Pace Federico, Callaghan Georgina
Médico Especialista en Psiquiatría Infantojuvenil. Hospital de Emergencias Psiquiátricas "Torcuato de Alvear". Miembro de la Comisión Directiva del Capítulo de Psiquiatría Infantojuvenil de la Asociación de Psiquiatras de Argentina (APSA).
Médica Especialista en Psiquiatría Infantojuvenil. Hospital "Carolina Tobar García". Especialista en Psiquiatría Universidad del Salvador. Vicepresidenta de la Comisión Directiva del Capítulo de Psiquiatría Infantojuvenil de la Asociación de Psiquiatras de Argentina (APSA).
Vertex. 2023 Jul 10;34(160, abr.-jun.):87-99. doi: 10.53680/vertex.v34i160.462.
The differential diagnosis between autism and schizophrenia in childhood has been the subject of numerous controversies. Because verbal hallucinations could be one of the main clinical phenomena when establishing a differential diagnosis, the objective was to investigate the presence or absence of verbal hallucinations in autism. For this, a selective and unsystematic review of the current scientific evidence was carried out. Added to this, the phenomenon of hallucination, and mainly verbal hallucination, was conceptualized from a historical perspective; the relevance given to hallucinations in the delimitation of the mentioned nosographic constructs was broached; and verbal hallucinations in autism were analyzed comparing different paradigms, including contributions from psychoanalysis. We observe that from the side of scientific evidence it is not possible to state strong conclusions regarding the presence or absence of verbal hallucinations in autism. In turn, the historical review of the concept of verbal hallucination from classical psychiatry together with contributions from psychoanalysis, invite us to think that one of the differential characteristics between autism and psychosis is the absence of verbal hallucinations in the first diagnosis, and that if there were hallucinations in autism, these would present different qualities from those of psychosis. We consider it highly relevant to be able to establish this differentiation in the hallucinatory phenomenon in autism, not only in order to establish a differential diagnosis between the two conditions, but also because of the implications that this could have in pharmacotherapy.
儿童期自闭症与精神分裂症的鉴别诊断一直是众多争议的主题。由于言语幻觉可能是建立鉴别诊断时的主要临床现象之一，因此目的是调查自闭症中言语幻觉的有无。为此，对当前的科学证据进行了选择性的、非系统性的综述。此外，从历史角度对幻觉现象，主要是言语幻觉进行了概念化；探讨了幻觉在上述疾病分类结构界定中的相关性；并比较了不同范式，包括精神分析的贡献，对自闭症中的言语幻觉进行了分析。我们观察到，从科学证据方面来看，无法就自闭症中言语幻觉的有无得出有力结论。反过来，经典精神病学中言语幻觉概念的历史回顾以及精神分析的贡献，促使我们思考自闭症与精神病之间的鉴别特征之一是初次诊断时不存在言语幻觉，并且如果自闭症中存在幻觉，这些幻觉将呈现出与精神病不同的特质。我们认为能够在自闭症的幻觉现象中建立这种区分非常重要，这不仅是为了在这两种病症之间建立鉴别诊断，也是因为这可能对药物治疗产生影响。
