Autistic Symptoms in Schizophrenia: Impact on Internalized Stigma, Well-Being, Clinical and Functional Characteristics

Abstract

Autism Spectrum Disorders (ASD) symptoms and internalized stigma (or self-stigma) can have a negative impact on cognitive and functional outcomes in people living with schizophrenia. Aim of the present study were to assess and compare internalized stigma, subjective well-being and other socio-demographic, clinical and functional characteristics in people diagnosed with schizophrenia with and without prominent autistic features. Ninety-four inpatients were assessed with measures of internalized stigma, subjective well-being, global clinical severity, schizophrenia symptoms severity, real-world functioning, medication side effects and attitude toward prescribed medications. Subjects with high levels of ASD symptoms were identified with the PANSS Autism Severity Score and compared to other participants. Predictors of prominent ASD features were also assessed. Thirteen patients showed prominent ASD symptoms. They were characterized by fewer years of education, worse real-world functioning and greater symptoms severity. No between-group differences were observed regarding subjective well-being and global internalized stigma severity; however, participants in the “autistic schizophrenia” group showed better stigma resistance. A worse clinical condition and fewer years of education emerged as predictors of autistic schizophrenia. Despite showing a more severe clinical presentation of the disorder and worse functional impairment, participants with prominent ASD symptoms do not present worse subjective well-being or more severe internalized stigma; on the contrary, they show better stigma resistance. ASD symptoms could therefore play a protective role in the internalization of stigma.

Assessment and correlates of autistic symptoms in Schizophrenia Spectrum Disorders measured with the PANSS Autism Severity Score: A systematic review

“…Finally, another recent study ( 59 ), including data on 94 individuals diagnosed with schizophrenia and assessed for a previous study ( 76 ), investigated the impact of autistic symptoms on global functioning, subjective well-being, and internalized stigma, measured with the Internalized Stigma of Mental Illness (ISMI) scale. Patients with autistic schizophrenia (PAUSS ≥ 30), compared to other participants, showed worse global functioning both a 1-week and 1-year assessment ( p < 0.001 for both); however, no significant difference was observed in subjective well-being.…”

“…Internalized stigma represents a feature that has an important impact on the lives of people with schizophrenia, strongly influencing their identity, their functioning and their quality of life ( 84 – 86 ). Only one study assessed the relationship between autistic features measured with the PAUSS and internalized stigma, showing that more severe autistic symptoms are not correlated with worse internalized stigma, and could even have a protective effect on stigma resistance ( 59 ). On the contrary, the results of two studies conducted by another research group suggest that more severe autistic symptoms could be correlated to worse internalized stigma ( 87 , 88 ).…”

Autistic symptoms in unaffected first-degree relatives of people with schizophrenia: results from the Italian Network for Research on Psychoses multicenter study

“…However, autistic symptoms may also have some protective effects: some studies report that autistic symptoms could mitigate the negative impact on functioning produced by high levels of psychotic symptoms [32][33][34]. Some studies also report that autistic symptoms appear to be related to other positive outcomes: one study has found a positive correlation between the severity of autistic symptoms and better stigma resistance, as measured by the Stigma Resistance factor of the Internalized Stigma of Mental Illness [35]; another study has reported that individuals diagnosed with SSD showing more prominent autistic features present better real-world social acceptability, as measured by the dedicated subscale of the Specific Level of Functioning Scale (SLOF), compared to other participants with same diagnosis with less severe autistic symptoms [28]. These effects may be partly explained by differences in relational and coping styles observed in individuals with prominent autistic features [36].…”