Francis K
2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital of Athens, Athens, Greece.
Psychiatriki. 2012 Jun;23 Suppl 1:66-73.
Autism Spectrum Disorders (ASDs) consist a group of neurodevelopmental disorders that are usually diagnosed in early childhood but they persist throughout life, although significant changes can happen. The prevalence of the ASDs is estimated to be 1-1.2%. Subjects with the more severe form of the disorder that are usually characterised by the absence of a communicative language and learning difficulties of various severity, are often referred as persons with lower functioning. In the other end of the spectrum we can find subjects with less severe symptomatology, communicative language and at least of normal intelligence that are referred as high functioning autistic people or -in case of an absence of a language delay- as suffering from Asperger syndrome. The lower functioning adults can be referred to an adult psychiatrist mainly due to their behavioral problems and disruptive behaviors. Their inability to express their difficulties, due to their language restrictions and empathy deficits, can lead these people to behavioural deviances (often self- or hetero-destructive) that challenge their personal environment ending up in the pursuit of psychiatric help. In most cases, although not always justified, psychotropic medications will be prescribed in an attempt to control their maladaptive behaviors. Special attention should be paid to the catatonic exacerbation of ASD, which can be exhibited after adolescence. The catatonic features presented shouldn't be perceived as a possible comorbidity with another disorder, such as schizophrenia, but rather as an extreme form anxiety within the context of an ASD. High Functioning adults with ASDs are more difficult to be detected, but they may also need psychiatric consultation. These subjects may have never been diagnosed with an ASD, but they could have in their history a variety of diagnostic categorizations. Their accurate diagnosis could be further hampered in cases where they are exhibiting remarkable abilities, professional success or even an adequate social adaptation, such as marriage and family. Very often their symptoms will be confused with those of other disorders and they will be also prescribed psychotropic medication with very few, if any, results. In the current paper, we will point out the symptoms and situations that should alert the psychiatrist for the presence of an ASD in an adult with a normal intelligence and adequate functioning that is referred to him for bizarre ideas or behaviors. The designated diagnostic procedure for the ascertainment of the ASD in this case is similar to the one followed for children and adolescents and comprises of a detailed developmental history and a relevant observation and interview. Finally, we will discuss the most common difficulties in the differential diagnosis of the high functioning adults with an ASD from those suffering from Obsessive Compulsive Disorder, Schizoid Personality Disorder, Schizophrenia and Psychosis, and we will provide key issues that can be of an assistance in the more accurate assessment and categorization of the presented symptoms.
自闭症谱系障碍（ASD）是一组神经发育障碍，通常在幼儿期被诊断出来，尽管会有显著变化，但会伴随终生。据估计，ASD的患病率为1%-1.2%。患有该疾病更严重形式的个体，通常表现为缺乏交流性语言以及存在各种严重程度的学习困难，常被称为低功能个体。在谱系的另一端，我们可以发现症状较轻、有交流性语言且至少智力正常的个体，他们被称为高功能自闭症患者；如果不存在语言发育迟缓，则被称为患有阿斯伯格综合征。低功能的成年人主要因其行为问题和破坏性行为而可能会被转介给成人精神科医生。由于他们的语言限制和共情缺陷，无法表达自己的困难，这可能导致这些人出现行为偏差（通常是自我毁灭或伤害他人的），给他们的个人环境带来挑战，最终寻求精神科帮助。在大多数情况下，尽管并不总是合理，但会开出精神药物来试图控制他们的适应不良行为。应特别注意ASD的紧张症加重情况，这种情况可能在青春期后出现。所呈现的紧张症特征不应被视为与另一种疾病（如精神分裂症）的可能共病，而应被视为ASD背景下的一种极端焦虑形式。高功能的成年ASD患者更难被发现，但他们也可能需要精神科咨询。这些个体可能从未被诊断患有ASD，但他们的病史中可能有各种诊断分类。如果他们表现出非凡的能力、职业成功甚至有足够的社会适应能力（如结婚和组建家庭），他们的准确诊断可能会进一步受到阻碍。他们的症状常常会与其他疾病的症状混淆，而且即使使用精神药物，也很少（如果有的话）有效果。在本文中，我们将指出一些症状和情况，这些症状和情况应提醒精神科医生，对于一个智力正常、功能良好但因怪异想法或行为前来就诊的成年人，要警惕其患有ASD。在这种情况下，用于确定ASD的指定诊断程序与针对儿童和青少年的程序类似，包括详细的发育史以及相关的观察和访谈。最后，我们将讨论高功能成年ASD患者与患有强迫症、分裂型人格障碍、精神分裂症和精神病的患者在鉴别诊断中最常见的困难，并提供一些关键问题，这些问题有助于更准确地评估和分类所呈现的症状。
