Risk of psychosis in autism spectrum disorder individuals exposed to psychosocial stressors: A 9‐year chart review study

Abstract

Psychosocial stressors have been suggested to precipitate psychotic episodes in patients with pre‐existing psychosis and otherwise healthy subjects. However, such a risk has never been formally investigated in individuals with autism spectrum disorder (ASD). Sixty‐nine autistic adolescents hospitalized for psychotic/manic symptoms (PSY) and other mental health issues (NPSY) over a 9‐year period were compared with reference to their previous exposure to psychosocial stressors. ASD diagnoses satisfied the International Classification of Diseases (ICD)‐10 criteria. Psychotic/manic symptom assessment followed the Kiddie Schedule for Affective Disorders and Schizophrenia (K‐SADS). Psychosocial stressor exposure was collected separately at each admission. Preliminarily, univariate between‐group comparisons were conducted. Then, a binomial model was adopted to investigate associations with previous exposure to psychosocial stressors. Results were reported with a change in AIC (ΔAIC). PSY patients presented with higher previous exposure to adverse life events (30.43% vs. 6.52%, OR = 6.079 [1.209, 40.926], p = 0.013) and school/work difficulties (30.43% vs. 8.70%, OR = 4.478 [0.984, 23.846], p = 0.034) than NPSY ones. Admissions for psychotic/manic symptoms occurred more likely in the context of family disturbances (OR = 2.275 [1.045, 5.045], p = 0.030) and adverse life events (OR = 3.489 [1.194, 11.161], p = 0.014). The fitted binomial model was found to be significant compared to the random effects model (ΔAIC = −1.962; χ210 = 21.96, p = 0.015), with the risk of presenting psychotic/manic symptoms being increased by family disturbances (z = +4.118) and school/work difficulties (z = +2.455). The results suggest a potential psychosis‐inducing effect of psychosocial stressors in ASD, which has clinical and policy implications.

Tic-Related Obsessive–Compulsive and Eating Disorders in Dandy–Walker Variant: A Case Report and Systematic Reappraisal of Psychiatric Profiles

“…Consistent with the previous research in the field, early language development difficulties influenced the patient's poor social adjustment during schoolyears, possibly leading to episodes of peer victimization and a tendency to isolation [54]. Together with social difficulties, her siblings' disability may have had an impact on the development of much clearer psychic distress during the transition from late adolescence to young adulthood [55][56][57], encompassing depressive symptoms, aberrant eating behaviors, obsessive-compulsive symptoms, and tics. To this extent, the previous literature has already documented instances of both adults and children with DWC abnormalities presenting with concurrent depression or OCD [26,38,39,44,58].…”

“…Additionally, approximately 30% of patients were not receiving any medications at the onset of their psychiatric symptoms [23,25,27,35,36,39,[43][44][45] and over 80% had not already been diagnosed with DWC until adulthood [21][22][23][25][26][27][28][29][32][33][34][37][38][39][40][43][44][45][46][47][48][49][50][51][52][53]. These considerations may imply that the condition often progresses silently from childhood to late adolescence, only to manifest abruptly upon reaching young adulthood, possibly through the manifestation of psychic distress triggered by exposure to environmental factors [55][56][57].…”

Autismo E Psicose: Uma Intersecção Psicopatológica

“…Nesses casos muitas vezes não é possível durante a avaliação distinguir com segurança se a apresentação dos sintomas presentes são ações estranhas à presença do próprio indivíduo e, portanto, características psicóticas, ou se é uma apresentação do autismo. A dificuldade ocorre também por causa dos próprios prejuízos no desenvolvimento global desse paciente ao longo da vida, onde a avaliação do curso e desenvolvimento dos transtornos mentais requerem maior atenção por causa do transtorno do neurodesenvolvimento vigente (CASTELLANA et al, 2023;PAIM, 1993;BORTOLETTO et al, 2023).…”

“…Interesses restritos, alexitimia, respostas concretas ( VAN SCHALKWYK et al, 2014) e, adicionalmente, estudos recentes revelaram que vivências psicóticas podem ocorrer juntamente com o TEA, ainda que isso possa representar reações diretas a estresses ou situações adversas de vida (BORTOLETTO et al, 2023). Particularmente na apresentação das manifestações de autismo e do transtorno bipolar com psicose pode ocorrer sintomas e sinais semelhantes, como comportamentos repetitivos: no autismo, isso pode incluir balançar o corpo, estalar os dedos, ou se fixar em um objeto ou atividade por um longo período (KHANZADA; BUTLER; MANZARDO, 2017).…”

Editorial: Case reports in autism

“…presented a case where emerging psychotic symptoms along with late regression posed a diagnostic challenge whether clinicians were facing a very-early onset schizophrenia or autism where social-communicative development and adaptive functioning had been adequate during the first years of life. Authors reflected on the neurodevelopmental continuum paradigm, where autism and psychiatric disorders that emerge later in life can be conceptualized within a pattern of pathological continuity ( 9 ). This is particularly relevant for milder forms of autism and female individuals, whose attempt at camouflaging pathognomonic features of autism may exacerbate psychic distress.…”