Personality disorders and autism spectrum disorders: what are the connections?

BackgroundThe relationship between autism spectrum disorders/pervasive developmental disorders and personality disorders is not completely clear, although both concepts imply lifelong impairment. The purpose of the present study was to investigate the presence of possible personality disorders in a group of young adults with Asperger syndrome.MethodFifty-four young adults with a clinical diagnosis of Asperger syndrome were assessed with Structured Clinical Interview for DSM-IV Axis II disorders to evaluate the presence of a concomitant personality disorder and completed the Autism Spectrum Quotient to measure level of autistic features. Autism spectrum diagnosis was confirmed by Diagnostic Interview for Social and Communication Disorders with a collateral informant.ResultsApproximately half of the study group fulfilled criteria for a personality disorder, all belonging to cluster A or C. There was a significant difference across sex: men with Asperger syndrome meeting personality disorder criteria much more often than women with Asperger syndrome (65% vs 32%). Participants fulfilling criteria for a personality disorder showed more marked autistic features according to the Autism Spectrum Quotient.ConclusionsThere is a considerable overlap in symptoms between Asperger syndrome and certain personality disorders. Similarities and differences of the two concepts are discussed in the framework of the Diagnostic and Statistical Manual of Mental Disorders classification system.     

Autism in the Faroe Islands. An Epidemiological Study

The Faroe Islands are considered to be a genetic isolate. This population study of the prevalence of autism sought to identify a representative cohort for future genetic studies. In 2002 all schools were screened for autism spectrum disorders. The target population were all children born in 1985 through 1994 and living in the Faroe Islands on December 31, 2002. Children who screened positive for autism characteristics were examined using the Diagnostic Interview for Social and Communication Disorders (DISCO). Of the children aged 8 through 17 years, 0.56% had childhood autism, Asperger syndrome or atypical autism. The male:female ratio was just under 6:1. The prevalence of autism in the Faroe Islands was very similar to that reported from many western countries.     

Comorbid Psychiatric Disorders Associated with Asperger Syndrome/High-functioning Autism: A Community- and Clinic-based Study

The present study identifies the prevalence and types of comorbid psychiatric disorders associated with Asperger syndrome (AS)/high-functioning autism (HFA) in a combined community- and clinic-based sample of fifty 9- to 16-year-old subjects using the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version. The level of functioning was estimated using the Children’s Global Assessment Scale. The results support common (prevalence 74%) and often multiple comorbid psychiatric disorders in AS/HFA; behavioral disorders were shown in 44%, anxiety disorders in 42% and tic disorders in 26%. Oppositional defiant disorder, major depressive disorder and anxiety disorders as comorbid conditions indicated significantly lower levels of functioning. To target interventions, routine evaluation of psychiatric comorbidity in subjects with AS/HFA is emphasized.     

Children with autism spectrum disorders and intellectual disability

PURPOSE OF REVIEW: The present article reviews the increasing literature on comorbidity, treatment and use of health service resources for children and adolescents with autism spectrum disorders and intellectual disability from January 2006 to January 2007. RECENT FINDINGS: Children and adolescents with autism spectrum disorders and intellectual disability have a high prevalence of attention-deficit/hyperactive disorder, mood disorders, catatonia and repetitive behaviours compared with children without autism. Psychopharmacology is effective in reducing symptoms of behavioural problems and attention-deficit/hyperactive disorder, although further studies are required. Autism spectrum disorders are recognized to occur with Smith-Lemli-Optiz syndrome and 22q11.2 deletion syndrome. Children and adolescents with autism spectrum disorders have a high use of mental health services. SUMMARY: There is increasing evidence of the comorbidity of psychiatric and behavioural disorders in young people with autism spectrum disorders and intellectual disability responding to established treatments. This high morbidity results in increased healthcare expenditure compared with children without autism and intellectual disability.     

