Autism Spectrum Disorder and Schizophrenia Are Better Differentiated by Positive Symptoms Than Negative Symptoms

Severity of autism-related symptoms in treatment-resistant schizophrenia: associations with cognitive performance, psychosocial functioning, and neurological soft signs - Clinical evidence and ROC analysis

Treatment-resistant schizophrenia (TRS) occurs when symptoms persist despite adequate antipsychotic treatment in terms of both timing and dosage. This severe condition is often overlooked, despite the existence of guidelines, with an average delay of 4-9 years before the introduction of clozapine, the gold standard treatment. We hypothesized that schizophrenia patients with severe autistic symptoms are more prone to develop TRS. To test this, we administered the Positive and Negative Syndrome Scale for Schizophrenia Autism Severity Scale (PAUSS) to 117 patients diagnosed with schizophrenia. Our results revealed that both TRS and clozapine non-responder (CLZ-nR) groups had higher rates of autistic symptoms than non-TRS patients. A machine learning model was developed to examine the relationship between PAUSS scores and TRS, obtaining an accuracy of 0.65 and an AUC of 0.67. Specifically, PAUSS items N6 ("lack of spontaneity and flow of conversation") and N7 ("stereotypical thinking") emerged as the most significant factors in the model. In addition, PAUSS was correlated with cognitive and social functions, as well as soft neurological signs, in TRS patients. Autism-related symptoms were found to predict significant variance in motor coordination, verbal fluency, functional ability and soft neurological signs. These results suggest that autism-related symptoms in schizophrenia may define a distinct subgroup with unique neurobiological characteristics.

Transdiagnostic Neurobiology of Social Cognition and Individual Variability as Measured by Fractional Amplitude of Low-Frequency Fluctuation in Autism and Schizophrenia Spectrum Disorders

BACKGROUND

Fractional amplitude of low-frequency fluctuation (fALFF) is a validated measure of resting-state spontaneous brain activity. Previous fALFF findings in autism and schizophrenia spectrum disorders (SSDs) have been highly heterogeneous. We aimed to use fALFF in a large sample of typically developing control (TDC), autistic, and SSD participants to explore group differences and relationships with inter-individual variability of fALFF maps and social cognition.

METHODS

FALFF from 495 participants (185 TDC, 68 autism, and 242 SSD) was computed using functional magnetic resonance imaging as signal power within two frequency bands (i.e., slow-4 and slow-5), normalized by the power in the remaining frequency spectrum. Permutation analysis of linear models was employed to investigate the relationship of fALFF with diagnostic groups, higher-level social cognition, and lower-level social cognition. Each participant's average distance of fALFF map to all others was defined as a variability score, with higher scores indicating less typical maps.

RESULTS

Lower fALFF in the visual and higher fALFF in the frontal regions were found in both SSD and autistic participants compared with TDCs. Limited differences were observed between autistic and SSD participants in the cuneus regions only. Associations between slow-4 fALFF and higher-level social cognitive scores across the whole sample were observed in the lateral occipitotemporal and temporoparietal junction. Individual variability within the autism and SSD groups was also significantly higher compared with TDC.

CONCLUSIONS

Similar patterns of fALFF and individual variability in autism and SSD suggest some common neurobiological features across these related heterogeneous conditions.

Investigating the attenuated psychosis syndrome in youth with autism spectrum disorder: results from an observational study

Introduction

Despite evidence suggesting increased rates of psychosis in individuals with autism spectrum disorder (ASD), the detection of prodromal psychotic symptoms, including attenuated psychosis syndrome (APS), remains underexplored in this population.

Methods

The primary aim of the present study was to characterize the clinical phenotype of young individuals with ASD who also present with APS (ASD/APS; n = 48) in comparison with individuals with APS only (n = 93) and those with ASD only (n = 30) (age range 9-23 years). Assessments included standardized measures of autistic symptoms (Autism Diagnostic Observation Schedule-Second Edition; ADOS-2), pre-psychotic symptoms (Structured Interview for Psychosis-Risk Syndromes; SIPS), and cognitive and adaptive functioning.

Results

Overall, the ASD/APS group demonstrated significantly poorer general adaptive skills compared with the APS group (p = 0.006) and the ASD group (p = 0.005). Compared with the APS group, the ASD/APS group exhibited lower scores across all SIPS domains, with the exception of SIPS-P1 (unusual thought content/delusional ideas; p = 0.062; t = -1.882; F = 5.44) and SIPS-P3 (grandiosity; p = 0.156; t = -1.435; F = 22.6). In contrast, the ASD/APS group displayed significantly higher scores in the repetitive and restricted behavior domain compared with the ASD group (p < 0.001). Notably, there were no significant differences in the age of APS onset across groups (p = 0.601; t = 0.525; F = 0.253).

Discussion

These findings provide a more nuanced characterization of APS features in individuals with ASD and emphasize the importance of screening for APS in this population, particularly those considered at increased risk. Early detection and intervention could facilitate timely therapeutic support, potentially improving long-term outcomes for these individuals.

