Polysubstance and Behavioral Addictions in a Patient with Bipolar Disorder: Role of Lifetime Subthreshold Autism Spectrum

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.

Sex Differences in the Relationship between PTSD Spectrum Symptoms and Autistic Traits in a Sample of University Students

“…Moreover, we found a prevalence of 17.1% of subjects that endorsed all the symptomatological criteria for PTSD (criteria B-E), with a significantly higher rate among AdAS Spectrum high scorers and without sex differences. The presence of higher trauma- and stress-related spectrum symptoms among subjects with AT is in line with previous literature, which reports that AT may be considered a consistent vulnerability factor for adjustment disorders and PTSD [5, 22, 30, 32, 35, 37, 43, 85]. From this point of view, our results seem to suggest that some subjects may suffer from a PTSD-like symptomatology even if they do not have a history of major traumatic events, as conceptualized yet by the Complex PTSD (cPTSD) model [41].…”

The broad autism phenotype in real-life: clinical and functional correlates of autism spectrum symptoms and rumination among parents of patients with autism spectrum disorder

“…2,4 More recently, increasing literature is stressing that subthreshold autism spectrum symptoms seem to be continuously distributed in general population, and in particular in some high-risk groups, such as university students, as well as among clinical samples of patients with other psychiatric disorders, where AT are generally associated with higher severity and with increased suicide ideation and behaviors. [35][36][37][38][39][40][41][42][43][44][45][46][47] Although in literature the impact of AT in global functioning has been investigated in general population, [48][49][50][51] studies among parents of ASD children generally focused mainly on work and social adjustment related to the burden to raise a child with ASD, rather than on the functional impairment related to their own AT. 52 On the other hand, the prevalence of psychiatric conditions has been investigated also among relatives of ASD probands, highlighting an increased risk for mood disorders: one of the firsts studies in the field was led by Delong and Dwyer, 53 who found a higher rate of mood disorders in relatives of ASD children with respect to the general population.…”

Overlapping features between social anxiety and obsessive-compulsive spectrum in a clinical sample and in healthy controls: toward an integrative model

“…62 This clue is particularly interesting considering the increasing body of studies suggesting a possible role of AT as a promoting factor for different psychiatric conditions. [63][64][65][66][67][68][69][70] As Dell'Osso et al 63,71 pointed out, ruminative thinking, often associated with subthreshold AT, could be considered as a common transnosological underpinning of several different psychiatric disorders that may affect prognosis and increase the risk of chronic course and suicidality. According to this paradigm, our study may contribute in supporting the dimensional association between depressive ruminations, SAD and OCD subthreshold symptoms, considering the high correlations, found also in MDD patients and in HC, between doubt and interpersonal sensitivity.…”