The relationship between Asperger’s syndrome and schizophrenia in adolescence

Asperger’s syndrome (AS), a pervasive developmental disorder (PDD), has nowadays been widely advocated in media. Therefore, psychiatrists treating adolescents frequently meet patients as well as their families reporting of symptoms resembling those of Asperger’s syndrome. It is known that symptoms of Asperger’s syndrome have some overlap with those of schizophrenia, but less is known about comorbidity between these two syndromes. We describe a sample of 18 adolescents with early onset schizophrenia. Diagnosis of schizophrenia was based on assessment with Kiddie Schedule for Affective Disorders and Schizophrenia. The diagnostic interview for Social and Communication Disorders version 11 was used to assess autism spectrum disorders. Ten adolescents fulfilled symptom criteria of Asperger’s syndrome after the onset of schizophrenia, while only two persons had Asperger’s syndrome before the onset of schizophrenia, a prerequisite for diagnosis. 44 % of the adolescents fulfilled the diagnosis of some PDD in childhood. Most of them were, however, unrecognized before the onset of schizophrenia. On the other hand, all 18 patients had one or more symptoms of PDDS in adolescence. Adolescents with schizophrenia have often symptoms consistent with AS, although only few of them have fulfilled the diagnostic criteria in their childhood, a prerequisite for the diagnosis of AS. There is a risk for misdiagnosis of adolescents with autistic symptoms if detailed longitudinal anamnesis is not obtained.     

Asperger Syndrome and Autism: A Comparative Longitudinal Follow-Up Study More than 5 Years after Original Diagnosis

Prospective follow-up study of 70 males with Asperger syndrome (AS), and 70 males with autism more than 5 years after original diagnosis. Instruments used at follow-up included overall clinical assessment, the Diagnostic Interview for Social and Communication Disorders, Wechsler Intelligence Scales, Vineland Adaptive Behavior Scales, and Global Assessment of Functioning Scale. Specific outcome criteria were used. Outcome in AS was good in 27% of cases. However, 26% had a very restricted life, with no occupation/activity and no friends. Outcome in the autism group was significantly worse. Males with AS had worse outcomes than expected given normal to high IQ. However, outcome was considerably better than for the comparison group of individuals with autism.     

Is autism spectrum disorder common in schizophrenia?

A century ago, Kraepelin and Bleuler observed that schizophrenia is often antedated by "premorbid" abnormalities. In this study we explore how the childhood neurodevelopmental problems found in patients with schizophrenia relate to the current concept of autism spectrum disorder (ASD). Forty-six young adult individuals with clinical diagnoses of schizophrenic psychotic disorders were assessed. The Structured Clinical Interview for DSM Disorders (SCID-I) was used in face-to-face psychiatric examination of each individual. In 32 of the 46 cases (70%), collateral information was provided by one or both parents. The Diagnostic Interview for Social and Communication Disorders - eleventh version (DISCO-11) was used when interviewing these relatives. This instrument covers, in considerable depth, childhood development, adaptive functioning, and symptoms of ASD - current and lifetime. There is a strict algorithm for ASD diagnosis. About half of the cases with schizophrenic psychosis had ASD according to the results of the parental interview. The rate of ASD was strikingly high (60%) in the group with a SCID-I diagnosis of schizophrenia paranoid type. The findings underscore the need to revisit the DSM's "either or" stance between ASD and schizophrenia.     

Psychiatric disorders in individuals with high-functioning autism and Asperger's disorder: Similarities and differences

Abstract

Objectives. To investigate and compare the rate and type of psychiatric co-morbidity in individuals with diagnosis of high functioning autism (HFA) and Asperger's disorder (AS). Methods. This study includes 30 children and adolescents with diagnosis of HFA and 30 with diagnosis of AS. Diagnoses of HFA and AS were made using strict DSM-IV criteria. Psychiatric co-morbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL-T). Results. The rate of comorbid psychiatric disorders was very high in both groups (93.3% in HFA and 100% in AS). The most common disorder in both groups was attention deficit hyperactivity disorder. There was no statistically significant difference between groups in the rate of associated psychiatric disorders, except for major depressive disorder (P = 0.029) and ADHD-combined type (P = 0.030). The AS group displayed greater comorbidity with depressive disorders and ADHD-CT. Conclusion. From a clinical perspective, it could be concluded that both disorders involve a high risk for developing psychiatric disorders, with AS patients at greater risk for depression. From a nosological perspective, the substantial similarities in terms of psychiatric comorbidity may support the idea that both disorders are on the same spectrum and differs in some aspects.     

