Abstract
There is strong evidence for the existence of a high comorbidity between autism and psychosis with percentages reaching up to 34. 8% and several significant implications for treatment and prognosis of these patients. However, the identification of comorbid psychosis in patients with Autism Spectrum Disorder represents a complex challenge from a psychopathological point of view, in particular in patients with greater deficits in verbal communication. Intercepting the onset of a psychotic breakdown in autism may be very difficult, both disorders in fact occur along a phenotypic continuum of clinical severity and in many cases, psychotic symptoms are present in an attenuated form. In this paper, we reviewed the available scientific literature about comorbidity between psychosis and autism, focusing our attention on four specific dimensions: delusions, hallucinations, negative symptoms, and clinical course. The aim of this paper is to provide clinical tools to identify these psychotic phenomena in autistic patients, even when they occur in their attenuated form.
Highlights
If historically schizophrenia and autism were judged to be closely related [1], subsequently, through epidemiological studies, these two syndromes have been reconsidered as two distinct entities, each with its own characteristics, clinical course, and typical onset [2–6]
We used a search strategy based on a combination of the following terms: [(autism) AND OR OR OR OR] AND [(asperger) AND OR OR OR OR]
The inclusion criteria were: [1] Time: the systematic review included published articles conducted between January 1, 1970, and August 1, 2021; [2] Study participants: we selected papers that studied patients with Schizophrenia Spectrum Disorders and Autism Spectrum Disorders with or without psychotic features; [3] Studies that evaluated the degree of four clinical dimensions: hallucinations, delusions, negative symptoms, and clinical course of both disorders
Summary
If historically schizophrenia and autism were judged to be closely related [1], subsequently, through epidemiological studies, these two syndromes have been reconsidered as two distinct entities, each with its own characteristics, clinical course, and typical onset [2–6]. There is a growing number of studies that focus their attention on the link between schizophrenia and autism spectrum disorders (ASD), finding significant overlaps in genetic studies, neuroimaging data, clinical signs, and cognitive features [7–10]. Up to 34.8% of the patients with a diagnosis of ASD can show psychotic symptoms and, autistic traits have been reported in schizophrenia patients (SCZ) in a percentage ranging between 3.6 and 60% [12]. Autism spectrum disorder is composed by different levels of complexity, with frequent comorbidity with intellectual disability [13] and recently, there is growing attention on the behavioral equivalents of schizophrenia in people with intellectual disability and autism spectrum disorder [14]
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