Prevalence of Non-Affective Psychoses in Individuals with Autism Spectrum Disorders: A Systematic Review

Abstract

Autism spectrum disorders (ASD) and non-affective psychoses such as schizophrenia are commonly acknowledged as discrete entities. Previous research has revealed evidence of high comorbidity between these conditions, but their differential diagnosis proves difficult in routine clinical practice due to the similarities between core symptoms of each disorder. The prevalence of comorbid non-affective psychoses in individuals with ASD is uncertain, with studies reporting rates ranging from 0% to 61.5%. We therefore performed a systematic review and pooled analysis of the available studies reporting the prevalence of non-affective psychosis in ASD. Fourteen studies, including a total of 1708 participants, were included, with a weighted pooled prevalence assessed at 9.5% (95% CI 2.6 to 16.0). In view of significant heterogeneity amongst the studies, subgroup analyses were conducted. We observed higher prevalence of non-affective psychoses among ASD inpatients versus outpatients, when operationalised criteria were used, and in studies with smaller sample sizes, whereas the figures were comparable between children and adults with ASD. Our results suggest that future studies involving larger samples should implement both operationalized criteria and specific scales for the assessment of psychotic symptoms in individuals with ASD. A deeper understanding of both differential and comorbid features of ASD and non-affective psychosis will be required for the development of optimized clinical management protocols.

Equity, acceptability and feasibility of using polyunsaturated fatty acids in children and adolescents with autism spectrum disorder: a rapid systematic review

“…While the body of evidence supporting the efficacy of psychosocial interventions is large, these treatments have limited accessibility, due to their high cost and the intense labor and parents' involvement needed [8], so that parents usually report greater adherence to medication [9,10]. ASD is frequently associated with psychiatric comorbidities requiring treatment [11] but, to date, only risperidone and aripiprazole have been approved by the Food and Drug Administration (FDA) for the treatment of irritability in ASD, with no medications approved by the European Medicines Agency (EMA), and no pharmacological treatment proved to be effective in treating core symptoms. Concerns about adverse events often shift parents to prefer complementary and alternative medicines (CAMs) [8,12].…”

Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder: a systematic review.

“…Antipsychotics are among the most widely prescribed drugs in children and adolescents with ASD, with a median prevalence of use of 17% [54]. This is in line with both the prevalence of irritability in this population, for which risperidone and aripiprazole are effective and indicated [12,55,56,57,58], and the frequent comorbidity with schizophrenia spectrum disorders symptoms [59].…”

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).…”

“…Children and adults with ASD were recruited from general population and clinical samples; Most studies were from the US (n = 5), Japan (n =3), and one each from The prevalence of suicide ideation ranged from 11% to 66% and suicidal attempts from 1% to 35%; mortality due to suicide was 0.31% among people with ASD compared to 0.04% among traditionally developed individuals; the prevalence of comorbid attention-deficit Australia, Canada, Sweden, Turkey, and the UK hyperactivity syndrome was reported as high as 65% among study samples (Zheng et al, 2018) PubMed, Embase, Cochrane Library, and additional sources; studies published till 2017 17; Metaanalysis Sample size ranged from 12 to 9,062 for people with ASD and 12 to 1,842,575 among controls Participants with ASD of all age group were included; the recruitment strategy was not specified; studies were conducted in Denmark (n = 4), the US (n = 4), Sweden (n = 3), and once study each in Norway, Canada, Australia, Finland, and the Netherlands The pooled prevalence of schizophrenia was significantly higher among individuals with ASD compared to the controls (OR = 3.55, 95% CI: 2.08-6.05, P < .001); also, the pooled prevalence of ASD in individuals with schizophrenia ranged from 3.4 to 52%; ASD participants in the case-control studies had higher odds (8.2, 95% CI: 3.25-20.66) compare to cross-sectional studies (2.47, 95% CI: 1.31-4.66); samples from European countries had higher odds (4.21, 95% CI: 1.8-9.85) compared to the US samples (2.61, 95% CI: 1.07-6.39) (De Giorgi et al, 2019) PubMed/MEDLINE, Web of Science, CINAHL; studies published till 2019 14; Metaanalysis The total sample size was 1,708 (ranged from 26 to 414) Samples comprised of both children and adults with ASD; recruited from mostly outpatient settings (12 out of 14 studies); studies were conducted in Sweden (n = 3), Denmark (n = 3). The US (n = 2), and one study each from the UK, Italy, France, Canada, Norway; one study had samples from both Sweden and France…”

“…The quality evaluation found fourteen reviews with high quality (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;Menezes et al, 2018;Morgan et al, 2020;van Steensel et al, 2011;van Steensel and Heeman, 2017;Wigham et al, 2017;Zheng et al, 2018), twelve reviews with medium quality (Arnevik and Helverschou, 2016;Hannon and Taylor, 2013;Hedley and Uljarević, 2018;Kalyva et al, 2016;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;Zahid and Upthegrove, 2017), and no studies had low quality (see the Supplementary material). Three clinical and one community sample were recruited comprising of children, adolescents, and young adults with ASD; study locations were not specified…”