First episode psychosis and comorbid ADHD, autism and intellectual disability

Abstract

Background:Comorbidity between neurodevelopmental disorders and psychotic disorders is common, but little is known about how neurodevelopmental disorders influence the presentation and outcome of first episode psychosis.Methods:A nation-wide cohort (n = 2091) with a first hospitalization for psychosis between 2007–2011 and at ages between 16–25 at intake was identified from Swedish population registries. Comorbid diagnoses of neurodevelopmental disorders were identified at first psychosis hospitalization and for ADHD also by dispensations of psychostimulants before the first psychosis hospitalization.Data from the registers on hospitalizations and dispensations of antipsychotic and psychostimulant medications during the year before and 2 years after the first psychosis hospitalization were analysed. Self-harm and substance use disorders were identified by ICD10 codes at hospitalizations.Results:2.5% of the cohort was identified with a diagnosis of intellectual disability, 5.0% with autism and 8.1% with ADHD. A larger proportion of cases with Autism (OR = 1.8, p < 0.05) and intellectual disability (OR = 3.1, p < 0.01) were using antipsychotic medication year 2 compared to the rest of the cohort. Delusional disorder was more common in the autism group (OR = 2.3, p < 0.05) at first psychosis hospitalization. ADHD was associated with higher risks for substance use disorders and self-harm both before and after the first psychosis hospitalization. Year 2 substance use disorder had a OR = 2.6 (p < 0.001) and self-harm OR = 4.1 (p < 0.001).Conclusions:Psychosis with comorbid ADHD is associated with high risks for substance use disorders and for self-harm, while psychosis with comorbid autism and intellectual disability is associated with longer treatment and higher doses of antipsychotic medication.

Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD)

“…The rate of lifetime co-occurring PsD in the ADHD group was 4.7% which is comparable to the previously reported co-occurrence of PsD and ADHD which can be up to 11%, especially when ADHD is of inattentive type [82] or associated with dysphoric mood [83] and persistent cannabis use and self-harm [84,85].…”

Lifetime co-occurring psychiatric disorders in newly diagnosed adults with Attention Deficit Hyperactivity Disorder (ADHD) or/and Autism Spectrum Disorder (ASD)

“…The rate of lifetime co-occurring PsD in the ADHD group was 4.7% which is comparable to the previously reported co-occurrence of PsD and ADHD which can be up to 11%, especially when ADHD is of inattentive type [59] or associated with dysphoric mood [83] and persistent cannabis use and self-harm [84,85].…”

Treatment of first-episode psychosis in patients with autism-spectrum disorder and intellectual deficiency

“…3 There is evidence that children and adults with first-episode psychosis and comorbid ASD at first presentation need higher dosages of antipsychotic medication than those without ASD. 4 They are also less likely to have a beneficial response to antipsychotic treatment, showing higher rates of persistent insufficient response and adverse effects than those without ASD. [4][5][6] The risks of ineffective antipsychotic treatment and multiple treatment failures are much higher in young people dually affected by ASD and early-onset psychosis.…”

“…4 They are also less likely to have a beneficial response to antipsychotic treatment, showing higher rates of persistent insufficient response and adverse effects than those without ASD. [4][5][6] The risks of ineffective antipsychotic treatment and multiple treatment failures are much higher in young people dually affected by ASD and early-onset psychosis. [4][5][6] Dystonic reactions are extremely distressful for patients and can lead to refusal of antipsychotic medication.…”

“…[4][5][6] The risks of ineffective antipsychotic treatment and multiple treatment failures are much higher in young people dually affected by ASD and early-onset psychosis. [4][5][6] Dystonic reactions are extremely distressful for patients and can lead to refusal of antipsychotic medication. When making treatment decisions in an emergency setting, it should be kept in mind that people with ID and ASD appear more susceptible to adverse effects -particularly on movement -and may be less responsive to antipsychotic medication.…”