Schizophrenia Research and Clinical Unit, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
J Psychiatr Res. 2021 May;137:48-54. doi: 10.1016/j.jpsychires.2021.02.044. Epub 2021 Feb 22.
Impairments in daily functioning characterize both autism spectrum disorder and schizophrenia. Research has shown that a subsample of schizophrenia patients presents autistic symptoms, leading to the hypothesis that their co-occurrence would be associated with a 'double dose' of deficit. A growing body of research examined this hypothesis by looking at the joint effect of autistic and positive psychotic symptoms, and yielded contrasting results, ranging from benefits to adverse effects. We hypothesized that the interactive effect of autistic and positive symptoms on functioning in schizophrenia might depend on the patients' symptom severity.
In 170 schizophrenia patients, a two-step cluster analysis identified two groups of patients with different levels of autistic and positive symptom severity. Using general linear models, we examined the interactions of groups, autistic and positive symptoms on functioning.
Autistic and positive symptoms were interactively associated with better functioning, but only in the symptomatically less severe patients. In contrast, autistic and positive symptoms were independently associated with worse functioning in the symptomatically more severe patients. These associations were observed above and beyond the effects of I.Q. and illness duration.
The findings highlight the complex role played by co-occurring autistic symptoms in schizophrenia, whose beneficial effects on functioning appear to depend on patients' psychopathological severity. Our findings may help to reconcile the seemingly contrasting results from previous studies, and to understand the heterogeneity of behavior and functional outcomes in schizophrenia. This study underscores the potential utility of routinely assessing autism in schizophrenia, in order to better formulate individualized rehabilitative programs.
自闭症谱系障碍和精神分裂症都表现为日常功能障碍。研究表明，一部分精神分裂症患者存在自闭症症状，这导致了一个假设，即它们的同时存在会导致“双重缺陷”。越来越多的研究通过观察自闭症和阳性精神病症状的共同作用来检验这一假设，结果喜忧参半，既有获益也有不利影响。我们假设自闭症和阳性症状对精神分裂症患者功能的交互作用可能取决于患者的症状严重程度。
在 170 名精神分裂症患者中，采用两步聚类分析确定了两组具有不同自闭症和阳性症状严重程度的患者。使用一般线性模型，我们检验了组间、自闭症和阳性症状对功能的交互作用。
自闭症和阳性症状与更好的功能相关，但仅在症状较轻的患者中存在交互作用。相比之下，自闭症和阳性症状与症状更严重的患者的功能较差独立相关。这些关联在智商和疾病持续时间的影响之外仍然存在。
这些发现强调了共患自闭症症状在精神分裂症中所扮演的复杂角色，其对功能的有益影响似乎取决于患者的精神病理严重程度。我们的发现可能有助于调和先前研究中看似矛盾的结果，并理解精神分裂症中行为和功能结果的异质性。这项研究强调了在精神分裂症中常规评估自闭症的潜在效用，以便更好地制定个体化的康复计划。
