are people with autism more prone to psychoticism?

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NullChamber
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07 Oct 2010, 8:56 pm

just an observation but a lot of people with mental illness seem to also have traits of autism. it makes me wonder if there's a connection between mental disorders and autism, even if it's mild autism or even autism phenotype.



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07 Oct 2010, 10:00 pm

I am going to say yes. Certain features of the meltdown phenomenon autistics are prone to have psychotic characteristics.



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07 Oct 2010, 10:43 pm

NullChamber wrote:
just an observation but a lot of people with mental illness seem to also have traits of autism. it makes me wonder if there's a connection between mental disorders and autism, even if it's mild autism or even autism phenotype.


Can you list some of the traits/behavior you have in mind? And which mental illnesses? I mean, i.e. depression and OCD don't seem easily lumped together by behavior, so it's hard to tell what you mean, exactly.

As far as stimming, normal people can be made to stim and possibly even head bang if put in the right conditions. There were some experiments where dolphins were confined to a very small space for a long time, and they began to show rhythmic rocking movements.

My guess would be that having a mental illness is probably generally stressful, and/or involves a lot of internal tension. And since stimming tends to relieve stress (in anyone), people with mental illnesses are probably more likely to do it due to incresed tension/stress (though, again, it would depend on the mental illness; depression to the point of catatonia wouldn't look like that).



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08 Oct 2010, 12:01 am

I developed paranoid schizophrenia at 14 but I also have Asperger's. It does happen


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08 Oct 2010, 12:07 am

adderall would drive me into a sort of psychosis often

gonna say yes


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08 Oct 2010, 1:53 am

Wait a minute--before we discuss this we need to define our terms properly.

Psychosis refers to perceptions or thoughts that run counter to reality as perceived by most people around you. It's kind of an old term but it's still used for any symptom that means "out of touch with reality". Common types of psychotic symptoms are hearing voices or seeing hallucinations, believing something illogical against all evidence to the contrary (for example, "the CIA is spying on me through my TV set"). Psychosis is most commonly found in schizophrenia and bipolar mania, though it can occasionally be associated with other kinds of mental illness, including dementia and the small subset of depression with psychotic symptoms, and can be a result of substance abuse or a physical illness. (Psychosis does not include synesthesia, sensory-integration problems, sleep disorders such as sleep-paralysis-related hallucinations, migraine or seizure-related auras and hallucinations, or eccentric beliefs such as conspiracy theories.)

Mental illness is a much larger category, including anything that can go out-of-balance with the human mind. It is a part of the larger category of psychological disorders (which includes developmental traits that do not represent an out-of-balance state, such as autism or dyslexia). Most mental illnesses do not involve psychosis; in fact, the great majority of people who have a mental illness will never experience any kind of psychotic symptoms. Most psychologists believe that mental illnesses come about as part of a sort of interaction between genetic vulnerability and environmental stress: Your genes may make you vulnerable to depression, but you may never develop it if your environment is favorable; conversely, a poor environment may not create depression in someone who is not naturally prone to it (though there's nothing to say he won't develop, say, OCD instead).

OK. So:
Autism and mental illness do have a positive correlation. The most common comorbidity is ADHD, with depression running a close second. Since you can't really call ADHD a "mental illness" (it is, like autism, primarily neurological), let's focus on the depression. I've been looking at some of the information and the reports vary widely; I have a range of anywhere from 25% to 75% of people with autism also having experienced depression, with most of the numbers below 50% (the 75 came from a survey of autistic teenagers). Compare that to the 20% rate for NTs, and you can see there's probably a greater risk for autistic people. I think this may have a lot to do with environment, because a similar sort of trend iss seen in any minority group. (Minority races and homosexual/bisexual individuals also have a higher rate of depression; the figures for those seem to range from 30-60% or so.)

Seems to me that a lot of the association between autism and depression could easily come from factors not directly related to autism, but more related to being part of a social minority group; other minority groups experience similar rates of depression, so those two factors can't be separated until autistic people are no longer a stigmatized minority.

Autism and psychosis have a weak link, if any. Yes, they can occur together. Autism has a rate of roughly 1% of the population; so does schizophrenia. Here at WP, that means that about one in a hundred people will have some kind of schizophrenia. About 2.5% will have bipolar disorder. So it's no surprise that we have a few people who have both.

