Autism Spectrum Disorder and Fetal Alcohol Spectrum Disorder: A Literature Review

Fetal alcohol spectrum disorders (FASD) are a group of conditions associated with the effects of prenatal alcohol exposure and characterized by somatic and neuropsychological alterations. On the other hand, autism spectrum disorder (ASD) is characterized by a multifaceted neurobehavioral syndrome. Since alcohol can affect every stage of brain development, some authors hypothesized that in utero alcohol exposure might be linked to an increased risk of ASD in subjects with genetic vulnerability. The present review aimed to summarize the available literature on the possible association between FASD and ASD, also focusing on the reported clinical overlaps and on the possible shared pathogenic mechanisms. Studies in this field have stressed similarities and differences between the two conditions, leading to controversial results. The available literature also highlighted that both the disorders are often misdiagnosed or underdiagnosed, stressing the need to broaden the perspective, paying specific attention to milder presentations and sub-syndromic traits

Emotional dysregulation as a part of the autism spectrum continuum: a literature review from late childhood to adulthood

The concept of emotional dysregulation (ED) has recently gained interest in the scientific literature and is commonly defined as the inability to use the modulatory mechanisms involved in emotion regulation, resulting in a functioning meaningfully below the baseline. Even though the data available are still limited, an increasing number of studies have hypothesized a promoting role for some of the core features of autism spectrum disorder (ASD) in the development of ED, in particular being repetitive behaviors, social difficulties and alexythimia. In this framework, the purpose of this study was to review the literature that is currently available about presence and correlates of ED in young adults with autism spectrum conditions as well as to offer some insights about possible implications for illness trajectories. The data reported seems to point to a shared etiology between ED and repetitive/restricted ASD symptoms, with perseveration features serving as the foundation for the inability to control one’s emotions. In this context, a neurodevelopmental basis for ED could be consistent with the transnosographic conceptualization of ASD, which hypothesizes a potential neurodevelopmental basis for several psychiatric disorders, whose autistic traits would be the phenotypical presentation

Presence and correlates of autistic traits among patients with social anxiety disorder

IntroductionDue to their similar behavioral presentation, it can sometimes be challenging to distinguish between a social anxiety disorder (SAD) and the social avoidance that is frequently described in autism spectrum disorder (ASD). Moreover, a growing body of evidences is reporting that a significant proportion of subjects with ASD also meet the requirements for SAD and, vice versa, subjects with SAD tend to exhibit a higher prevalence of autistic traits.AimIn this framework, the current study aims to evaluate prevalence and correlates of autistic traits in a sample of adult subjects diagnosed with SAD and healthy controls (HC), also evaluating which autism spectrum dimensions may statistically predict higher SAD symptoms.Methods56 subjects with a clinical diagnosis of SAD and 56 gender and age matched HC were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, the Social Anxiety Spectrum – Short Version (SHY- SV) and the Adult Autism Subthreshold Spectrum (AdAS Spectrum).ResultsSAD group scored significantly higher in all AdAS Spectrum and SHY-SV domains and total score compared to the HC group with no significant gender difference. SHY-SV total and domain scores, were strongly and positively and strongly correlated with all AdAS Spectrum domains and total score. AdAS Spectrum total score and Childhood/Adolescence, Non-Verbal Communication, Empathy and Restricted interests and Rumination domain scores score were significant predictors of higher SHY-SV score.ConclusionOur results confirm the link between SAD and autistic traits also in adult population, describing not only high levels of autistic traits in SAD adults, but also significant correlations between many core features of the two disorders and a predictive role of autistic traits on higher SAD symptoms

Validation of the short version of the obsessive compulsive spectrum questionnaire

