Psychosocial functioning in the balance between autism and psychosis: evidence from three populations

Abstract

Functional impairment is a core feature of both autism and schizophrenia spectrum disorders. While diagnostically independent, they can co-occur in the same individual at both the trait and diagnostic levels. The effect of such co-occurrence is hypothesized to worsen functional impairment. The diametric model, however, suggests that the disorders are etiologically and phenotypically diametrical, representing the extreme of a unidimensional continuum of cognition and behavior. A central prediction of this model is that functional impairment would be attenuated in individuals with mixed symptom expressions or genetic liability to both disorders. We tested this hypothesis in two clinical populations and one healthy population. In individuals with chronic schizophrenia and in individuals with first episode psychosis we evaluated the combined effect of autistic traits and positive psychotic symptoms on psychosocial functioning. In healthy carriers of alleles of copy number variants (CNVs) that confer risk for both autism and schizophrenia, we also evaluated whether variation in psychosocial functioning depended on the combined risk conferred by each CNV. Relative to individuals with biased symptom/CNV risk profiles, results show that functional impairments are attenuated in individuals with relatively equal levels of positive symptoms and autistic traits—and specifically stereotypic behaviors—, and in carriers of CNVs with relatively equal risks for either disorder. However, the pattern of effects along the “balance axis” varied across the groups, with this attenuation being generally less pronounced in individuals with high-high symptom/risk profile in the schizophrenia and CNV groups, and relatively similar for low-low and high-high individuals in the first episode psychosis group. Lower levels of functional impairments in individuals with “balanced” symptom profile or genetic risks would suggest compensation across mechanisms associated with autism and schizophrenia. CNVs that confer equal risks for both disorders may provide an entry point for investigations into such compensatory mechanisms. The co-assessment of autism and schizophrenia may contribute to personalized prognosis and stratification strategies.

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

“…Participants with more severe levels of ASD symptoms also showed worse functional capacity and worse psychosocial functioning, particularly in areas where social abilities are more relevant, such as real-world interpersonal relationships, community activities, and work outcomes. This is another expected finding, which is again in line with those observed in people living with SSD [26,28,32,80]. Participants with minimal autistic symptoms did not show worse real-world functional outcomes compared to those without autistic symptoms; however, they showed significantly reduced personal and social functioning as measured by the PSP.…”

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

“…The data regarding the autistic symptoms measured with the PAUSS scale were then separately presented ( 55 ). Finally, the fourth large study was a recent multicentric investigation ( 56 ) including 299 individuals diagnosed with schizophrenia and 99 individuals with first episode psychosis that were assessed with the PAUSS and different measures of functioning; this study also included 142 healthy controls drawn from a previous study ( 57 ) investigating the effects on cognition of specific copy number variants.…”

“…A large and recent study ( 56 ) included 299 participants with chronic schizophrenia and 99 participants with first episode psychosis. Both samples were assessed with the PANSS to evaluate global and positive symptoms severity and with the PAUSS to evaluate the severity of autistic traits; functioning was assessed in participants diagnosed with schizophrenia with the GAF and those with first episode psychosis with the Social and Occupational Functioning Assessment Scale.…”

“…Although all the above-mentioned issues are described in most of the included studies, some evidences suggest that, when considering a specific group of patients, autistic symptoms can also have a protective effect: in cases of severe positive symptoms, autistic traits appear to be associated with better attention ( 58 , 75 ), better social acceptability ( 55 ), better functioning ( 56 , 75 ) and better quality of life ( 62 ).…”

The effect of the interaction between autistic traits and psychotic proneness on empathy: a cross-sectional study with a non-clinical sample

“…Although the findings of this study should be replicated within clinical populations to make any conclusion about the co-occurrence of autism and psychosis (Sasson and Bottema-Beutel, 2022), the findings have some potential clinical implications, especially for clinical assessment. Considering ASD and SSD as diametric disorders which can co-occur and assessing autistic traits in SSD or psychotic symptoms in ASD could contribute to having a deeper understanding of these clinical conditions (Abu-Akel et al , 2022). The findings indicating that social cognitive impairments could be attenuated with relatively balanced levels of autistic traits and psychotic proneness suggest that some individuals may display fewer social cognition impairments owing to this balance and will be diagnosed only at the extreme states of these clinical conditions (Abu-Akel et al , 2015).…”