There have been some studies that showed that autism and schizophrenia seem to run in the same families; but I wonder about those because autism used to be diagnosed as schizophrenia and that alone could account for the correlation. Maybe the two have a few genes in common; maybe it's just the shared history. Either way, there doesn't seem to be an obvious connection between autism and either bipolar or schizophrenia.

If you skimmed that:
1. Psychosis and mental illness are not the same thing; psychosis means seeing/hearing/believing things that don't make sense, and mental illness is just a big category for "my brain's out of balance" stuff.
2. Autism and mental illness are associated; autistic people are more vulnerable to mental illness, possibly because of their status as part of a minority group.
3. Autism and psychosis have a weak association, if any at all; autism used to be diagnosed as schizophrenia and that could account for it. Autism and psychosis can be found together relatively often because autism, schizophrenia, and bipolar disorder are all very common conditions.


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08 Oct 2010, 3:45 am

Callista wrote:
Autism and psychosis have a weak link, if any. Yes, they can occur together. Autism has a rate of roughly 1% of the population; so does schizophrenia. Here at WP, that means that about one in a hundred people will have some kind of schizophrenia. About 2.5% will have bipolar disorder. So it's no surprise that we have a few people who have both.


There are at least three issues that link psychosis and autism: 1) Many of the behaviours and verbal expressions of autistic people seem detached from reality as it is usually expressed; 2) Psychosis is an outcome of chronic depression; and 3) Irrespective of the first two, there appears to be a strong statistical association between autism and psychosis / schizophrenia.

Quote:
Deb S, Thomas M, Bright C. Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years. J Intellect Disabil Res. 2001 Dec;45(Pt 6):495-505.
The reported prevalence of psychiatric illness among adults with intellectual disability (ID) varies widely between 10 and 39%; however, many methodological problems exist. The aims of the present study were to establish the prevalence of functional psychiatric illness among adults with ID who live in the community, in order to compare the overall rate and types of psychiatric illness between the population with ID and the general population without ID, and to establish the risk factors associated with psychiatric illness in adults with ID. The study was done in two stages. In the first part, a trained psychiatrist interviewed 101 randomly selected adults with ID and their carers using the Mini Psychiatric Assessment Schedule for adults with Developmental Disability (Mini PAS-ADD) to screen for psychiatric caseness. Out of these 101 adults, 90 had sufficient communicative abilities that made the administration of Mini PAS-ADD possible. A second trained psychiatrist interviewed 19 out of the 20 adults who were diagnosed as psychiatric cases according to the initial Mini PAS-ADD interview. This psychiatrist interviewed patients and their carers in line with the full PAS-ADD interview. The second psychiatrist was blind to the initial diagnoses made according to the Mini PAS-ADD questionnaire. A final psychiatric diagnosis was made according to International Classification of Diseases - 10th Revision (ICD-10) criteria. Some 14.4% (95% confidence interval = 7.4-21.4%) of the cohort had a psychiatric diagnosis according to ICD-10 criteria: 4.4% had schizophrenia, 2.2% depressive disorder, 2.2% generalized anxiety disorder, 4.4% phobic disorder and 1% delusional disorder. The overall rate of functional psychiatric illness (point prevalence) was similar to that found in the general population (16%). However, the rates of schizophrenic illness and phobic disorder were significantly higher in the study cohort compared with those in the general population (0.4% and 1.1%, respectively). Increasing age and the presence of physical disability were significantly associated with the occurrence of psychiatric illness. Out of the 11 remaining adults with severe ID, two (18%) had a diagnosis of a psychiatric illness (one mania and one anxiety disorder) according to the Diagnostic Assessment for the Severely Handicapped (DASH) questionnaire.



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08 Oct 2010, 6:02 am

StuartN wrote:
Callista wrote:
Autism and psychosis have a weak link, if any. Yes, they can occur together. Autism has a rate of roughly 1% of the population; so does schizophrenia. Here at WP, that means that about one in a hundred people will have some kind of schizophrenia. About 2.5% will have bipolar disorder. So it's no surprise that we have a few people who have both.