Rare mutations implicate CGE interneurons as a vulnerable axis of cognitive deficits across psychiatric disorders

Neuropsychiatric disorders such as autism spectrum disorder (ASD) and schizophrenia (SCZ) share genetic risk factors, including rare high penetrance single nucleotide variants and copy number variants (CNVs), and exhibit both overlapping and distinct clinical phenotypes. Cognitive deficits and intellectual disability-critical predictors of long-term outcomes-are common to both conditions. To investigate shared and disorder-specific neurobiological impact of highly penetrant rare mutations in ASD and SCZ, we analyzed human single-nucleus whole-brain sequencing data to identify strongly affected brain cell types. Our analysis revealed Caudal Ganglionic Eminence (CGE)-derived GABAergic interneurons as a key nexus for cognitive deficits across these disorders. Notably, genes within 22q11.2 deletions, known to confer a high risk of SCZ, ASD, and cognitive impairment, showed a strong expression bias toward vasoactive intestinal peptide-expressing cells (VIP+) among CGE subtypes. To explore VIP+ GABAergic interneuron perturbations in the 22q11.2 deletion syndrome in vivo , we examined their activity in the Df(16)A +/- mouse model during a spatial navigation task and observed reduced activity along with altered responses to random rewards. At the population level, VIP+ interneurons exhibited impaired spatial encoding and diminished subtype-specific activity suggesting deficient disinhibition in CA1 microcircuits in the hippocampus, a region essential for learning and memory. Overall, these results demonstrate the crucial role of CGE-derived interneurons in mediating cognitive processes that are disrupted across a range of psychiatric and neurodevelopmental disorders.

Autism spectrum disorder and schizophrenia: a phenomenological comparison

A mental illness can lead to a distortion in a person's capacity to engage with the world and other people in a variety of ways. This is particularly relevant to schizophrenia and autism spectrum disorder (ASD), which are not only historically linked, but also overlap clinically in several respects. From a phenomenological point of view, the differences or similarities between both disorders have not yet been sufficiently investigated. Schizophrenic autism can be characterized as a disorder of three interconnected dimensions, namely the self, intersubjectivity and the self's relationship with the life-world. The present work therefore investigates differences in these three dimensions between the two disorders. One key difference is that the self-world relationship in schizophrenia can be described as unstable or fragmented, whereas in ASD it is considered stable. Finally, possible differences in the experience of delusions are discussed as a change in the self's relationship with the world.

Maternal immune activation alters the GABAergic system in the prefrontal cortex of female rat offspring: Role of interleukin-6

Maternal immune activation (MIA) induces long-term cognitive impairments by modulating the gamma-aminobutyric acid (GABA)ergic system. Experimental evidence suggests that maternal immune challenge with bacterial active ingredient lipopolysaccharide (LPS) reduces GABAergic tone in the offspring's prefrontal cortex. In this study, we aimed to assess whether interleukin-6 (IL-6) contributes to this reduced GABAergic system in the prefrontal cortex of juvenile offspring. Pregnant rats were given intraperitoneal injections of either LPS (100 µg/Kg) or a pyrogen-free saline solution in the absence or the presence of an IL-6 neutralizing antibody (IL-6Ab, 10 µg/Kg) on gestation day (GD) 15, GD17 and GD19. Parvalbumin and somatostatin GABAergic interneurons and the density of inhibitory synapses were monitored in 30-day-old male and female rat offspring using fluorescent immunohistochemistry. The expression levels of Cl- transporters (NKCC1 and KCC2) were assessed using western blotting. Prenatal LPS induced a significant reduction in the cell density of parvalbumin-containing interneurons in the prefrontal cortex of female but not male rat offspring. LPS-induced MIA led to a reduction in the expression levels of NKCC1 in the prefrontal cortices of both male and female offspring. These long-lasting impacts of the MIA were alleviated when the IL-6Ab was co-administered with LPS during pregnancy. This study shows that the GABAergic system in the prefrontal cortex of female rats is highly sensitive to prenatal immune challenges. These data pave the way for exploring the specific mechanism(s) underlying the sex-dependent effects of early-life immune challenges.

Sex differences in the prevalence and clinical correlates of autistic features in patients with chronic schizophrenia: a large scale cross-sectional study

OBJECTIVE

Sex differences have been suggested in both schizophrenia (SCZ) and autism spectrum disorder (ASD). This study aims to assess the prevalence and clinical correlates of autistic features in male and female patients with chronic SCZ.

METHODS

A total of 1690 chronic SCZ patients (M/F: 1122/568) were recruited from ten psychiatric hospitals in China. The Positive and Negative Syndrome Scale Autism Severity Score and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were utilised to assess the presence of autistic features and measure cognitive function, respectively.

RESULTS

Female SCZ patients had a higher prevalence of autistic features than male SCZ patients. In male patients, those with autistic features exhibited higher illness duration and RBANS scores, but lower years of education. Whereas in female patients, those with autistic features had higher RBANS scores, but lower years of education. Binary logistic regression analysis revealed that years of education, illness duration, visuospatial/constructional abilities, and language were correlated with autistic features in male patients. In female patients, years of education, language, and delayed memory were correlated with the presence of autistic features.

CONCLUSIONS

Our findings suggest that sex differences exist in the prevalence and clinical correlates of autistic features in chronic SCZ patients.

Identifying overlapping and distinctive traits of autism and schizophrenia using machine learning classification

INTRODUCTION

Autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD) share some symptoms. We conducted machine learning classification to determine if common screeners used for research in non-clinical and subclinical populations, the Autism-Spectrum Quotient (AQ) and Schizotypal Personality Questionnaire - Brief Revised (SPQ-BR), could identify non-overlapping symptoms.

METHODS

1,397 undergraduates completed the SPQ-BR and AQ. Random forest classification modelled whether SPQ-BR item scores predicted AQ scores and factors, and vice versa. The models first used all item scores and then the least/most important features.

RESULTS

Robust trait overlap allows for the prediction of AQ from SPQ-BR and vice versa. Results showed that AQ item scores predicted 2 of 3 SPQ-BR factors (disorganised, interpersonal), and SPQ-BR item scores successfully predicted 2 of 5 AQ factors (communication, social skills). Importantly, classification model failures showed that AQ item scores could not predict the SPQ-BR cognitive-perceptual factor, and the SPQ-BR item scores could not predict 3 AQ factors (imagination, attention to detail, attention switching).

