Association between schizophrenia and autism spectrum disorder: A systematic review and meta‐analysis

Abstract

Schizophrenia and autism spectrum disorder (ASD) are significant public health problems. Scientists have recently explored the association between schizophrenia and ASD, but the findings are inconsistent. Thus, we conducted a systematic review and meta-analysis of epidemiological studies to examine the association between schizophrenia and ASD. PubMed, Embase, and the Cochrane Library were used for literature searches to identify eligible studies published in English before October 2, 2017. Relevant studies estimating the association between schizophrenia and ASD were included. The meta-analysis of the prevalence of schizophrenia in individuals with ASD encompassed 1,950,113 participants and 14,945 individuals with ASD. A random-effects model was chosen to synthesize the effect sizes of individual studies. The prevalence of schizophrenia was significantly higher in individuals with ASD than in controls (odds ratio = 3.55, 95% confidence interval: 2.08-6.05, P < .001). Both sensitivity analysis and publication bias testing revealed that the findings were robust. The systematic review of the prevalence of ASD in individuals with schizophrenia encompassed 930 participants. The prevalence of ASD in individuals with schizophrenia ranged from 3.4 to 52%. The systematic review and meta-analysis showed a significant association between schizophrenia and ASD.Lay Summary: This systematic review and meta-analysis explored the association between schizophrenia and ASD. We found that the prevalence of schizophrenia was significantly higher in individuals with ASD than in controls and the prevalence of ASD in individuals with schizophrenia ranged from 3.4 to 52%. A comprehensive estimation of schizophrenia and ASD has important implications for the diagnosis, treatment, prognosis, and development of a fundamental understanding of these disorders.

Psychotic symptoms in 16p11.2 copy‐number variant carriers

“…It has, however, long been recognized that subtle symptoms, such as delay and abnormality in language, often precede the emergence of frank psychotic behavior [Courvoisie, Labellarte, & Riddle, 2001;Millan et al, 2016], and SCZ increasingly has been considered a disorder of abnormal neurodevelopment [Insel, 2010;Owen, O'Donovan, Thapar, & Craddock, 2011;Rapoport, Giedd, & Gogtay, 2012]. A recent meta-analysis showed that ASD and SCZ co-occur more frequently than chance would suggest, with SCZ over three times as common in individuals with ASD as in controls [Zheng, Zheng, & Zou, 2018].…”

Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses

“…Further, we evaluated the full-texts of 86 articles and excluded 60 articles that did not meet all the criteria of this review. Finally, 26 articles meeting all the criteria were included in this umbrella review (see Table 3), including 14 systematic reviews (Arnevik and Helverschou, 2016;Hannon and Taylor, 2013;Hedley and Uljarević, 2018;Kalyva et al, 2016;Menezes et al, 2018;Nickel et al, 2019;Padgett et al, 2010;Richa et al, 2014;Segers and Rawana, 2014;Skokauskas and Gallagher, 2009;Stewart et al, 2006;Vannucchi et al, 2014;Wigham et al, 2017;Zahid and Upthegrove, 2017) and 12 meta-analyses (De Giorgi et al, 2019;Díaz-Román et al, 2018;Elrod and Hood, 2015;Hollocks et al, 2019;Hudson et al, 2019;Lai et al, 2019;Lugo-Marín et al, 2019;Lugo Marín et al, 2018;Morgan et al, 2020;van Steensel et al, 2011;van Steensel and Heeman, 2017;Zheng et al, 2018).…”

Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses

“…Further, we evaluated the full-texts of 86 articles and excluded 60 articles that did not meet all the criteria of this review. Finally, 26 articles meeting all the criteria were included in this umbrella review (see Table 3), including 14 systematic reviews (Arnevik and Helverschou, 2016;Hannon and Taylor, 2013;Hedley and Uljarević, 2018;Kalyva et al, 2016;Menezes et al, 2018;Nickel et al, 2019;Padgett et al, 2010;Richa et al, 2014;Skokauskas and Gallagher, 2009;Stewart et al, 2006;Vannucchi et al, 2014;Wigham et al, 2017;Zahid and Upthegrove, 2017) and 12 meta-analyses (De Díaz-Román et al, 2018;Elrod and Hood, 2015;Hollocks et al, 2019;Hudson et al, 2019;Lai et al, 2019;Lugo-Marín et al, 2019;Lugo Marín et al, 2018;Morgan et al, 2020;van Steensel et al, 2011;van Steensel and Heeman, 2017;Zheng et al, 2018). Three clinical and one community sample were recruited comprising of children, adolescents, and young adults with ASD; study locations were not specified…”

“…The prevalence of schizophrenia spectrum and other psychotic disorders was reported in eight reviews, which ranged from 4% to 67% (De Lai et al, 2019;Lugo Marín et al, 2018;Padgett et al, 2010;Skokauskas and Gallagher, 2009;Zahid and Upthegrove, 2017;Zheng et al, 2018). For example, a meta-analytic review by Zheng and colleagues found that individuals with ASD had an odds ratio of 3.55 (95% CI: 2.08 -6.05, p < .001) to develop schizophrenia spectrum disorders compared to the typically-developed controls .…”

“…A major proportion of the reviews did not report the sampling techniques, which may affect the generalizability of the findings. For example, studies conducted in clinical settings have shown higher prevalence rates for different psychiatric disorders compared to those conducted in community settings Hudson et al, 2019;Zheng et al, 2018). Therefore, further evaluation would be essential to understand the true burden of psychiatric comorbidity in ASD.…”