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Psychosis in autism spectrum disorder: a clinical review

Published online by Cambridge University Press:  19 July 2023

D. R. Gomes ,
F. Silveira  and
R. Freitas
D. R. Gomes*
Affiliation:
Departamento de Psiquiatria e Saúde Mental, Hospital do Espírito Santo de Évora, Évora, Portugal
F. Silveira
Affiliation:
Departamento de Psiquiatria e Saúde Mental, Hospital do Espírito Santo de Évora, Évora, Portugal
R. Freitas
Affiliation:
Departamento de Psiquiatria e Saúde Mental, Hospital do Espírito Santo de Évora, Évora, Portugal
*
*Corresponding author.

Abstract

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Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by frequent comorbidity including mood, anxiety and psychotic disorders. Psychiatric comorbidity in ASD has been associated with poor prognosis.

Objectives

To summarize clinical data regarding the relationship between autism spectrum disorder and psychosis comorbidity, namely its epidemiology, diagnosis, treatment and prognosis.

Methods

We conducted a non-systematic review of the literature relevant to the topic published in the PubMed database. Articles were selected based on title and abstract review.

Results

Epidemiological studies report significant rates of comorbidity between ASD and psychosis. According to a recent systematic review, prevalence of non-affective psychosis in ASD has been estimated at 9,56%, despite heterogeneity across included studies.

The differential diagnosis of psychosis in a patient with ASD is frequently a challenge and depends on the severity of intellectual and language impairment, medical comorbidities (including epilepsy and associated pharmacological iatrogenic factors), psychiatric comorbidities and substance use. Conversely, establishing the diagnosis of ASD in a patient presenting with psychosis is not always clear, and clinicians must rely on collecting a detailed developmental history.

There are no large controlled studies regarding the treatment of psychosis in this specific patient group, but risperidone and aripiprazole have been used based on efficacy in primary psychotic disorders, as well as efficacy and safety profile in other symptomatic clusters of ASD, namely irritability.

ASD and psychosis comorbidity has been associated with lower response rates to antipsychotic treatment and negative long-term prognosis.

Conclusions

Psychosis is a common and serious comorbidity of ASD, with limited data regarding treatment options. Further research is needed to improve global outcomes.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 66 , Special Issue S1: Abstracts of the 31st European Congress of Psychiatry , March 2023 , pp. S754 - S755
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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