CONCLUSIONS

Overall, the SPQ-BR and AQ measure overlapping symptoms that can be isolated to some factors. Importantly, where we observe model failures, we capture distinctive factors. We provide guidance for leveraging existing screeners to avert misdiagnosis and advancing specific/selective biomarker identification.

International perspective on social cognition in schizophrenia: current stage and the next steps

In the last decades, research from cognitive science, clinical psychology, psychiatry, and social neuroscience has provided mounting evidence that several social cognitive abilities are impaired in people with schizophrenia and contribute to functional difficulties and poor clinical outcomes. Social dysfunction is a hallmark of the illness, and yet, social cognition is seldom assessed in clinical practice or targeted for treatment. In this article, 17 international experts, from three different continents and six countries with expertise in social cognition and social neuroscience in schizophrenia, convened several meetings to provide clinicians with a summary of the most recent international research on social cognition evaluation and treatment in schizophrenia, and to lay out primary recommendations and procedures that can be integrated into their practice. Given that many extant measures used to assess social cognition have been developed in North America or Western Europe, this article is also a call for researchers and clinicians to validate instruments internationally and we provide preliminary guidance for the adaptation and use of social cognitive measures in clinical and research evaluations internationally. This effort will assist promoting scientific rigor, enhanced clinical practice, and will help propel international scientific research and collaboration and patient care.

Prevalence of autism in first-episode psychosis in two Hong Kong teaching hospitals

LAY ABSTRACT

Autistic features are commonly observed in children and adolescents with first-episode psychosis, but they are sometimes overlooked by clinicians and caregivers. By comprehensively examining the clinical profiles of 103 children and adolescents (below 18 years old) with first-episode psychosis and conducting the Autism Diagnostic Interview-Revised (the 'gold standard' autism diagnostic tool) with their primary caregivers, we showed that around 28% of patients with first-episode psychosis had a comorbid autism diagnosis, and boys were 3.57 times more likely to have first-episode psychosis-autism spectrum disorder comorbidity than girls. After administering the Autism Diagnostic Interview-Revised, we also observed that an additional 30% of patients with first-episode psychosis met the autism spectrum disorder diagnostic cut-off; their autism spectrum disorder symptoms were probably overshadowed by prodromal psychotic symptoms and left undetected before this study. The co-occurrence of autism and first-episode psychosis might be more common than we previously thought. Careful autism screening and assessment is highly recommended for clinicians working with patients with psychosis.

Pattern glare sensitivity distinguishes subclinical autism and schizotypy

INTRODUCTION

Schizophrenia and autism spectrum disorder are distinct neurodevelopmental disorders sharing clinically relevant behaviours. However, early sensory responses show divergent responses. Individuals with schizophrenia typically exhibit cortical hypo-excitability whereas individuals with autism show cortical hyperexcitability. Identifying reliable neurobiological differences between the disorders can diminish misdiagnosis and optimise treatments.

METHODS

The pattern glare test (PGT) is a simple measure of behavioural hyperexcitability. It measures the number of illusions seen in a static horizontal grating. We collected PGT data from non-clinical adults varying in traits of autism and schizophrenia (schizotypy). 576 undergraduate students completed an online survey consisting of the Schizotypal Personality Questionnaire - Brief Revised, the Autism Spectrum Quotient, and the PGT.

RESULTS

Subclinical autism and schizotypy traits were highly positively correlated. However, only schizotypy scores were significantly predictive of reporting more pattern glare (PG) illusions. When assessing the subcomponents of the schizotypy and autism scores, positive and disorganised schizotypy traits were predictive of reporting more PG illusions. Whereas, subclinical autism factors were not predictive of PG illusions.

CONCLUSIONS

High schizotypy performed the PGT in a manner consistent with behavioural hyperexcitability. The PGT distinguished subclinical autistic traits from schizotypy, suggesting potential clinical application.

Differential Diagnosis of Autism and Other Neurodevelopmental Disorders

This article discusses the diagnostic criteria for autism spectrum disorder (ASD), as well as other neurodevelopmental disorders that may be confused with or co-occur with ASD. Practitioners involved in diagnostic assessment of ASD must be well versed in the features that differentiate ASD from other conditions and be familiar with how co-occurring conditions may manifest in the context of ASD. ASD symptoms present differently across development, underscoring the need for training about typical developmental expectations for youth. Periodic reevaluations throughout development are also important because support needs for individuals with autism change over time.

Autism Spectrum Disorder and Early Psychosis: a narrative review from a neurodevelopmental perspective

Autism Spectrum Disorder (ASD), characterized by socio-communicative abnormalities and restricted, repetitive, and stereotyped behaviors, is part of Neurodevelopmental Disorders (NDDs), a diagnostic category distinctly in accordance with the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, (DSM-5), clearly separated from Schizophrenia Spectrum Disorder (SSD) (schizophrenia, schizophreniform disorder, schizoaffective disorder, schizotypal personality disorder). Over the last four decades, this clear distinction is gradually being replaced, describing ASD and SSD as two heterogeneous conditions but with neurodevelopmental origins and overlaps. Referring to the proposal of a neurodevelopmental continuum model, the current research's aim is to provide an update of the knowledge to date on the course of clinical symptoms and their overlaps among ASD and SSD. A narrative review of the literature published between January 2010 and June 2023 was conducted. Five studies were included. All studies show a global impairment in both conditions. Two studies show a focus on neurodevelopmental perspective in ASD and SSD. Only one study of these adopts a longitudinal prospective in terms of prognostic markers among ASD and SSD. Three studies underline the overlap between ASD and SSD in terms of negative, disorganized and positive symptomatology. To date, there is a gap in the current scientific literature focused on ASD-SSD course of clinical symptoms and their overlaps from a neurodevelopmental perspective. Future longitudinal studies to identify risk markers and tailored treatments are needed.

