Older adults with autism spectrum disorders in Sweden: a register study of diagnoses, psychiatric care utilization and psychotropic medication of 601 individuals

In a Swedish sample of persons eligible for disability services and aged 55 years or older in 2012, persons (n = 601) with autism spectrum disorder diagnoses registered in specialist care were identified. Register data concerning diagnoses of other psychiatric disorders, psychiatric care, and psychiatric medication were reviewed. More than 60% had been in contact with psychiatric care. The majority had no intellectual disability (ID) diagnosis recorded during the study period. Apart from ID, affective disorders, anxiety and psychotic disorders were most commonly registered; alcohol/substance abuse disorders were uncommon. Psychotropic drug prescriptions were very common, especially in the ID group. Professionals need awareness of this vulnerable group; studies concerning their life circumstances and service requirements should be conducted

Acquisition of complement fixing antibodies targeting Plasmodium falciparum merozoites in infants and their mothers in Uganda

BackgroundAntibody-mediated complement fixation has previously been associated with protection against malaria in naturally acquired immunity. However, the process of early-life development of complement-fixing antibodies in infants, both in comparison to their respective mothers and to other immune parameters, remains less clear.ResultsWe measured complement-fixing antibodies in newborns and their mothers in a malaria endemic area over 5 years follow-up and found that infants’ complement-fixing antibody levels were highest at birth, decreased until six months, then increased progressively until they were similar to birth at five years. Infants with high levels at birth experienced a faster decay of complement-fixing antibodies but showed similar levels to the low response group of newborns thereafter. No difference was observed in antibody levels between infant cord blood and mothers at delivery. The same result was found when categorized into high and low response groups, indicating placental transfer of antibodies. Complement-fixing antibodies were positively correlated with total schizont-specific IgG and IgM levels in mothers and infants at several time points. At nine months, complement-fixing antibodies were negatively correlated with total B cell frequency and osteopontin concentrations in the infants, while positively correlated with atypical memory B cells and P. falciparum-positive atypical memory B cells.ConclusionThis study indicates that complement-fixing antibodies against P. falciparum merozoites are produced in the mothers and placentally-transferred, and they are acquired in infants over time during the first years of life. Understanding early life immune responses is crucial for developing a functional, long lasting malaria vaccine

The Swedish Version of the Ritvo Autism and Asperger Diagnostic Scale: Revised (RAADS-R). A Validation Study of a Rating Scale for Adults

There is a paucity of diagnostic instruments for adults with autism spectrum disorder (ASD). This study evaluates the psychometric properties of the Swedish version of the Ritvo Autism and Asperger Diagnostic Scale-Revised (RAADS-R), an 80-item self-rating scale designed to assist clinicians diagnosing ASD in adults. It was administered to 75 adults with ASD and 197 comparison cases. Also, a subset completed the Autism Spectrum Quotient (AQ). Three out of four subscales had high internal consistency. Sensitivity was 91% and specificity was 93%. The ASD subjects had significantly higher mean scores on all subscales. ASD females had higher scores than ASD males on the sensory motor subscale, a dimension not included in the AQ. RAADS-R showed promising test re-test reliability

Static platelet adhesion, flow cytometry and serum TXB2 levels for monitoring platelet inhibiting treatment with ASA and clopidogrel in coronary artery disease: a randomised cross-over study

<p>Abstract</p> <p>Background</p> <p>Despite the use of anti-platelet agents such as acetylsalicylic acid (ASA) and clopidogrel in coronary heart disease, some patients continue to suffer from atherothrombosis. This has stimulated development of platelet function assays to monitor treatment effects. However, it is still not recommended to change treatment based on results from platelet function assays. This study aimed to evaluate the capacity of a static platelet adhesion assay to detect platelet inhibiting effects of ASA and clopidogrel. The adhesion assay measures several aspects of platelet adhesion simultaneously, which increases the probability of finding conditions sensitive for anti-platelet treatment.</p> <p>Methods</p> <p>With a randomised cross-over design we evaluated the anti-platelet effects of ASA combined with clopidogrel as well as monotherapy with either drug alone in 29 patients with a recent acute coronary syndrome. Also, 29 matched healthy controls were included to evaluate intra-individual variability over time. Platelet function was measured by flow cytometry, serum thromboxane B₂(TXB₂)-levels and by static platelet adhesion to different protein surfaces. The results were subjected to Principal Component Analysis followed by ANOVA, t-tests and linear regression analysis.</p> <p>Results</p> <p>The majority of platelet adhesion measures were reproducible in controls over time denoting that the assay can monitor platelet activity. Adenosine 5'-diphosphate (ADP)-induced platelet adhesion decreased significantly upon treatment with clopidogrel compared to ASA. Flow cytometric measurements showed the same pattern (r²= 0.49). In opposite, TXB₂-levels decreased with ASA compared to clopidogrel. Serum TXB₂and ADP-induced platelet activation could both be regarded as direct measures of the pharmacodynamic effects of ASA and clopidogrel respectively. Indirect pharmacodynamic measures such as adhesion to albumin induced by various soluble activators as well as SFLLRN-induced activation measured by flow cytometry were lower for clopidogrel compared to ASA. Furthermore, adhesion to collagen was lower for ASA and clopidogrel combined compared with either drug alone.</p> <p>Conclusion</p> <p>The indirect pharmacodynamic measures of the effects of ASA and clopidogrel might be used together with ADP-induced activation and serum TXB₂for evaluation of anti-platelet treatment. This should be further evaluated in future clinical studies where screening opportunities with the adhesion assay will be optimised towards increased sensitivity to anti-platelet treatment.</p

