Generic placeholder image

Current Psychiatry Research and Reviews

Author(s): Petra Šustová* and Mabel Rodriguez

DOI: 10.2174/2666082218666220210143230

DownloadDownload PDF Flyer Cite As
Autistic Traits in Schizophrenia Spectrum Disorders

Page: [94 - 107] Pages: 14

  • * (Excluding Mailing and Handling)

Explore Articles
About Journal
For Authors
For Editors
For Reviewers

Abstract

Background: In recent years, there has been an emerging interest in the overlap between schizophrenia and autism. The co-occurrence between these two disorders may be seen not only at a diagnostic level but also as the presence of autistic traits in schizophrenia. There has been a rapid rise in the number of studies focusing on autistic traits in schizophrenia and their clinical associations.

Objective: Here, we provide a review that summarizes the current findings and highlights gaps that may be addressed by future research.

Results: Higher levels of autistic traits have been associated with earlier age of onset, longer duration of illness, resistance to treatment, and more severe cognitive deficit. However, regarding social cognition and psychosocial functioning, the findings are mixed.

Conclusion: Patients with prominent autistic traits seem to be more affected. The effect of autistic traits on social cognition and psychosocial functioning remains unclear, as does their relationship with negative symptoms. Therefore, longitudinal studies are highly needed.

Keywords: Schizophrenia, autistic traits, autism, autistic symptoms, diametric model, social cognition.