Elucidating multifinal and equifinal pathways to developmental disorders by constructing real-world neurorobotic models

Vigorous research has been conducted to accumulate biological and theoretical knowledge about neurodevelopmental disorders, including molecular, neural, computational, and behavioral characteristics; however, these findings remain fragmentary and do not elucidate integrated mechanisms. An obstacle is the heterogeneity of developmental pathways causing clinical phenotypes. Additionally, in symptom formations, the primary causes and consequences of developmental learning processes are often indistinguishable. Herein, we review developmental neurorobotic experiments tackling problems related to the dynamic and complex properties of neurodevelopmental disorders. Specifically, we focus on neurorobotic models under predictive processing lens for the study of developmental disorders. By constructing neurorobotic models with predictive processing mechanisms of learning, perception, and action, we can simulate formations of integrated causal relationships among neurodynamical, computational, and behavioral characteristics in the robot agents while considering developmental learning processes. This framework has the potential to bind neurobiological hypotheses (excitation-inhibition imbalance and functional disconnection), computational accounts (unusual encoding of uncertainty), and clinical symptoms. Developmental neurorobotic approaches may serve as a complementary research framework for integrating fragmented knowledge and overcoming the heterogeneity of neurodevelopmental disorders.

Vasopressin as Possible Treatment Option in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is rather common, presenting with prevalent early problems in social communication and accompanied by repetitive behavior. As vasopressin was implicated not only in salt-water homeostasis and stress-axis regulation, but also in social behavior, its role in the development of ASD might be suggested. In this review, we summarized a wide range of problems associated with ASD to which vasopressin might contribute, from social skills to communication, motor function problems, autonomous nervous system alterations as well as sleep disturbances, and altered sensory information processing. Beside functional connections between vasopressin and ASD, we draw attention to the anatomical background, highlighting several brain areas, including the paraventricular nucleus of the hypothalamus, medial preoptic area, lateral septum, bed nucleus of stria terminalis, amygdala, hippocampus, olfactory bulb and even the cerebellum, either producing vasopressin or containing vasopressinergic receptors (presumably V1a). Sex differences in the vasopressinergic system might underline the male prevalence of ASD. Moreover, vasopressin might contribute to the effectiveness of available off-label therapies as well as serve as a possible target for intervention. In this sense, vasopressin, but paradoxically also V1a receptor antagonist, were found to be effective in some clinical trials. We concluded that although vasopressin might be an effective candidate for ASD treatment, we might assume that only a subgroup (e.g., with stress-axis disturbances), a certain sex (most probably males) and a certain brain area (targeting by means of virus vectors) would benefit from this therapy.

Schizophrenia in autistic people with intellectual disabilities: Symptom manifestations and identification

BACKGROUND

The assessment of schizophrenia in autistic people with intellectual disabilities is challenging. This study aimed to explore the identification of schizophrenia in this population.

METHODS

Using data from a clinical multi-centre study, reported symptoms in 26 autistic individuals with intellectual disabilities diagnosed with co-occurring schizophrenia were explored. Scores on two checklists (Psychopathology in Autism Checklist [PAC], Aberrant Behaviour Checklist [ABC]) were compared with two comparison groups: autistic individuals with intellectual disabilities and other mental disorders (94), or no mental disorder (63).

RESULTS

Reported symptoms of schizophrenia in this population met the formal diagnostic criteria. For PAC/ABC scales, only PAC psychosis differed for the schizophrenia group. Among participants with schizophrenia, two were diagnosed with additional mental disorders. Elevated scores for anxiety and depression were common.

CONCLUSIONS

Emphasising core symptoms seems necessary when assessing co-occurring schizophrenia in autistic people with intellectual disabilities. The PAC may serve as a helpful screening tool.

Differences in self-reported psychotic symptoms between patients with autism spectrum disorder and those with schizophrenia

AIM

Patients with autism spectrum disorder (ASD) are prone to develop overt psychosis and share symptom presentations with those with schizophrenia (SZ). This study aimed to explore differences in the distributions of psychotic symptoms among first-visit patients with ASD, SZ, or a nonpsychiatric diagnosis (N-PD).

METHODS

Data from first-visit patients were retrospectively collected from medical records from the Department of Psychiatry, Dokkyo Medical University Hospital between June 2019 and May 2021. A total of 254 patients with data on the PRIME Screen-Revised (PS-R) assessments were included in our analysis. In the hospital, all psychiatric diagnoses were based on the DSM-5 diagnostic criteria.

RESULTS

In the ASD, SZ, and N-PD groups, endorsements of perplexity and delusional mood were 15.6% (7/45), 41.5% (44/106), and 1.1% (1/88), and those of perceptual abnormalities were 11.1% (5/45), 40.6% (43/106), and 2.3% (2/88), respectively. Trend analysis clarified that the endorsement of these psychotic symptoms increased from N-PD to ASD and SZ. In the multivariate-adjusted multinomial logistic regression analysis, the ASD and N-PD groups were compared with the SZ group. Higher age and the presence of perceptual abnormalities were associated with lack of an ASD diagnosis, whereas male sex, lack of perplexity and delusional mood, and lack of perceptual abnormalities were associated with N-PD.