An exploration of concomitant psychiatric disorders in children with autism spectrum disorder

ObjectiveWe explored patterns of concomitant psychiatric disorders in a large sample of treatment-seeking children and adolescents with autism spectrum disorder (ASD).MethodsParticipants were 658 children with ASD (age 3–17 years; mean = 7.2 years) in one of six federally-funded multisite randomized clinical trials (RCT) between 1999 and 2014. All children were referred for hyperactivity or irritability. Study designs varied, but all used the Child and Adolescent Symptom Inventory or Early Childhood Inventory to assess Attention Deficit Hyperactivity Disorder (ADHD), Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), Anxiety Disorders, and Mood Disorders. In addition, several measures in common were used to assess demographic and clinical characteristics.ResultsOf the 658 children, 73% were Caucasian and 59% had an IQ >70. The rates of concomitant disorders across studies were: ADHD 81%, ODD 46%, CD 12%, any anxiety disorder 42%, and any mood disorder 8%. Two or more psychiatric disorders were identified in 66% of the sample. Of those who met criteria for ADHD, 50% also met criteria for ODD and 46% for any anxiety disorder. Associations between types of concomitant disorders and a number of demographic and clinical characteristics are presented.ConclusionIn this well-characterized sample of treatment-seeking children with ASD, rates of concomitant psychiatric disorders were high and the presence of two or more co-occurring disorders was common. Findings highlight the importance of improving diagnostic practice in ASD and understanding possible mechanisms of comorbidity.     

The long-term outcome in two females with autism spectrum disorder

We describe the results of a long-term follow-up examination of two adult females diagnosed exhibiting an autism spectrum disorder in childhood. Over four decades after the initial diagnosis made by Gerhard Bosch, besides Leo Kanner and Hans Asperger, one of the first clinicians to describe cases of autistic behavior, the individuals had largely different psychiatric outcomes. Despite the fact that both females continuously showed definite autistic traits, one woman exhibited a generalized anxiety disorder, while the other was predominantly characterized by schizoaffective symptoms. The trajectories of the two cases are discussed in the light of research on possible associations and overlaps between autism spectrum disorders, psychosis and anxiety disorders. It is suggested that adult outcome studies in autism should consider a broader range of comorbidity.     

The use of genetic epidemiology to guide classification in child and adult psychopathology

The goal of this paper is to illustrate the application of the tools of genetic epidemiology, particularly the family study method, to inform the classification of psychiatric disorders in adults and children. The first section describes family studies of adults designed to investigate the causes of comorbidity of anxiety and depression. The analysis of familial traits provides stronger evidence for the validity of certain sub-types of anxiety and mood disorders that co-occur within the same individual and within families. The second section presents an example of the use of the family study method to examine the validity of the autism spectrum disorders (ASD). A review of these studies suggests that the most consistently familial traits in ASD are language and communication skills, insistence on sameness and non-verbal IQ. These are also the traits most commonly associated with the differentiation of autism from Asperger disorder and PDDNOS using both cross-sectional and longitudinal studies. From these data, a new classification system of the ASDs is proposed based on these familial traits.     

The use of genetic epidemiology to guide classification in child and adult psychopathology

The goal of this paper is to illustrate the application of the tools of genetic epidemiology, particularly the family study method, to inform the classification of psychiatric disorders in adults and children. The first section describes family studies of adults designed to investigate the causes of comorbidity of anxiety and depression. The analysis of familial traits provides stronger evidence for the validity of certain sub-types of anxiety and mood disorders that co-occur within the same individual and within families. The second section presents an example of the use of the family study method to examine the validity of the autism spectrum disorders (ASD). A review of these studies suggests that the most consistently familial traits in ASD are language and communication skills, insistence on sameness and non-verbal IQ. These are also the traits most commonly associated with the differentiation of autism from Asperger disorder and PDDNOS using both cross-sectional and longitudinal studies. From these data, a new classification system of the ASDs is proposed based on these familial traits.     