Graphical Abstract

[1]
Bechi M, Agostoni G, Buonocore M, et al. The association of autistic traits with Theory of Mind and its training effica-cy in patients with schizophrenia. Schizophr Res Cogn 2019; 19: 100164.
[http://dx.doi.org/10.1016/j.scog.2019.100164] [PMID: 31832344]
[2]
Bechi M, Agostoni G, Buonocore M, et al. The influence of premorbid adjustment and autistic traits on social cognitive dysfunction in schizophrenia. J Int Neuropsychol Soc 2020; 26(3): 276-85.
[http://dx.doi.org/10.1017/S1355617719000961] [PMID: 31507263]
[3]
Barlati S, Deste G, Gregorelli M, Vita A. Autistic traits in a sample of adult patients with schizophrenia: Prevalence and correlates. Psychol Med 2019; 49(1): 140-8.
[http://dx.doi.org/10.1017/S0033291718000600] [PMID: 29554995]
[4]
Deste G, Barlati S, Gregorelli M, et al. Looking through autistic features in schizophrenia using the PANSS Autism Sever-ity Score (PAUSS). Psychiatry Res 2018; 270: 764-8.
[http://dx.doi.org/10.1016/j.psychres.2018.10.074] [PMID: 30551322]
[5]
Deste G, Vita A, Nibbio G, et al. Autistic symptoms in people with schizophrenia: Neurocognitive, socio-cognitive, clini-cal and real-world functional characteristics of individuals without autistic features. Schizophr Res 2021; 236: 12-8.
[http://dx.doi.org/10.1016/j.schres.2021.07.037] [PMID: 34364032]
[6]
Kästner A, Begemann M, Michel TM, et al. Autism beyond diagnostic categories: Characterization of autistic pheno-types in schizophrenia. BMC Psychiatry 2015; 15(1): 115.
[http://dx.doi.org/10.1186/s12888-015-0494-x] [PMID: 25968177]
[7]
Vita A, Barlati S, Deste G, et al. The influence of autistic symptoms on social and non-social cognition and on real-life functioning in people with schizophrenia: Evidence from the Italian Network for Research on Psychoses multicenter study. Eur Psychiatry 2020; 63(1): e98.
[8]
Craddock N, Owen MJ. The Kraepelinian dichotomy - going, going... but still not gone. Br J Psychiatry 2010; 196(2): 92-5.
[http://dx.doi.org/10.1192/bjp.bp.109.073429] [PMID: 20118450]
[9]
Crespi B, Badcock C. Psychosis and autism as diametrical disorders of the social brain. Behav Brain Sci 2008; 31(3): 241-61.
[http://dx.doi.org/10.1017/S0140525X08004214] [PMID: 18578904]
[10]
Bleuler E. Dementia Praecox or the Group of Schizophrenias. New York: NY International Universities Press 1950.
[11]
Evans B. How autism became autism: The radical transformation of a central concept of child development in Britain. Hist Human Sci 2013; 26(3): 3-31.
[http://dx.doi.org/10.1177/0952695113484320] [PMID: 24014081]
[12]
Barlati S, Deste G, Ariu C, Vita A. Autism spectrum disorder and schizophrenia: Do they overlap. Int J Emerg Ment Health Hum Resil 2016; 18(1): 760-3.
[http://dx.doi.org/10.4172/1522-4821.1000318]
[13]
Fernandes JM, Cajão R, Lopes R, Jerónimo R, Barahona-Corrêa JB. Social cognition in schizophrenia and autism spec-trum disorders: A systematic review and meta-analysis of direct comparisons. Front Psychiatry 2018; 9: 504.
[http://dx.doi.org/10.3389/fpsyt.2018.00504] [PMID: 30459645]
[14]
Eack SM, Bahorik AL, McKnight SAF, et al. Commonalities in social and non-social cognitive impairments in adults with autism spectrum disorder and schizophrenia. Schizophr Res 2013; 148(1-3): 24-8.
[http://dx.doi.org/10.1016/j.schres.2013.05.013] [PMID: 23768814]
[15]
Schmidt L, Kirchner J, Strunz S, et al. Psychosocial functioning and life satisfaction in adults with autism spectrum dis-order without intellectual impairment. J Clin Psychol 2015; 71(12): 1259-68.
[http://dx.doi.org/10.1002/jclp.22225] [PMID: 26406481]
[16]