CONCLUSION

Our results are preliminary; however, a detailed assessment of positive symptoms might facilitate differentiation between ASD and SZ.

Distinct Symptom Network Structure and Shared Central Social Communication Symptomatology in Autism and Schizophrenia: A Bayesian Network Analysis

Autism (ASD) and schizophrenia spectrum disorders (SCZ) are neurodevelopmental conditions with overlapping and interrelated symptoms. A network analysis approach that represents clinical conditions as a set of "nodes" (symptoms) connected by "edges" (relations among symptoms) was used to compare symptom organization in the two conditions. Gaussian graphical models were estimated using Bayesian methods to model separate symptom networks for adults with confirmed ASD or SCZ diagnoses. Though overall symptom organization differed by diagnostic group, both symptom networks demonstrated high centrality of social communication difficulties. Autism-relevant restricted and repetitive behaviors and schizophrenia-related cognitive-perceptual symptoms were uniquely central to the ASD and SCZ networks, respectively. Results offer recommendations to improve differential diagnosis and highlight potential treatment targets in ASD and SCZ.

Association between increased anterior cingulate glutamate and psychotic-like experiences, but not autistic traits in healthy volunteers

Despite many differences, autism spectrum disorder and schizophrenia spectrum disorder share environmental risk factors, genetic predispositions as well as neuronal abnormalities, and show similar cognitive deficits in working memory, perspective taking, or response inhibition. These shared abnormalities are already present in subclinical traits of these disorders. The literature proposes that changes in the inhibitory GABAergic and the excitatory glutamatergic system could explain underlying neuronal commonalities and differences. Using magnetic resonance spectroscopy (1H-MRS), we investigated the associations between glutamate concentrations in the anterior cingulate cortex (ACC), the left/right putamen, and left/right dorsolateral prefrontal cortex and psychotic-like experiences (Schizotypal Personality Questionnaire) and autistic traits (Autism Spectrum Quotient) in 53 healthy individuals (26 women). To investigate the contributions of glutamate concentrations in different cortical regions to symptom expression and their interactions, we used linear regression analyses. We found that only glutamate concentration in the ACC predicted psychotic-like experiences, but not autistic traits. Supporting this finding, a binomial logistic regression predicting median-split high and low risk groups for psychotic-like experiences revealed ACC glutamate levels as a significant predictor for group membership. Taken together, this study provides evidence that glutamate levels in the ACC are specifically linked to the expression of psychotic-like experiences, and may be a potential candidate in identifying early risk individuals prone to developing psychotic-like experiences.

The Autism Rating Scale for Schizophrenia - Revised English Version: An Instrument to Characterize Schizophrenia Spectrum Disorders Phenotype

Dis-sociality (DS) reflects the impairment of social experience in people with schizophrenia; it encompasses both negative features (disorder of attunement, inability to grasp the meaning of social contexts, the vanishing of social shared knowledge) and positive features (a peculiar set of values, ruminations not oriented to reality), reflecting the existential arrangement of people with schizophrenia. DS is grounded on the notion of schizophrenic autism as depicted by continental psychopathology. A rating scale has been developed, providing an experiential phenotype. Here we present the Autism Rating Scale for Schizophrenia - Revised English version (ARSS-Rev), developed on the Italian version of the scale. The scale is provided by a structured interview to facilitate the assessment of the phenomena investigated here. ARSS-Rev is composed of 16 distinctive items grouped into 6 categories: hypo-attunement, invasiveness, emotional flooding, algorithmic conception of sociality, antithetical attitude toward sociality, and idionomia. For each item and category, an accurate description is provided. Different intensities of phenomena are assessed through a Likert scale by rating each item according to its quantitative features (frequency, intensity, impairment, and need for coping). The ARSS-Rev has been able to discriminate patients with remitted schizophrenia from euthymic patients with psychotic bipolar disorder. This instrument may be useful in clinical/research settings to demarcate the boundaries of schizophrenia spectrum disorders from affective psychoses.

Automatic evaluation-feedback system for automated social skills training

Social skills training (SST), which is a rehabilitation program for improving daily interpersonal communication, has been used for more than 40 years. Although such training's demand is increasing, its accessibility is limited due to the lack of experienced trainers. To tackle this issue, automated SST systems have been studied for years. An evaluation-feedback pipeline of social skills is a crucial component of an SST system. Unfortunately, research that considers both the evaluation and feedback parts of automation remains insufficient. In this paper, we collected and analyzed the characteristics of a human-human SST dataset that consisted of 19 healthy controls, 15 schizophreniacs, 16 autism spectrum disorder (ASD) participants, and 276 sessions with score labels of six clinical measures. From our analysis of this dataset, we developed an automated SST evaluation-feedback system under the supervision of professional, experienced SST trainers. We identified their preferred or most acceptable feedback methods by running a user-study on the following conditions: with/without recorded video of the role-plays of users and different amounts of positive and corrective feedback. We confirmed a reasonable performance of our social-skill-score estimation models as our system's evaluation part with a maximum Spearman's correlation coefficient of 0.68. For the feedback part, our user-study concluded that people understood more about what aspects they need to improve by watching recorded videos of their own performance. In terms of the amount of feedback, participants most preferred a 2-positive/1-corrective format. Since the average amount of feedback preferred by the participants nearly equaled that from experienced trainers in human-human SSTs, our result suggests the practical future possibilities of an automated evaluation-feedback system that complements SSTs done by professional trainers.