注意缺陷多动障碍患儿的成人早期精神状况随访研究

目的 了解注意缺陷多动障碍(ADHD)患儿在成人早期罹患精神障碍的状况.方法 采用前瞻性设计方法,对就诊于北京大学精神卫生研究所精神科门诊的300例ADHD患儿进行随访,同意参加随访者116例(随访率38.7%),基线至随访为2.0～13.5年;患儿基线年龄为7.5～17.0岁,随访时年龄为18.0～23.5岁;采用以美国精神障碍诊断与统计手册第4版为诊断标准制订的定式会谈工具确定诊断,包括Conners成人ADHD诊断会谈量表(Conners Adult ADHD Diagnostic Interview for DSM-Ⅳ,CAADID)、DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查(SCID-Ⅰ)和DSM-Ⅳ轴Ⅱ障碍定式临床检查(SCID-Ⅱ)工具.结果 随访时116例中符合成人ADHD诊断者共59例(50.9%),其中单纯符合成人ADHD诊断标准者18例(15.5%),同时符合成人ADHD及精神障碍/人格障碍者41例(35.3%);不符合成人ADHD诊断,但符合精神障碍/人格障碍者17例(14.7%);不符合任何精神疾病诊断者40例(34.5%),其中功能缓解29例(25.0%),功能未缓解11例(9.5%).116例中,40例(34.5%)至少共患1种DSM-Ⅳ轴Ⅰ障碍,其中21例(18.1%)共患情感障碍,12例(10.3%)共患焦虑障碍,6例(5.2%)共患物质滥用;38例(32.8%)符合DSM-Ⅳ轴Ⅱ人格障碍诊断,其中6例(5.2%)符合A组人格障碍诊断,23例(19.8%)符合B组人格障碍诊断,包括20例(17.2%)反社会型人格障碍,18例(15.5%)符合C组人格障碍诊断,6例(6.0%)符合其他人格障碍诊断.结论 ADHD患儿至成人早期预后较差,2/3左右罹患成人ADHD、精神障碍或人格障碍,其中50.9%符合成人ADHD.     

Autism and Asperger syndrome: coexistence with other clinical disorders

OBJECTIVE:: To provide a clinically useful analysis of the extent to which autism and Asperger syndrome coexist with other disorders. METHOD: Selective review of the literature detailing data pertaining to symptoms and disorders sometimes encountered in connection with autism or Asperger syndrome. RESULTS: A large number of medical conditions, psychiatric disorders and behavioural and motor dyscontrol symptoms are associated with autism and Asperger syndrome. CONCLUSION: Comorbidity is to be expected in autism spectrum disorders -directly or indirectly. Comorbid conditions may be markers for underlying pathophysiology and suggest a more varied treatment approach. There is a great need for in-depth research into this area, meaning that the exclusion criteria of current diagnostic manuals, i.e. those that rule out a diagnosis of autism in some disorders, and a diagnosis of certain other disorders in autism may have to be revised.     

Effects of vagus nerve stimulation in a patient with temporal lobe epilepsy and Asperger syndrome: case report and review of the literature

Seizures are a common comorbidity of autism and occur in as many as 30% of patients. This case report describes a 23-year-old man diagnosed with both Asperger syndrome and bitemporal epilepsy. The patient had behavioral regression that correlated with worsening of his intractable seizures. He subsequently underwent implantation of a vagus nerve stimulation therapy device for his refractory epilepsy. Both his seizures and his behavior were monitored for 6 months. We describe the efficacy of vagus nerve stimulation therapy in reducing seizure severity as well as improving the behavioral components of his Asperger syndrome. We also review the current literature regarding epilepsy in autistic spectrum disorders.     