Kushima I, Aleksic B, Nakatochi M, et al. Comparative analyses of copy-number variation in autism spectrum disorder and schizophrenia reveal etiological overlap and biological insights. Cell Rep 2018; 24(11): 2838-56.
[http://dx.doi.org/10.1016/j.celrep.2018.08.022] [PMID: 30208311]
[17]
Constantino JN, Todd RD. Autistic traits in the general population: A twin study. Arch Gen Psychiatry 2003; 60(5): 524-30.
[http://dx.doi.org/10.1001/archpsyc.60.5.524] [PMID: 12742874]
[18]
Johns LC, van Os J. The continuity of psychotic experiences in the general population. Clin Psychol Rev 2001; 21(8): 1125-41.
[http://dx.doi.org/10.1016/S0272-7358(01)00103-9] [PMID: 11702510]
[19]
Chisholm K, Lin A, Abu-Akel A, Wood SJ. The association between autism and schizophrenia spectrum disorders: A review of eight alternate models of co-occurrence. Neurosci Biobehav Rev 2015; 55: 173-83.
[http://dx.doi.org/10.1016/j.neubiorev.2015.04.012] [PMID: 25956249]
[20]
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association 2013.
[21]
Kincaid DL, Doris M, Shannon C, Mulholland C. What is the prevalence of autism spectrum disorder and ASD traits in psychosis? A systematic review. Psychiatry Res 2017; 250: 99-105.
[http://dx.doi.org/10.1016/j.psychres.2017.01.017] [PMID: 28152400]
[22]
Rapoport J, Chavez A, Greenstein D, Addington A, Gogtay N. Autism spectrum disorders and childhood-onset schizo-phrenia: Clinical and biological contributions to a relation revisited. J Am Acad Child Adolesc Psychiatry 2009; 48(1): 10-8.
[http://dx.doi.org/10.1097/CHI.0b013e31818b1c63] [PMID: 19218893]
[23]
Jones RM, Cadby G, Melton PE, Abraham LJ, Whitehouse AJ, Moses EK. Genome-wide association study of autistic-like traits in a general population study of young adults. Front Hum Neurosci 2013; 7: 658.
[http://dx.doi.org/10.3389/fnhum.2013.00658] [PMID: 24133439]
[24]
Ronald A, Happé F, Price TS, Baron-Cohen S, Plomin R. Phenotypic and genetic overlap between autistic traits at the extremes of the general population. J Am Acad Child Adolesc Psychiatry 2006; 45(10): 1206-14.
[http://dx.doi.org/10.1097/01.chi.0000230165.54117.41] [PMID: 17003666]
[25]
Ronald A, Hoekstra RA. Autism spectrum disorders and autistic traits: A decade of new twin studies. Am J Med Genet B Neuropsychiatr Genet 2011; 156B(3): 255-74.
[http://dx.doi.org/10.1002/ajmg.b.31159] [PMID: 21438136]
[26]
Courty A, Maria AS, Lalanne C, et al. Levels of autistic traits in anorexia nervosa: A comparative psychometric study. BMC Psychiatry 2013; 13(1): 222.
[http://dx.doi.org/10.1186/1471-244X-13-222] [PMID: 24015680]
[27]
Matsuo J, Kamio Y, Takahashi H, et al. Autistic-like traits in adult patients with mood disorders and schizophrenia. PLoS One 2015; 10(4): e0122711.
[http://dx.doi.org/10.1371/journal.pone.0122711] [PMID: 25838109]
[28]
Trait. In: APA Dictionary of Psychology. Available from: https://dictionary.apa.org/trait (Accessed on 2021 June 27).
[29]
Symptom. In: APA Dictionary of Psychology. Available from: https://dictionary.apa.org/symptom (Accessed on 2021 June 27).
[30]
DeYoung CG, Chmielewski M, Clark LA, et al. The distinction between symptoms and traits in the Hierarchical Taxon-omy of Psychopathology (HiTOP). J Pers 2022; 90(1): 20-33.
[http://dx.doi.org/10.1111/jopy.12593] [PMID: 32978977]
[31]
Chisholm K, Pelton M, Duncan N, et al. A cross-sectional examination of the clinical significance of autistic traits in individuals experiencing a first episode of psychosis. Psychiatry Res 2019; 282: 112623.
[http://dx.doi.org/10.1016/j.psychres.2019.112623] [PMID: 31685288]
[32]