The blind men and the elephant: The case for a transdiagnostic approach to initiation

Difficulty initiating voluntary action is an under-recognized and often invisible impairment in various psychiatric, neurodevelopmental, and neurological conditions. Understanding the commonalities of volition impairments across diagnoses is limited by a lack of consistent terminology, arbitrary distinctions between conditions, the habit of looking only to the prevailing definitions and theories to explain observed traits, and the covert nature of initiation. The siloed approach to research in this area evokes the parable of the blind men and the elephant, where understanding the whole picture is impeded by a limited view. There has been little effort to consider how differing terms overlap or to use objective methods to differentiate phenomena along meaningful lines. We propose a triad of interacting elements, all of which are needed for successful initiation of voluntary action: (i) executive function, (ii) volition, and (iii) movement. Failure to initiate a response may be due to impairments in any of these, which often co-occur. This paper calls for the following considerations to improve research in this area: (i) put aside preconceptions about conditions and their mechanisms to adopt a flexible transdiagnostic approach; (ii) consider executive function, movement, and volition as possible dimensional variations with related underlying mechanisms; (iii) carefully differentiate components of complex functions; (iv) look to first-hand reports for covert and previously unrecognized traits. These approaches have the potential to elucidate the cognitive and biological mechanisms underpinning voluntary action and create a foundation to develop more appropriate and informed interventions.

Executive functions in daily living skills: A study in adults with autism spectrum disorder

Introduction

Adults with autism and adults with schizophrenia show difficulties in adaptive skills, especially those related to daily functioning. Some studies suggest that adaptive skills are associated with deficits in executive functions (EF), while others indicate that intelligence quotient (IQ) might also play a role. Literature suggests that autistic symptoms further affect adaptive skills. The interest of the current study, therefore, was to explore to what extent IQ, EFs as well as core autistic symptoms predict adaptive skills.

Methods

To do this, 25 controls, 24 adults with autism, and 12 with schizophrenia were assessed on IQ (Wechsler Adult Intelligence Scale), and executive functioning. The EF was measured with neuropsychological tasks (inhibition, updating, and task switching) and with the Dysexecutive-Spanish Questionnaire (DEX-Sp) which assessed everyday life EF problems. Core ASD symptoms were measured using the Autism Diagnostic Observation Schedule, the Autism Spectrum Quotient-Short version (AQ-S), and the Repetitive Behavior Questionnaire - 3 (RBQ-3).

Results

The results indicated EF difficulties in both, autism and schizophrenia. The IQ explained a high percentage of the variance found in adaptive skills, but only in the autism group. We can conclude, therefore, that high IQ is associated with low adaptive skills levels and EFs affect adaptive functioning in people with autism; however, this does not explain the difficulties in adaptive functioning in the schizophrenia group. Core features of autism assessed with self-report questionnaires (but not the ADOS-2) predicted low scores on the adaptive skills, only in the autism group.

Discussion

Both EF measures predicted adaptive skills scores in autism, but not in schizophrenia. Our results suggest that different factors affect the adaptive functioning in each disorder. For instance, the EFs should be a central focus for improvement, especially for individuals with autism.

Treatment resistant psychosis in children and adolescents and clozapine: Nuances

With proliferation in research on high-risk psychosis spectrum diseases, it is crucial to distinguish a prodrome or psychosis-like episode in children and adolescents from true psychosis. The limited role of psychopharmacology in such circumstances is well-documented, underlining the difficulties in diagnosing treatment resistance. To add to the confusion is emerging data on the head-to-head comparison trials for treatment-resistant and treatment-refractory schizophrenia. Clozapine, the gold-standard drug for resistant schizophrenia and other psychotic psychopathology, lacks FDA or manufacturer guidelines for use in the pediatric population. Possibly due to developmental pharmacokinetic (PK) considerations, clozapine-related side effects are more commonly seen in children than adults. Despite evidence of an increased risk for seizures and hematological problems in children, clozapine is widely used off-label. Clozapine reduces the severity of resistant childhood schizophrenia, aggression, suicidality, and severe non-psychotic illness. There is inconsistent prescribing, administration, and monitoring of clozapine, and limited database evidence-backed guidelines. Despite the overwhelming efficacy, problems remain regarding unambiguous indications of use and risk-benefits assessments. This article reviews the nuances in the diagnosis of treatment resistance psychosis in childhood and adolescents and its management, in particular highlighting the evidence base for clozapine in this population group.

Antivax attitude in the general population along the autism-schizophrenia continuum and the impact of socio-demographic factors

Introduction

One of the most important inventions in human history is vaccines. However, to date a consistent amount of people exhibit a hesitant approach toward them and mixed results have emerged in the attempt to characterize which factors may play a role in predicting such negative attitude. Here, we aimed at investigating how the individual scoring along the autism-schizophrenic continuum component and socio-cultural factors contribute toward vaccination attitudes in the general population.

Methods

To test whether individual position along the autism-schizophrenic continuum could predict vaccine attitude, we used principal component analysis (PCA) to extract the component showing diametric loading between the Schizotypal Personality Questionnaire (SPQ) and Autistic Quotient (AQ) subscales. Then, we performed a series of multiple linear regression analyses to understand the relation between the ASD-SSD continuum component and Vax scores. We also included socio-demographic factors (i.e., gender, education level, and age) as predictors.

Results

Multiple regression analysis revealed that the closer the individual lied on the positive schizotypal pole, the higher was their negative attitude toward vaccines. A diametric, more favorable disposition was found for individuals closer to the autistic end of the continuum. Furthermore, we reported that among the socio-cultural factors, only age can be considered a significant predictor of vaccination attitudes, with younger participants showing a more positive attitudes toward vaccination, while the level of education is an important protective factor in mitigating the negative impact that the proximity to the SSD pole and age play against vaccination disposition.

