Assessment and correlates of autistic symptoms in Schizophrenia Spectrum Disorders measured with the PANSS Autism Severity Score: A systematic review

Abstract

Schizophrenia Spectrum Disorders (SSD) and Autism Spectrum Disorders (ASD) are considered separate entities, but the two spectra share important similarities, and the study of these areas of overlap represents a field of growing scientific interest. The PANSS Autism Score (PAUSS) was recently developed specifically to assess autistic symptoms in people living with SSD reliably and quickly. The aims of the present systematic review were to provide a comprehensive assessment of the use of the PAUSS scale in available literature and to systematically analyze cognitive, functional and neurobiological correlates of autistic symptoms measured with this instrument in SSD. The systematic literature search included three electronic databases (PubMed, Scopus and PsycINFO) as well as a manual search in Google Scholar and in reference lists of included papers. Screening and extraction were conducted by at least two independent reviewers. Out of 213 identified records, 22 articles referring to 15 original studies were included in the systematic review. Studies were conducted in several different countries by independent groups, showing consistent scientific interest in the use of the scale; most works focused on cognitive and functional correlates of ASD symptoms, but some also considered neurobiological features. Results of included studies showed that autistic symptoms in people with SSD are consistently associated with worse cognitive performance, especially in the social cognition domain, and with worse psychosocial functioning. However, the presence of autistic symptoms appears to also have a protective role, particularly on functioning, in subjects with more severe psychotic symptoms. Further exploring the impact of autistic symptoms could be of significant scientific and clinical interest, allowing the development of tailored interventions to improve treatment for people living with SSDs.

Autistic symptoms in unaffected first-degree relatives of people with schizophrenia: results from the Italian Network for Research on Psychoses multicenter study

“…Moreover, the present study did not include a sample of participants drawn from the general population: for this reason, it was not possible to directly compare the prevalence, severity, and the correlates of autistic symptoms measured with the PAUSS in our sample with those of healthy controls without a diagnosis of any mental disorder who were not first-degree relatives of people living with SSD. Finally, while the PAUSS has been extensively validated [27, 48, 52] and employed in several different international studies with large samples of people with SSD [26, 28, 32, 77], more data regarding its clinical specificity, in particular its long-term stability, is currently required [50].…”

“…The PAUSS is a scale composed of eight items ranging one to seven derived from the Positive and Negative Syndrome Scale [49] and has been designed specifically to assess the expression of an autistic phenotype in people with SSD. Included items feature N1 (“blunted affect”), N3 (“poor rapport”), N4 (“social withdrawal”), N5 (“difficulties in abstract thinking”), N6 (“lack of spontaneity and flow of conversation”), N7 (“stereotyped thinking”), G5 (“mannerism”), and G15 (“preoccupation”): these features, rather than assessing the presence and diagnosis of ASD as a distinct neurodevelopmental disorder, explore the severity of difficulties in social interactions and in communication and the limited, repetitive, and stereotypic patterns of behavior that characterize the autistic phenotype in people with SSD [48, 50, 51].…”

“…Its validity and precision have been already demonstrated and found to be satisfying, with the PAUSS strongly correlating with other more established diagnostic tools for the assessment of autistic features and showing even better sensitivity than such scales in measuring autistic symptoms severity in people with SSD [50, 52]. It has also been used to assess genetic and neurobiological correlates of autistic features in people with SSD [53–55] and in first-episode psychosis [32, 56, 57] as well as healthy subjects [58].…”

A Cross-sectional Conceptual Replication and Longitudinal Evaluation of the PANSS-Autism-Severity-Score Measure Suggests It Does Not Capture Autistic Traits in Individuals with Psychosis

“…Although the PAUSS is gaining traction with researchers, 17 it has not yet been fully validated externally. Other than the development paper, validation samples have been small, and cut-offs remain undetermined.…”

Validation and reliability test of Chinese language patient-reported impact of symptoms in schizophrenia scale

“…Hence, this disease requires long-term management to reduce side effects and improve the long-term treatment effect (4)(5)(6). Patients with schizophrenia are monitored at regular intervals using multiple assessment tools to check the effect of the ongoing treatment and changes in care management (7)(8)(9). Each of the tools used to assess the symptoms of schizophrenia patients has priority and assesses only a hand full of symptoms at a time.…”