There are at least three issues that link psychosis and autism: 1) Many of the behaviours and verbal expressions of autistic people seem detached from reality as it is usually expressed; 2) Psychosis is an outcome of chronic depression; and 3) Irrespective of the first two, there appears to be a strong statistical association between autism and psychosis / schizophrenia.

Quote:
Deb S, Thomas M, Bright C. Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years. J Intellect Disabil Res. 2001 Dec;45(Pt 6):495-505.
The reported prevalence of psychiatric illness among adults with intellectual disability (ID) varies widely between 10 and 39%; however, many methodological problems exist. The aims of the present study were to establish the prevalence of functional psychiatric illness among adults with ID who live in the community, in order to compare the overall rate and types of psychiatric illness between the population with ID and the general population without ID, and to establish the risk factors associated with psychiatric illness in adults with ID. The study was done in two stages. In the first part, a trained psychiatrist interviewed 101 randomly selected adults with ID and their carers using the Mini Psychiatric Assessment Schedule for adults with Developmental Disability (Mini PAS-ADD) to screen for psychiatric caseness. Out of these 101 adults, 90 had sufficient communicative abilities that made the administration of Mini PAS-ADD possible. A second trained psychiatrist interviewed 19 out of the 20 adults who were diagnosed as psychiatric cases according to the initial Mini PAS-ADD interview. This psychiatrist interviewed patients and their carers in line with the full PAS-ADD interview. The second psychiatrist was blind to the initial diagnoses made according to the Mini PAS-ADD questionnaire. A final psychiatric diagnosis was made according to International Classification of Diseases - 10th Revision (ICD-10) criteria. Some 14.4% (95% confidence interval = 7.4-21.4%) of the cohort had a psychiatric diagnosis according to ICD-10 criteria: 4.4% had schizophrenia, 2.2% depressive disorder, 2.2% generalized anxiety disorder, 4.4% phobic disorder and 1% delusional disorder. The overall rate of functional psychiatric illness (point prevalence) was similar to that found in the general population (16%). However, the rates of schizophrenic illness and phobic disorder were significantly higher in the study cohort compared with those in the general population (0.4% and 1.1%, respectively). Increasing age and the presence of physical disability were significantly associated with the occurrence of psychiatric illness. Out of the 11 remaining adults with severe ID, two (18%) had a diagnosis of a psychiatric illness (one mania and one anxiety disorder) according to the Diagnostic Assessment for the Severely Handicapped (DASH) questionnaire.


You cite a study that examines people with intellectual disabilities, not autism. How is this relevant?



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08 Oct 2010, 7:13 am

wavefreak58 wrote:
You cite a study that examines people with intellectual disabilities, not autism. How is this relevant?


I am sorry, it is completely irrelevant. I had a file open and copied the wrong item, with my mind completely on another problem.



wavefreak58
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08 Oct 2010, 8:05 am

StuartN wrote:
wavefreak58 wrote:
You cite a study that examines people with intellectual disabilities, not autism. How is this relevant?


I am sorry, it is completely irrelevant. I had a file open and copied the wrong item, with my mind completely on another problem.


Oops. :lol:



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08 Oct 2010, 8:12 am

I am sorry I didn't read all the posts here entirely, but I am at work at can't focus completely on reading all that has been written here. But I just want to add something (which may have already been stated) about autism and a psychosis.

The way I perceive it:

Yes, I have autism, and I tend to live in my own world (of special intense interests). But, I realize while I am in this world that it is my own fictional world and not reality. I can carry on conversations within my own world with other people in it, but I realize it is my creativity at work at not real. It is like daydreaming. As for a psychosis, I believe those people can live in their own world too---but may think it actually is reality.

I began thinking a lot about this when I watched the Night Gallery (Rod Serling early 1970s series) episode Silent Snow, Secret Snow---based on Conrad Aiken's story. I think you can still view the episode on Youtube, or you can find information on the story on the internet if you are not familiar with it. The question in the story is, "What condition does the boy Paul have?" The most popular theories are either autism or schizophrenia. So where are there is a difference in the two, I can understand why some people could see simialities in the two. But the realization of reality is the key---in my opinion.


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08 Oct 2010, 9:12 am

glider18 wrote:

Yes, I have autism, and I tend to live in my own world (of special intense interests). But, I realize while I am in this world that it is my own fictional world and not reality. I can carry on conversations within my own world with other people in it, but I realize it is my creativity at work at not real. It is like daydreaming. As for a psychosis, I believe those people can live in their own world too---but may think it actually is reality.


