disregarded in adult psychiatry, in the peculiar addictive profile developed by this patient with BD that may deserve appropriate treatment.
Highlights
Mental disorders and substance abuse frequently cooccur with about 50% of individuals with severe and persistent mental disorders reporting Substance Use Disorders (SUD)
We presented the case of a 23-year-old man with Bipolar Disorder (BD) type II and SUD in a peculiar addictive profile and a set of impulsive and antisocial behaviors in the context of high work functioning drawing attention to the potential relevance of undetected autism spectrum features
Other psychopathological details resulting in the context of the psychiatric assessment included a Ritvo Autism and Asperger Diagnostic Scale (RAADS-r) total score of 93 and an AdAS Spectrum total score of 88
Summary
Mental disorders and substance abuse frequently cooccur with about 50% of individuals with severe and persistent mental disorders reporting Substance Use Disorders (SUD). Lalanne et al reported two cases of high-functioning autism patients by using alcohol and psychostimulants to cope with their anxiety and to improve their cognitive abilities According to these authors, alcohol use disorder might be even underdiagnosed among such patients, in virtue of the normalizing effect displayed by alcohol on social skills of these patients [17]. Alcohol use disorder might be even underdiagnosed among such patients, in virtue of the normalizing effect displayed by alcohol on social skills of these patients [17] With these observations, a study conducted on 129 ASD or ADHD adults, with and without a history of SUD, proved that, with regard to the social skills level, patients with ASD and comorbid SUD showed less impairment than those without SUD [18].
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