De Crescenzo F, Postorino V, Siracusano M, et al. Autistic symptoms in schizophrenia spectrum disorders: A systematic review and meta-Analysis. Front Psychiatry 2019; 10: 78.
[http://dx.doi.org/10.3389/fpsyt.2019.00078] [PMID: 30846948]
[33]
Esterberg ML, Trotman HD, Brasfield JL, Compton MT, Walker EF. Childhood and current autistic features in adoles-cents with schizotypal personality disorder. Schizophr Res 2008; 104(1-3): 265-73.
[http://dx.doi.org/10.1016/j.schres.2008.04.029] [PMID: 18554872]
[34]
Yoshihara Y, Lisi G, Yahata N, et al. Overlapping but asymmetrical relationships between schizophrenia and autism revealed by brain connectivity. Schizophr Bull 2020; 46(5): 1210-8.
[http://dx.doi.org/10.1093/schbul/sbaa021] [PMID: 32300809]
[35]
Zhou HY, Yang HX, Gong JB, et al. Revisiting the overlap between autistic and schizotypal traits in the non-clinical population using meta-analysis and network analysis. Schizophr Res 2019; 212: 6-14.
[http://dx.doi.org/10.1016/j.schres.2019.07.050] [PMID: 31387828]
[36]
Ziermans TB, Schirmbeck F, Oosterwijk F, Geurts HM, de Haan L. Autistic traits in psychotic disorders: Prevalence, familial risk, and impact on social functioning. Psychol Med 2021; 51(10): 1704-13.
[http://dx.doi.org/10.1017/S0033291720000458] [PMID: 32151297]
[37]
Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The autism-spectrum quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord 2001; 31(1): 5-17.
[http://dx.doi.org/10.1023/A:1005653411471] [PMID: 11439754]
[38]
Lord C, Risi S, Lambrecht L, et al. The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord 2000; 30(3): 205-23.
[http://dx.doi.org/10.1023/A:1005592401947] [PMID: 11055457]
[39]
Constantino JN, Gruber CP. Social Responsiveness Scale: Manual. Los Angeles, CA: Western Psychological Services 2005.
[40]
Nylander L, Gillberg C. Screening for autism spectrum disorders in adult psychiatric out-patients: A preliminary report. Acta Psychiatr Scand 2001; 103(6): 428-34.
[http://dx.doi.org/10.1034/j.1600-0447.2001.00175.x] [PMID: 11401656]
[41]
Wing L, Leekam SR, Libby SJ, Gould J, Larcombe M. The Diagnostic Interview for Social and Communication Disor-ders: Background, inter-rater reliability and clinical use. J Child Psychol Psychiatry 2002; 43(3): 307-25.
[http://dx.doi.org/10.1111/1469-7610.00023] [PMID: 11944874]
[42]
Cochran DM, Dvir Y, Frazier JA. “Autism-plus” spectrum disorders: intersection with psychosis and the schizophrenia spectrum. Child Adolesc Psychiatr Clin N Am 2013; 22(4): 609-27.
[http://dx.doi.org/10.1016/j.chc.2013.04.005] [PMID: 24012076]
[43]
Maibing CF, Pedersen CB, Benros ME, Mortensen PB, Dalsgaard S, Nordentoft M. Risk of schizophrenia increases after all child and adolescent psychiatric disorders: A nationwide study. Schizophr Bull 2015; 41(4): 963-70.
[http://dx.doi.org/10.1093/schbul/sbu119] [PMID: 25193974]
[44]
Bastiaansen JA, Meffert H, Hein S, et al. Diagnosing autism spectrum disorders in adults: The use of Autism Diagnostic Observation Schedule (ADOS) module 4. J Autism Dev Disord 2011; 41(9): 1256-66.
[http://dx.doi.org/10.1007/s10803-010-1157-x] [PMID: 21153873]
[45]
Nakata Y, Kanahara N, Kimura A, et al. Autistic traits and cognitive profiles of treatment-resistant schizophrenia. Schizophr Res Cogn 2020; 22: 100186.
[http://dx.doi.org/10.1016/j.scog.2020.100186] [PMID: 32760657]
[46]
Downs JM, Lechler S, Dean H, et al. The association between comorbid autism spectrum disorders and antipsychotic treatment failure in early-onset psychosis: A historical cohort study using electronic health records. J Clin Psychiatry 2017; 78(9): e1233-41.