Discussion

These findings are relevant to improve targeted public health interventions, highlighting the crucial role of demographic, psychological, and social correlates in predicting anti-vax beliefs, which have the devasting potential to increase the spread of infectious disease.

Electrophysiological Studies of Reception of Facial Communication in Autism Spectrum Disorder and Schizophrenia

Autism spectrum disorder (ASD) and schizophrenia spectrum disorders (SZ) are characterized by difficulty with social cognition and atypical reception of facial communication - a key area in the Research Domain Criteria framework. To identify areas of overlap and dissociation between ASD and SZ, we review studies of event-related potentials (ERP) to faces across ASD and SZ populations, focusing on ERPs implicated in social perception: P100, N170, N250, and P300. There were many inconsistent findings across studies; however, replication was strongest for delayed N170 latency in ASD and attenuated N170 amplitude in SZ. These results highlight the challenges of replicating research findings in heterogeneous clinical populations and the need for transdiagnostic research that continuously quantifies behavior and neural activity across neurodevelopmental disorders.

Diagnostic and Therapeutic Challenges of Comorbid ASD, ADHD and Psychosis: A Case Report

Autism Spectrum Disorder (ASD) and attention deficit hyperactivity disorder (ADHD) comorbidity is common in clinical practice and it seems to be related to shared etiological mechanisms and genetic susceptibility. Moreover, occurrence of psychosis can further complicate these complex clinical pictures. Here, we discuss the case of a nine-years-old boy presenting with an episode of abnormal sustained posture of the upper limbs, resembling dystonia, at the age of 3. At this time, auditory and visual hallucinations, as well as obsessive thoughts and attentional lability were also present and a diagnosis of "Early onset psychosis" was initially made. Due to the worsening of clinical picture, several hospitalizations were necessary and pharmacological treatment with carbamazepine, risperidone and aripiprazole was carried out. Extensive clinic evaluation revealed a past medical and personal history of toe walking, weak social skills and stereotyped behavior observed and ADOS-2 Module 2 administration revealed severe Autism scores. Moreover, signs of attention and hyperactivity were consistent with ADHD diagnosis. This work highlights the importance of a complete diagnostic assessment in patients with complex presentation, suggesting the possible overlap diagnosis of ADHD and Autism even in presence of psychotic-like symptoms.

A new multimodality fusion classification approach to explore the uniqueness of schizophrenia and autism spectrum disorder

Schizophrenia (SZ) and autism spectrum disorder (ASD) sharing overlapping symptoms have a long history of diagnostic confusion. It is unclear what their differences at a brain level are. Here, we propose a multimodality fusion classification approach to investigate their divergence in brain function and structure. Using brain functional network connectivity (FNC) calculated from resting-state fMRI data and gray matter volume (GMV) estimated from sMRI data, we classify the two disorders using the main data (335 SZ and 380 ASD patients) via an unbiased 10-fold cross-validation pipeline, and also validate the classification generalization ability on an independent cohort (120 SZ and 349 ASD patients). The classification accuracy reached up to 83.08% for the testing data and 72.10% for the independent data, significantly better than the results from using the single-modality features. The discriminative FNCs that were automatically selected primarily involved the sub-cortical, default mode, and visual domains. Interestingly, all discriminative FNCs relating to the default mode network showed an intermediate strength in healthy controls (HCs) between SZ and ASD patients. Their GMV differences were mainly driven by the frontal gyrus, temporal gyrus, and insula. Regarding these regions, the mean GMV of HC fell intermediate between that of SZ and ASD, and ASD showed the highest GMV. The middle frontal gyrus was associated with both functional and structural differences. In summary, our work reveals the unique neuroimaging characteristics of SZ and ASD that can achieve high and generalizable classification accuracy, supporting their potential as disorder-specific neural substrates of the two entwined disorders.

Predicting the future of neuroimaging predictive models in mental health

Predictive modeling using neuroimaging data has the potential to improve our understanding of the neurobiology underlying psychiatric disorders and putatively information interventions. Accordingly, there is a plethora of literature reviewing published studies, the mathematics underlying machine learning, and the best practices for using these approaches. As our knowledge of mental health and machine learning continue to evolve, we instead aim to look forward and "predict" topics that we believe will be important in current and future studies. Some of the most discussed topics in machine learning, such as bias and fairness, the handling of dirty data, and interpretable models, may be less familiar to the broader community using neuroimaging-based predictive modeling in psychiatry. In a similar vein, transdiagnostic research and targeting brain-based features for psychiatric intervention are modern topics in psychiatry that predictive models are well-suited to tackle. In this work, we target an audience who is a researcher familiar with the fundamental procedures of machine learning and who wishes to increase their knowledge of ongoing topics in the field. We aim to accelerate the utility and applications of neuroimaging-based predictive models for psychiatric research by highlighting and considering these topics. Furthermore, though not a focus, these ideas generalize to neuroimaging-based predictive modeling in other clinical neurosciences and predictive modeling with different data types (e.g., digital health data).