AimIn the recent years, a rising amount of research has stressed the importance of a dimensional perspective on mental disorders. In particular, the conceptualization of an obsessive–compulsive spectrum appears to be in line with the very first descriptions of Obsessive–Compulsive Disorder and has been partially acknowledged by the inclusion of the “OCD-spectrum related syndromes and disorders” section in the DSM-5. The goal of the current study is to ascertain the psychometric characteristics of the Obsessive–Compulsive Spectrum–Short Version (OBS-SV), a novel questionnaire designed to measure the complete range of obsessive–compulsive symptoms, from severe full blown to subthreshold ones.MethodsForty three subjects with a clinical diagnosis of OCD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5); 42 subjects with a clinical diagnosis of social anxiety disorder (SAD), and 60 individuals without current or lifetime mental disorders (HC) were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the OBS-SV.ResultsOBS-SV showed strong test–retest reliability for both the total and the domains scores, as well as a high level of internal consistency. The Pearson’s coefficients for the OBS-SV domain scores ranged from 0.771 to 0.943, and they were positively and strongly linked with one another (p < 0.001). The OBS-SV total score had a strong correlation with each of the OBS-SV domain scores. All correlation coefficients between OBS-SV and additional measures of OCS were observed to be strong, significant and positive. Both OBS-SV domain and overall score differences between diagnostic groups were found to be statistically significant. From HCs, to the SAD, up to the OC group, which had the highest values, the OBS-SV total score grew dramatically and progressively.ConclusionThe OBS-SV demonstrated significant convergent validity with other dimensional OCD measures, excellent internal consistency, and test–retest reliability. Across the three diagnostic categories, the questionnaire functioned differently, with a rising score gradient from healthy controls through SAD patients to OCD subjects

Trauma, Mood and Ruminations in Borderline Personality Disorder

The inter-relation between mood diseases and Borderline Personality Disorder (BPD) has been debated since the introduction of BPD diagnosis itself. On the other hand, as studies on Post-traumatic Stress Disorder (PTSD) grew in number, the question of the close relationship between traumatic events and BPD has been posed with more and more emphasis. Moreover, only in recent times it is considered that Ruminations could have an independent role respect to other co-morbidities, like mood diseases, in the development and severity of BPD. In this study, for the first time, we compare the weight of these three psychopathological dimensions in determining BPD condition. METHOD: 50 patients who met the criteria for Borderline Personality Disorder, and 69 healthy controls were enrolled. Clinical diagnoses were determined by Structured Clinical Interview for DSM-5 (Scid-5). Mood Spectrum Self-Report (MOODS-SR) and Rumination Response Scale (RRS) were administered. RESULTS: Using a logistic regression model we found that BPD risk increases by 47% (OR=1.47, P=0.19) for every increase point of RRS brooding domain score and by almost three times (OR=2.87, P<0.001) for every DSM-5 PTSD criterion satisfied. No contribution of mood spectrum was found, while reflective ruminations showed to be protective respect to BPD (B = -0,36; OR = 0,70; p = 0,047). CONCLUSIONS: Our study confirms the very high importance of trauma and defines a possible role of ruminations in the psychopathogenesis and treatment of BPD; it shows that BPD requires an adjunctive problematization effort by investigating, at first, possible traumatic episodes. Rumination could, moreover, constitute one of the personological nuclei of BPD, and this seems to prevail respect to the Mood Spectrum. On the other hand we could hypothesise that in BPD traumatic life events represent a determining factor in mood dysregulation. The protective effect of reflective ruminations in BPD suggests that a targeted psychotherapeutic approach could be of help respect to the maladaptive modes with which the patient perceives himself. Further studies are needed in order to investigate if rumination play a permissive role respect to trauma, i.e. through a continuous reproposition of the traumatic event in mind such as to crystallize it, so contributing to determine the BPD condition

Measuring Social Camouflaging in Individuals with High Functioning Autism: A Literature Review

In the recent years, growing attention has been paid to the use of camouflaging strategies by adult populations suffering from autism spectrum disorder (ASD) with milder manifestations and without intellectual impairment, which may lead to a delay in diagnosis or even a misdiagnosis. In fact, high-functioning ASD individuals were reported to be more aware of their communication difficulties and were more likely make considerable efforts to adjust their behavior to conventional rules of non-autistic individuals, learning to imitate other non-ASD individuals. Moreover, females reported a higher frequency of camouflaging strategies, suggesting a role of camouflaging in the gender gap of the ASD diagnosis. Although camouflaging strategies can sometimes grant a better level of adjustment, even resulting in a hyper-adaptive behavior, they are also often correlated with negative mental health consequences due to the long-term stress associated with continuous attempts to adapt in day-to-day life. In this framework, the aim of the present work was to review the available studies that assessed the presence and correlates of camouflaging strategies in individuals with ASD. Although the literature available on the topic is still scarce, some interesting correlations between camouflaging and anxious and depressive symptoms, as well as suicidality, were highlighted. In particular, the controversial and sometime opposite thoughts and results about camouflaging may be clarified and integrated in light of a dimensional approach to psychopathology

Occurrence of Terrifying Nightmares after Few Days of Mirtazapine Use in Elderly Patients

