Autism Spectrum Disorder in a Patient with Bipolar Disorder and Its Relationship with Catatonia Spectrum: A Case Study

Abstract

According to several studies, the prevalence of Autism Spectrum Disorder (ASD) ranges from 2.4 to 9.9 percent among adult mental inpatients. However, subjects with forms of ASD that fit in the high functioning spectrum may remain undiagnosed during childhood and adolescence without reaching clinical attention until they develop in adult life other psychiatric disorders, often characterized by treatment resistance and poor outcomes. The aim of this case report was to evaluate the role of an undiagnosed ASD in the mental illness trajectory and discuss the diagnostic and therapeutic implications. We reported a case of a young man with an undiagnosed ASD that came to clinical attention only after the development of a severe manic episode with mixed and psychotic features and with catatonia in adulthood, despite meeting DSM-5-TR (APA, 2022) diagnostic criteria for ASD since early childhood. This case confirms the need of a timely identification of ASD in order to prevent the development of a mental illness trajectory and to improve the prognosis and the outcome. Moreover, on the heuristic level, this case seems to support the presence of a continuum between ASD and catatonia. In this framework, the use of a questionnaire based on a spectrum model, such as the AdAS Spectrum, could be useful in early diagnosis of ASD without intellectual or language impairment as well as in early detection of subthreshold conditions (broad autism spectrum phenotype or autistic traits), which represents a vulnerability factor for the development of various mental disorders.

Exploring clozapine use in severe psychiatric symptoms associated with autism spectrum disorder: A scoping review

“…Besides benefiting depression, mania, and mixed states, clozapine also alleviated severe mood dysregulation, impulsivity, and self-injurious behaviors (Atlas and Gerbino-Rosen, 1995). It is worth noting that three ASD patients with suicidal behavior benefited from clozapine treatment (Dell'Osso et al, 2023;Rhee et al, 2022;Słopień et al, 2017).…”

Case report: hikikomori syndrome in Italy and its link with autistic traits and internet gaming disorder

“…In particular, some authors highlighted how hikikomori and IGD may reinforce each other in a vicious circle, with hikikomori condition opening the way to the use of internet as a tool to communicate with the outside world and escaping towards videogames, while IGD would enhance the tendency towards social withdrawal for spending more time playing ( 26 , 27 ). It has also been highlighted that hikikomori co-occurs in around one-third of those with autism spectrum disorder (ASD), which, in turn, has been associated with IGD ( 14 , 25 , 27 – 31 ).…”

“…Even though ASD and hikikomori may share some symptomatologic overlap such as deficits in social reciprocity and social withdrawal and, eventually, restricted and intensively pursued interests, to date the relationship between the two is still poorly investigated in the scientific literature ( 27 ). In this framework, it should be noted that a comorbidity with IGD has been reported for both conditions ( 27 ). Some studies highlighted that subject diagnosed with hikikomori reports higher AT, showing lower social skills and deficits in communication, imagination, attention span, multitask ability and adaptation to change compared to healthy controls ( 49 ), while ASD dysfunctional social interaction, causing deficiencies in introspectiveness and problem-solving strategies, may lead to a low self-esteem and social withdrawal ( 49 , 50 ).…”

“…In fact, hikikomori is now known to be comorbid with many psychiatric disorders including various anxiety disorders, major depression, personality disorders, internet addiction and internet gaming disorder (IGD) (10,(22)(23)(24)(25). In particular, some authors highlighted how hikikomori and IGD may reinforce each other in a vicious circle, with hikikomori condition opening the way to the use of internet as a tool to communicate with the outside world and escaping towards videogames, while IGD would enhance the tendency towards social withdrawal for spending more time playing (26,27). It has also been highlighted that hikikomori cooccurs in around one-third of those with autism spectrum disorder (ASD), which, in turn, has been associated with IGD (14,25,(27)(28)(29)(30)(31).…”

“…Noticeably, AT have been linked to a worse quality of life and a greater risk of suicidality, even at subthreshold levels (37,(45)(46)(47)(48). Even though ASD and hikikomori may share some symptomatologic overlap such as deficits in social reciprocity and social withdrawal and, eventually, restricted and intensively pursued interests, to date the relationship between the two is still poorly investigated in the scientific literature (27). In this framework, it should be noted that a comorbidity with IGD has been reported for both conditions (27).…”