Bipolar obsessive-compulsive disorder and personality disorders

OBJECTIVES: Relatively few systematic data exist on the clinical impact of bipolar comorbidity in obsessive-compulsive disorder (OCD) and no studies have investigated the influence of such a comorbidity on the prevalence and pattern of Axis II comorbidity. The aim of the present study was to explore the comorbidity of personality disorders in a group of patients with OCD and comorbid bipolar disorder (BD). METHODS: The sample consisted of 204 subjects with a principal diagnosis of OCD (DSM-IV) and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score>or=16 recruited from all patients consecutively referred to the Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin over a period of 5 years (January 1998-December 2002). Diagnostic evaluation and Axis I comorbidities were collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Personality status was assessed by using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Socio-demographic and clinical features (including Axis II comorbidities) were compared between OCD patients with and without a lifetime comorbidity of BD. RESULTS: A total of 21 patients with OCD (10.3%) met DSM-IV criteria for a lifetime BD diagnosis: 4 (2.0%) with BD type I and 17 (8.3%) with BD type II. Those without a BD diagnosis showed significantly higher rates of male gender, sexual and hoarding obsessions, repeating compulsions and lifetime comorbid substance use disorders, when compared with patients with BD/OCD. With regard to personality disorders, those with BD/OCD showed higher prevalence rates of Cluster A (42.9% versus 21.3%; p=0.027) and Cluster B (57.1% versus 29.0%; p=0.009) personality disorders. Narcissistic and antisocial personality disorders were more frequent in BD/OCD. CONCLUSIONS: Our results point towards clinically relevant effects of comorbid BD on the personality profiles of OCD patients, with higher rates of narcissistic and antisocial personality disorders in BD/OCD patients.     

Childhood inattention and hyperactivity symptoms self-reported by adults with Asperger syndrome

BACKGROUND: Increasing public awareness of the adult manifestations of developmental neuropsychiatric disorders, like Asperger syndrome and attention deficit hyperactivity disorder (ADHD), has provoked an increasing number of persons to seek assessment for the first time in adulthood. As these disorders have their origin in childhood, instruments for retrospective evaluation of childhood behavior are needed. SAMPLING AND METHODS: In this preliminary study, 20 adults with Asperger syndrome filled in the Wender-Utah Rating Scale for ADHD to describe retrospectively their childhood behavior. RESULTS: Fourteen out of 20 adults with Asperger syndrome self-rated above the cut-off limit for ADHD. The median total score was also higher than that reported in normal populations in previous studies. When compared with 10 controls, patients with Asperger syndrome scored higher in almost all individual items. CONCLUSIONS: A high score on the Wender-Utah rating Scale for ADHD in this patient group might be a sign of true comorbidity with ADHD, an indication of overlapping features typical of both disorders, or a result of other psychiatric comorbidity originating already in childhood. Moreover, there are no data about the proper cut-off limit for ADHD in these subjects. Therefore, one should be cautious when applying this scale beyond its original context of comparison between adults with ADHD, unipolar depression and healthy controls.     

Comorbid psychopathology in adolescents and young adults treated for substance use disorders

OBJECTIVE: In a recent review, the prevalence of comorbid psychiatric disorders in non-treated adolescents and young adults with substance use disorders (SUD) in the general population was summarized. This review looks into the prevalence of psychiatric comorbidity in adolescents and young adults treated for SUD. METHOD: A computerized literature search was conducted resulting in ten eligible studies. RESULTS: The prevalence of comorbid psychiatric disorders varied from 61% to 88%. Externalizing disorders, especially Conduct Disorder (CD), were most consistently linked to SUD in treatment seeking adolescents. Girls are distinguished by their high rate of comorbid internalizing disorders. CONCLUSIONS: Comparison with data from community and juvenile justice studies shows an ascending trend of comorbidity rates of externalizing disorders from community to clinical and finally to juvenile justice samples. It seems that young addicts with comorbid disorders are at high risk of ending up in the juvenile justice system.     

Comparison of Form and Motion Coherence Processing in Autistic Spectrum Disorders and Dyslexia

A large body of research has reported visual perception deficits in both people with dyslexia and autistic spectrum disorders. In this study, we compared form and motion coherence detection between a group of adults with high-functioning autism, a group with Asperger's disorder, a group with dyslexia, and a matched control group. It was found that motion detection was intact in dyslexia and Asperger. Individuals with high-functioning autism showed a general impaired ability to detect coherent form and motion. Participants with Asperger's syndrome showed lower form coherence thresholds than the dyslexic and normally developing adults. The results are discussed with respect to the involvement of the dorsal and ventral pathways in developmental disorders.