[http://dx.doi.org/10.4088/JCP.16m11422] [PMID: 29125721]
[47]
Deste G, Vita A, Penn DL, Pinkham AE, Nibbio G, Harvey PD. Autistic symptoms predict social cognitive performance in patients with schizophrenia. Schizophr Res 2020; 215: 113-9.
[http://dx.doi.org/10.1016/j.schres.2019.11.008] [PMID: 31780344]
[48]
Rodriguez M, Zaytseva Y. Cvrčková A, et al. Cognitive profiles and functional connectivity in first-episode schizophre-nia spectrum disorders - linking behavioral and neuronal data. Front Psychol 2019; 10: 689.
[http://dx.doi.org/10.3389/fpsyg.2019.00689] [PMID: 31001171]
[49]
de Boer M, Spek AA, Lobbestael J. Comparing cognitive functioning in schizophrenia and autism using WAIS-III. Res Autism Spectr Disord 2014; 8(7): 737-45.
[http://dx.doi.org/10.1016/j.rasd.2014.03.001]
[50]
Green MF, Horan WP, Lee J. Social cognition in schizophrenia. Nat Rev Neurosci 2015; 16(10): 620-31.
[http://dx.doi.org/10.1038/nrn4005] [PMID: 26373471]
[51]
Harvey PD, Deckler E, Jarskog F, Penn DL, Pinkham AE. Predictors of social functioning in patients with higher and lower levels of reduced emotional experience: Social cognition, social competence, and symptom severity. Schizophr Res 2019; 206: 271-6.
[http://dx.doi.org/10.1016/j.schres.2018.11.005] [PMID: 30446271]
[52]
Madeira N, Caldeira S, Bajouco M, Pereira AT, Martins MJ, Macedo A. Social cognition, negative symptoms and psy-chosocial functioning in schizophrenia. IJCNMH 2016; 1(3): 1.
[53]
Vaskinn A, Horan WP. Social cognition and schizophrenia: Unresolved issues and new challenges in a maturing field of research. Schizophr Bull 2020; 46(3): 464-70.
[http://dx.doi.org/10.1093/schbul/sbaa034] [PMID: 32133507]
[54]
Hajdúk M, Harvey PD, Penn DL, Pinkham AE. Social cognitive impairments in individuals with schizophrenia vary in severity. J Psychiatr Res 2018; 104: 65-71.
[http://dx.doi.org/10.1016/j.jpsychires.2018.06.017] [PMID: 29982084]
[55]
Vaskinn A, Abu-Akel A. The interactive effect of autism and psychosis severity on theory of mind and functioning in schizophrenia. Neuropsychology 2019; 33(2): 195-202.
[http://dx.doi.org/10.1037/neu0000499] [PMID: 30346197]
[56]
Abu-Akel A, Bailey AL. The possibility of different forms of theory of mind impairment in psychiatric and develop-mental disorders. Psychol Med 2000; 30(3): 735-8.
[http://dx.doi.org/10.1017/S0033291799002123] [PMID: 10883728]
[57]
Frith CD. The Cognitive Neuropsychology of Schizophrenia. London: Psychology Press 2014.
[http://dx.doi.org/10.4324/9781315785011]
[58]
Mayer JD, Salovey P. Mayer-Salovery-Caruso Emotional Intelligence Test. Toronto: Multi-Health Systems Incorpo-rated 2007.
[59]
Salagre E, Grande I, Solé B, et al. Exploring risk and resilient profiles for functional impairment and baseline predictors in a 2-year follow-up first-episode psychosis cohort using latent class growth analysis. J Clin Med 2020; 10(1): 73.
[http://dx.doi.org/10.3390/jcm10010073] [PMID: 33379225]
[60]
Horton LE, Tarbox SI, Olino TM, Haas GL. Trajectories of premorbid childhood and adolescent functioning in schizo-phrenia-spectrum psychoses: A first-episode study. Psychiatry Res 2015; 227(2-3): 339-46.
[http://dx.doi.org/10.1016/j.psychres.2015.02.013] [PMID: 25829134]
[61]
Isvoranu A-M, Ziermans T, Schirmbeck F, Borsboom D, Geurts HM, de Haan L. Autistic symptoms and social func-tioning in psychosis: A network approach. Schizophr Bull 2021; sbab084. [Online ahead of print].
[http://dx.doi.org/10.1093/schbul/sbab084] [PMID: 34313767]
[62]
Komatsu H, Ono T, Maita Y, et al. Association between autistic symptoms and self-stigma in patients with schizophre-nia spectrum disorders. Neuropsychiatr Dis Treat 2020; 16: 2553-61.