Intra-Genomic Ribosomal RNA Polymorphism and Morphological Variation in Elphidium macellum Suggests Inter-Specific Hybridization in Foraminifera

Elphidium macellum is a benthic foraminifer commonly found in the Patagonian fjords. To test whether its highly variable morphotypes are ecophenotypes or different genotypes, we analysed 70 sequences of the SSU rRNA gene from 25 specimens. Unexpectedly, we identified 11 distinct ribotypes, with up to 5 ribotypes co-occurring within the same specimen. The ribotypes differ by varying blocks of sequence located at the end of stem-loop motifs in the three expansion segments specific to foraminifera. These changes, distinct from typical SNPs and indels, directly affect the structure of the expansion segments. Their mosaic distribution suggests that ribotypes originated by recombination of two or more clusters of ribosomal genes. We propose that this expansion segment polymorphism (ESP) could originate from hybridization of morphologically different populations of Patagonian Elphidium. We speculate that the complex geological history of Patagonia enhanced divergence of coastal foraminiferal species and contributed to increasing genetic and morphological variation

Attention-deficit/hyperactivity disorder and autism spectrum disorders in adult psychiatric patients

Background: Knowledge about attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) in adult psychiatry is scant. Aims: Estimate prevalence, psychiatric morbidity patterns and impact of ADHD/ASD diagnoses in general adult psychiatry services. Material and methods: Two adult psychiatric out-patient groups were screened and clinically examined for ADHD and ASD. A new screening instrument, the Autism Spectrum Disorders in Adults Screening Questionnaire (ASDASQ) was developed for ASD. The Wender Utah Rating Scale was used for retrospective screening of childhood ADHD symptoms. A new questionnaire was used in an attempt to measure the subjective impact of receiving an ADHD or ASD diagnosis in adulthood in a group of consecutively clinically evaluated adult patients and their significant others. A very large data-set of all registered psychiatric patients at one clinic over a 20-year-period was used to assess time trends in clinical diagnoses of ADHD and ASD and “comorbidities”/psychiatric service use. Results: Of screened adult psychiatric patients 1.4% had ASD and most of these were treated at a centre for chronic disorders. The rate of ASD in this centre was 3.2%. A quarter of the patients with ASD had previous diagnoses of schizophrenia. The ASDASQ showed good psychometric properties. The rate of ADHD in the screened group of general psychiatric out-patients was 21.9%. These patients had been variably diagnosed, often with affective disorder. Greater subjective impact of the diagnosis for patients with ADHD than ASD was suggested. Perceived positive post-diagnosis change was reported by patients and significant others, and as regards medication (ADHD), housing and habilitation service contact (ASD). The rate of ADHD diagnoses increased from 1990 to 2009, but only about 2.7% of the whole adult psychiatric patient group received this diagnosis. ASD diagnosis rates also went up but only to about 1.3% of all registered patients. Discussion: In adult psychiatry, many patients have ADHD or ASD, developmental disorders that underlie or are overshadowed by “psychiatric illness”. Some patients seek help for problems related to the formerly unrecognized ADHD or ASD rather than for “psychiatric disorder”. ADHD seems to be much more common than ASD, and in both disorders concomitant psychiatric illness is usually present. It is important not to rely only on self-assessment questionnaires for diagnosis. An essential part of diagnostic work-up is a detailed history taking and testing of cognitive and adaptive development/capacity, currently not standard in adult psychiatric practice. Measuring the subjective impact of ADHD or ASD diagnoses proved to be difficult. The rate of diagnosed ADHD/ASD in adult psychiatry went up over the past two decades but was, by 2010, far below the likely “real” rate. The underdiagnosis of ADHD/ASD in adult psychiatry remains a huge clinical problem. Key words: Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), adults, psychiatry, Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ

Low prevalence of smoking in patients with autism spectrum disorders

Psychiatric patients are significantly more often smokers than the general population, the only known exception being obsessive-compulsive disorder (OCD) and catatonic schizophrenia. We have investigated nicotine use in subjects with autism spectrum disorders (ASD). Ninety-five subjects (25 females and 70 males) consecutively diagnosed with any ASD and of normal intelligence were included in the study. Only 12.6% were smokers, compared with 19% in the general population and 47% in a control group of 161 outpatients diagnosed with schizophrenia or a schizophreniform disorder. The results suggest that smoking is rare among subjects with ASD, while the opposite was shown for schizophrenia. If replicated, this finding could suggest biological differences between non-catatonic schizophrenia and ASD, and support the theory of a biological link between ASD and a subtype of OCD, and between ASD and catatonic schizophrenia. (C) 2003 Elsevier Ireland Ltd. All rights reserved