Introduction. Sleep disturbance and insomnia are some of the most frequent complaints in patients suffering from depression. Some common antidepressant with excitatory effects may worsen sleep qualities, whereas others (like mirtazapine), thanks to their antihistaminergic action, are associated with sedative properties and can quickly improve sleep quality. In the case of mirtazapine, even if its mechanisms of action on sleep remain controversial, beneficial changes in sleep pattern may be observable since the first dose and are associated with a faster onset of the antidepressive action. Case Presentation. Despite these documented beneficial effects, we reported five cases of elderly patients (age ranging from 69 to 79) with various diagnoses and comorbidities (severe or recurrent depression, general anxiety disorder, borderline personality disorder, and Parkinson’s disease) assessed during clinical daily routine for whom the use of mirtazapine was linked to the onset of nightmares so impressive and dramatic that made it necessary to interrupt the treatment. Discussion. This peculiar side effect is still scarcely documented, and the literature on this topic remains conflicting; however, considering that the cases were collected in a short range of time, the exacerbation of nightmares caused by mirtazapine may be more frequent than previously believed. Furthermore, some common features shared by all the cases reported have been highlighted such as the onset of the nightmares being chronologically associated with the initiation of the therapy with mirtazapine, the disappearance with the interruption, the similar age range of all, and the occurrence of the episodes described during fall season

Implications of Social Anxiety Symptoms in Adults with Autism Spectrum Disorder: Is There a Predictive Role of Interpersonal Sensitivity and Substance Abuse?

Social anxiety disorder (SAD) has been frequently reported by subjects with Autism Spectrum Disorder (ASD). However, interestingly, the overlap between social anxiety and autistic traits may sometimes impede ASD diagnosis in subjects without intellectual or language impairment. The aim of the present work was to evaluate the presence and correlates of social phobic features among subjects with ASD, with a specific focus on evaluating which social anxiety symptoms may be statistically predictive of an ASD diagnosis. With this purpose, 48 subjects with ASD and 48 gender- and age- matched healthy controls (HCs) were recruited and assessed with the SHY-SV and the AdAS Spectrum questionnaires. Results highlighted higher scores in all SHY-SV Spectrum domains and total scores for the ASD group. Moreover, AdAS Spectrum scores were significantly correlated with all SHY-SV domain and total scores. A logistic regression analysis highlighted the SHY-SV Interpersonal sensitivity and Substance Abuse domains scores as significant positive predictors of an ASD diagnosis. These results confirm the link between ASD and SAD. Because of this association, particular attention should be paid to subjects with high interpersonal sensitivity traits and substance abuse problems

Food addiction spectrum: a theoretical model from normality to eating and overeating disorders

The authors comment on the recently proposed food addiction spectrum that represents a theoretical model to understand the continuum between several conditions ranging from normality to pathological states, including eating disorders and obesity, as well as why some individuals show a peculiar attachment to food that can become an addiction. Further, they review the possible neurobiological underpinnings of these conditions that include dopaminergic neurotransmission and circuits that have long been implicated in drug addiction. The aim of this article is also that at stimulating a debate regarding the possible model of a food (or eating) addiction spectrum that may be helpful towards the search of novel therapeutic approaches to different pathological states related to disturbed feeding or overeating

Polysubstance and Behavioral Addictions in a Patient with Bipolar Disorder: Role of Lifetime Subthreshold Autism Spectrum

This case report draws attention to the potential relevance of undetected autism spectrum symptoms in a bipolar patient with high work functioning showing a peculiar addictive profile with impulsive and antisocial behaviors. A 23-year-old man with a diagnosis of Bipolar Disorder (BD) and Substance Use Disorder (SUD) was hospitalized at the Psychiatric Clinic of the University of Pisa for diuretics and β-2 adrenergic agonist abuse in a remission phase of benzodiazepines and substance abuse. He reported a history of behavioral addictions in the framework of a global high work functioning with particular skills in computer science. When assessed for adult autism spectrum symptoms, despite not fulfilling a DSM-5 diagnosis of Autism Spectrum Disorder (ASD), he reported a score of 93/240 at the Ritvo Autism and Asperger Diagnostic Scale (RAADS-r) and of 88/160 at the Adult Autism Subthreshold Spectrum (AdAS Spectrum), both indicative of ASD. We argue the possible role of adult subthreshold autism spectrum features, generally disregarded in adult psychiatry, in the peculiar addictive profile developed by this patient with BD that may deserve appropriate treatment