I think you are right. Your inner world is recognized by you as fictional. Psychosis would be believing such an inner world is reality.



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08 Oct 2010, 9:21 am

Quote:
There are at least three issues that link psychosis and autism: 1) Many of the behaviours and verbal expressions of autistic people seem detached from reality as it is usually expressed; 2) Psychosis is an outcome of chronic depression; and 3) Irrespective of the first two, there appears to be a strong statistical association between autism and psychosis / schizophrenia.
The "detached from reality" thing you get with autism is actually not psychosis; it's closer to dissociation. Think of dissociation as daydreaming or zoning out--rather than perceiving something that isn't reality, you're simply tuning out of perception. Dissociative disorders have very little to do with psychosis. Plus, most autistic people are too tuned in--they notice too much about their surroundings, so much so that they have trouble responding to people because they're trying to filter out the communication from the noise.

There is a kind of psychosis that is related to depression, but I haven't heard that it has anything to do with chronic depression. Depression with psychotic symptoms seems to be a minor subtype, and if it is more common among autistics, the association probably disappears when you control for the higher rate of depression in general.


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08 Oct 2010, 12:56 pm

Callista wrote:
The "detached from reality" thing you get with autism is actually not psychosis; it's closer to dissociation. Think of dissociation as daydreaming or zoning out--rather than perceiving something that isn't reality, you're simply tuning out of perception. Dissociative disorders have very little to do with psychosis.


I wonder if they can't exist in a kind of continuum (living in real world - living most time in your head - living in a "irreal" world)



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08 Oct 2010, 3:42 pm

StuartN wrote:
I had a file open and copied the wrong item, with my mind completely on another problem.


Here is something more relevant:

Quote:
Hofvander B, Delorme R, Chaste P, Nydén A, Wentz E, Ståhlberg O, Herbrecht E, Stopin A, Anckarsäter H, Gillberg C, Råstam M, Leboyer M. Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry. 2009 Jun 10;9:35.
RESULTS: Core autistic symptoms were highly prevalent in all ASD subgroups. Though AD subjects had the most pervasive problems, restrictions in non-verbal communication were common across all three subgroups and, contrary to current DSM criteria, so were verbal communication deficits. Lifetime psychiatric axis I comorbidity was very common, most notably mood and anxiety disorders, but also ADHD and psychotic disorders. The frequency of these diagnoses did not differ between the ASD subgroups or between males and females. Antisocial personality disorder and substance abuse were more common in the PDD NOS group. Of all subjects, few led an independent life and very few had ever had a long-term relationship. Female subjects more often reported having been bullied at school than male subjects.

Skokauskas N, Gallagher L. Psychosis, affective disorders and anxiety in autistic spectrum disorder: prevalence and nosological considerations. Psychopathology. 2010;43(1):8-16. Epub 2009 Nov 6.
RESULTS AND CONCLUSION: There is conflicting evidence regarding the frequency of schizophrenia in this population. Depression appears to be common, although most individuals with autism do not have sufficient language skills to verbalize changes in mood. Anxiety disorders represent the most common psychiatric co-morbidity in this population.

Dossetor DR. 'All that glitters is not gold': misdiagnosis of psychosis in pervasive developmental disorders--a case series. Clin Child Psychol Psychiatry. 2007 Oct;12(4):537-48.
The early literature established the validity of the distinction between early onset schizophrenia and autism. In the modern context of increasing recognition of pervasive developmental disorders (PDD) and a growing interest in very early onset schizophrenia and other childhood onset psychoses, this clinical distinction is often difficult to make. This article looks at problems arising from overdiagnosing psychosis in those with PDD. Four case examples of misattributed diagnosis of psychosis are described. The features that were mistaken for psychotic phenomena are described and explained and successfully treated in the context of a diagnosis of PDD. The article describes problems of reliability of ascertaining subjective mental phenomena and the range of mental phenomena that need to be recognized in PDD. The overlap of abnormal perceptions and cognitions in both these conditions is described with reference to the literature. It is evident that more needs to be done to improve diagnostic reliability of psychosis in PDD, by improving clinical awareness and research tools.