[http://dx.doi.org/10.2147/NDT.S280485] [PMID: 33154642]
[63]
Abu-Akel AM, Wood SJ, Hansen PC, Apperly IA. Perspective-taking abilities in the balance between autism tendencies and psychosis proneness. Proc R Soc B 2015; 282(1808): 20150563.
[64]
Bechi M, Abu-Akel A, Agostoni G, et al. Functional benefits of co-occurring autistic symptoms in schizophrenia is de-limited by symptom severity. J Psychiatr Res 2021; 137: 48-54.
[http://dx.doi.org/10.1016/j.jpsychires.2021.02.044] [PMID: 33652326]
[65]
Dell’Osso L, Carpita B, Cremone IM, et al. Autism spectrum in patients with schizophrenia: Correlations with real-life functioning, resilience, and coping styles. CNS Spectr 2021; 1-11. [Online ahead of print]
[http://dx.doi.org/10.1017/S1092852921000353] [PMID: 33843551]
[66]
Bell M, Fiszdon J, Richardson R, Lysaker P, Bryson G. Are self-reports valid for schizophrenia patients with poor in-sight? Relationship of unawareness of illness to psychological self-report instruments. Psychiatry Res 2007; 151(1-2): 37-46.
[http://dx.doi.org/10.1016/j.psychres.2006.04.012] [PMID: 17343920]
[67]
Bevan Jones R, Thapar A, Lewis G, Zammit S. The association between early autistic traits and psychotic experiences in adolescence. Schizophr Res 2012; 135(1-3): 164-9.
[http://dx.doi.org/10.1016/j.schres.2011.11.037] [PMID: 22245185]
[68]
Harms MB, Martin A, Wallace GL. Facial emotion recognition in autism spectrum disorders: A review of behavioral and neuroimaging studies. Neuropsychol Rev 2010; 20(3): 290-322.
[http://dx.doi.org/10.1007/s11065-010-9138-6] [PMID: 20809200]
[69]
Chan RCK, Li H, Cheung EFC, Gong QY. Impaired facial emotion perception in schizophrenia: A meta-analysis. Psychiatry Res 2010; 178(2): 381-90.
[http://dx.doi.org/10.1016/j.psychres.2009.03.035] [PMID: 20483476]
[70]
Martinez G, Alexandre C, Mam-Lam-Fook C, et al. Phenotypic continuum between autism and schizophrenia: Evi-dence from the Movie for the Assessment of Social Cognition (MASC). Schizophr Res 2017; 185: 161-6.
[http://dx.doi.org/10.1016/j.schres.2017.01.012] [PMID: 28089135]
[71]
Sugranyes G, Kyriakopoulos M, Corrigall R, Taylor E, Frangou S. Autism spectrum disorders and schizophrenia: Meta-analysis of the neural correlates of social cognition. PLoS One 2011; 6(10): e25322.
[http://dx.doi.org/10.1371/journal.pone.0025322] [PMID: 21998649]
[72]
Chen H, Uddin LQ, Duan X, et al. Shared atypical default mode and salience network functional connectivity between autism and schizophrenia. Autism Res 2017; 10(11): 1776-86.
[http://dx.doi.org/10.1002/aur.1834] [PMID: 28730732]
[73]
Mastrovito D, Hanson C, Hanson SJ. Differences in atypical resting-state effective connectivity distinguish autism from schizophrenia. Neuroimage Clin 2018; 18: 367-76.
[http://dx.doi.org/10.1016/j.nicl.2018.01.014] [PMID: 29487793]
[74]
Sasson N, Tsuchiya N, Hurley R, et al. Orienting to social stimuli differentiates social cognitive impairment in autism and schizophrenia. Neuropsychologia 2007; 45(11): 2580-8.
[http://dx.doi.org/10.1016/j.neuropsychologia.2007.03.009] [PMID: 17459428]
[75]
Ciaramidaro A, Bölte S, Schlitt S, et al. Schizophrenia and autism as contrasting minds: Neural evidence for the hypo-hyper-intentionality hypothesis. Schizophr Bull 2015; 41(1): 171-9.
[http://dx.doi.org/10.1093/schbul/sbu124] [PMID: 25210055]
[76]
Toal F, Bloemen OJN, Deeley Q, et al. Psychosis and autism: Magnetic resonance imaging study of brain anatomy. Br J Psychiatry 2009; 194(5): 418-25.
[http://dx.doi.org/10.1192/bjp.bp.107.049007] [PMID: 19407271]