According to Jaspers ( 16), there are three crucial criteria to define delusions: (1) subjective certainty, incomparable to other convictions (2) imperviousness to counterarguments (3) implausibility of content. In particular, we discuss the clinical presentation of four dimensions that must be considered crucial to recognize psychosis in ASD: (1) delusions, (2) hallucinations, (3) negative symptoms, and (4) clinical course of both disorders.ĭelusions are defined as “fixed beliefs that are not amenable to change in light of conflicting evidence” ( 15). In this paper, we analyze from a clinical and phenomenological point of view the occurrence of psychosis or attenuated psychotic symptoms in ASD individuals. Moreover, psychotic and autistic subthreshold or attenuated symptoms, can make even more difficult to recognize the two comorbid disorders ( 11). The expression of autistic core symptoms may vary significantly among ASD patients and may be influenced by the disorder's age of onset. Precisely because of this high comorbidity rate between ASD and SCZ, many authors hypothesized the existence of a significant psychotic vulnerability in patients with neurodevelopmental disorders: in particular, impairments in information processing are common in ASD and may favor the risk for a transition to psychosis ( 12). According to literature, up to 34.8% of the patients with a diagnosis of ASD can show psychotic symptoms and, similarly, autistic traits have been reported in schizophrenia patients (SCZ) in a percentage ranging between 3.6 and 60% ( 12).Īutism 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).īoth ASD and SCZ occur along a phenotypic continuum of clinical severity and are susceptible to common environmental risk factors such as advanced paternal age, pregnancy and birth complications, migration status ( 12). There is strong evidence for the existence of high rates of comorbidity between autism and psychosis ( 11). However, 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). 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). 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. 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. 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. 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. 8% and several significant implications for treatment and prognosis of these patients. There is strong evidence for the existence of a high comorbidity between autism and psychosis with percentages reaching up to 34. 7IRCCS–Fondazione Santa Lucia, Rome, Italy.6Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.5Child Neurology and Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.4Department of Mental Health, Azienda Sanitaria Locale (ASL) Roma 1, Rome, Italy.3Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy.2Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.1Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy.Michele Ribolsi 1 * Federico Fiori Nastro 2,3 Martina Pelle 2,3 Caterina Medici 2,3 Silvia Sacchetto 2,3 Giulia Lisi 4 Assia Riccioni 5 Martina Siracusano 6 Luigi Mazzone 5 Giorgio Di Lorenzo 2,3,7
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