Clinical Profiles and Conversion Rates Among Young Individuals With Autism Spectrum Disorder Who Present to Clinical High Risk for Psychosis Services
Clinical Profiles and Conversion Rates Among Young Individuals With Autism Spectrum Disorder Who Present to Clinical High Risk for Psychosis Services
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DOI：
10.1016/j.jaac.2018.09.446
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发表时间：
2019-06-01
影响因子：
13.3
通讯作者：
Bearden, Carrie E.
中科院分区：
文献类型：
--
作者：
Foss-Feig, Jennifer H.;Velthorst, Eva;Bearden, Carrie E.
目的：自闭症谱系障碍（ASD）和精神分裂症的重叠与独立是一个吸引了几代临床医生和科学家关注的话题。虽然在ASD患者中已经确定了高比例的精神病症状，但ASD患者亚临床精神病经历的性质、患病率和预后意义仍然知之甚少。方法：本研究旨在比较北美前驱期纵向研究（NAPLS, N = 764）第二阶段有或没有ASD诊断的临床精神病高危（CHR）年轻人的基线特征、临床概况和转化结果。结果：CHR合并ASD患者（CHR/ASD+, n = 26）往往表现出更大的社会和社会认知困难，但与CHR合并ASD患者（CHR/ASD-）表现出相对水平的核心精神病症状。在CHR/ASD+组和CHR/ASD-组之间，转化为合并精神病的风险（CHR/ASD+组为18.2%，CHR/ASD-组为16.8%）是相等的，而且NAPLS2精神病风险计算器预测两组之间转化为精神病的效果是一样的。结论：这些结果表明，伴有和不伴有ASD的CHR患者的基线精神病症状、转化风险的预测因素和最终转化率是相似的。他们进一步建议，当这些青少年出现在CHR环境中时，不应将ASD视为一种相互排斥的诊断。未来的研究需要在更大的CHR和共病ASD个体队列中更好地跟踪轨迹，并了解在更广泛的CHR人群中有效的治疗建议是否对这一特定人群也有用。
Objective: The overlap versus independence of autism spectrum disorder (ASD) and schizophrenia is a topic that has garnered the attention of generations of clinicians and scientists. Although high rates of psychotic symptoms have been identified in individuals with ASD, the nature, prevalence, and prognostic significance of subclinical psychotic experiences in ASD remain poorly understood.Method: This study sought to compare baseline characteristics, clinical profiles, and conversion outcomes between young individuals at clinical high risk for psychosis (CHR) who presented with or without a prior ASD diagnosis during the second phase of the North American Prodrome Longitudinal Study (NAPLS, N = 764).Results: Patients with CHR and ASD (CHR/ASD+, n = 26) tended to exhibit greater social and social cognitive difficulties, but expressed relatively levels of core psychosis symptoms similar to those of to patients with CHR but no ASD (CHR/ASD-). Risk for conversion to co-occurring psychosis (18.2% CHR/ASD+ versus 16.8% CHR/ASD-) was equivalent between CHR/ASD+ and CHR/ASD- groups, and the NAPLS2 Psychosis Risk Calculator predicted conversion to psychosis equally well across groups.Conclusion: These results suggest that baseline psychosis symptoms, predictors of risk for conversion, and ultimate conversion rates are similar in patients with CHR with and without ASD. They further suggest that ASD must not be considered a mutually exclusive diagnosis when such youth present in CHR settings. Future research is needed to better track trajectories in larger cohorts of individuals with CHR and comorbid ASD and to understand whether treatment recommendations effective in the broader CHR population are useful for this particular population as well.