Autism spectrum disorder and schizophrenia: An updated conceptual review

Autism spectrum disorder (ASD) and schizophrenia (SCZ) are separate disorders, with distinct clinical profiles and natural histories. ASD, typically diagnosed in childhood, is characterized by restricted or repetitive interests or behaviors and impaired social communication, and it tends to have a stable course. SCZ, typically diagnosed in adolescence or adulthood, is characterized by hallucinations and delusions, and tends to be associated with declining function. However, youth with ASD are three to six times more likely to develop SCZ than their neurotypical counterparts, and increasingly, research has shown that ASD and SCZ converge at several levels. We conducted a systematic review of studies since 2013 relevant to understanding this convergence, and present here a narrative synthesis of key findings, which we have organized into four broad categories: symptoms and behavior, perception and cognition, biomarkers, and genetic and environmental risk. We then discuss opportunities for future research into the phenomenology and neurobiology of overlap between ASD and SCZ. Understanding this overlap will allow for researchers, and eventually clinicians, to understand the factors that may make a child with ASD vulnerable to developing SCZ. LAY SUMMARY: Autism spectrum disorder and schizophrenia are distinct diagnoses, but people with autism and people with schizophrena share several characteristics. We review recent studies that have examined these areas of overlap, and discuss the kinds of studies we will need to better understand how these disorders are related. Understanding this will be important to help us identify which autistic children are at risk of developing schizophrenia.

Diagnostic Difficulties in Discriminating Autism Spectrum Disorder in an Adult With Periodic Psychosis Versus Schizophrenia Spectrum Condition: An Insight From Psychological Testing

It has long been recognized that the biological underpinnings of autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD) may share a common basis; however, the two conditions remain separate in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) due to a few distinguishing characteristics. Both disorders are characterized by cognitive and social deficits and have been presumed to be linked to multiple genes. We describe a 46-year-old male who presented atypically with three previous and one current episode of schizoaffective-like symptoms. We describe his previous inpatient admissions, current inpatient course, psychological test results, and treatment. The patient initially presented with schizoaffective disorder, but with a thorough interview, collateral information review, and psychological evaluation, it was determined that he instead was presenting with a previously undiagnosed case of ASD with brief psychosis when under stress. This case serves as an example of an atypical presentation of ASD which can be mistaken for schizoaffective disorder. It is important to establish the correct diagnosis, as the subsequent treatment and management of the patient’s problems will depend on it. In such a patient, a low dose of atypical antipsychotic medication with serotonergic properties and psychotherapy would be the treatment of choice.

Clinical profile and conversion rate to full psychosis in a prospective cohort study of youth affected by autism spectrum disorder and attenuated psychosis syndrome: A preliminary report

Psychosis can occur at high rates in individuals with autism spectrum disorder (ASD). However, the detection of prodromal psychotic symptoms, including attenuated psychosis syndrome (APS), conditions at high risk of converting to full psychosis, has not been extensively investigated in ASD. We longitudinally evaluate a sample of young ASD individuals (age, mean ± SD: 13 ± 2.9) with (n = 13) or without (n = 18) concomitant APS through a standardized assessment of autistic (Autism Diagnostic Observation Schedule-Second Edition; ADOS-2) and psychotic (Structured Interview for Psychosis-Risk Syndromes, SIPS) symptoms and cognitive and adaptive skills. Individuals with other neuropsychiatric disorders were excluded. We estimated the conversion rate to full psychosis (according to SIPS criteria) over time (39.6 ± 11.5 months) and explored the role of clinical variables at baseline in the transition to full psychosis. A conversion rate to full psychosis of 30.7% was found in ASD/APS. Conversion to full psychosis was not affected by the severity of the autistic and psychotic symptoms. At baseline, young individuals with ASD/APS who later converted to full psychosis showed lower cognitive performance (d = 2.05) and greater impairment of adaptive social functioning profile (d = 1.2) than those with ASD. The results of this preliminary report revealed that nearly a third of young individuals with ASD/APS convert to full psychosis over time. Conversion to full psychosis is affected by decreased cognitive and adaptive skills. Further investigations are needed to confirm the utility of APS detection and to better characterize the psychotic developmental trajectory in ASD, with consequent important implications on prognosis and therapeutic strategies.

Abnormal brain development of monoamine oxidase mutant zebrafish and impaired social interaction of heterozygous fish

Monoamine oxidase (MAO) deficiency and imbalanced levels of brain monoamines have been associated with developmental delay, neuropsychiatric disorders and aggressive behavior. Animal models are valuable tools to gain mechanistic insight into outcomes associated with MAO deficiency. Here, we report a novel genetic model to study the effects of mao loss of function in zebrafish. Quantitative PCR, in situ hybridization and immunocytochemistry were used to study neurotransmitter systems and expression of relevant genes for brain development in zebrafish mao mutants. Larval and adult fish behavior was evaluated through different tests. Stronger serotonin immunoreactivity was detected in mao^+/− and mao^−/− larvae compared with their mao^+/+ siblings. mao^−/− larvae were hypoactive, and presented decreased reactions to visual and acoustic stimuli. They also had impaired histaminergic and dopaminergic systems, abnormal expression of developmental markers and died within 20 days post-fertilization. mao^+/− fish were viable, grew until adulthood, and demonstrated anxiety-like behavior and impaired social interactions compared with adult mao^+/+ siblings. Our results indicate that mao^−/− and mao^+/− mutants could be promising tools to study the roles of MAO in brain development and behavior.

This article has an associated First Person interview with the first author of the paper.

Summary: We assessed developmental, neurochemical and behavioral alterations displayed by mao^+/− and mao^−/− zebrafish, establishing that these model organisms are promising tools to study the consequences of MAOA/B deficiency.

Predictive waves in the autism-schizophrenia continuum: A novel biobehavioral model

The brain is a predictive machine. Converging data suggests a diametric predictive strategy from autism spectrum disorders (ASD) to schizophrenic spectrum disorders (SSD). Whereas perceptual inference in ASD is rigidly shaped by incoming sensory information, the SSD population is prone to overestimate the precision of their priors' models. Growing evidence considers brain oscillations pivotal biomarkers to understand how top-down predictions integrate bottom-up input. Starting from the conceptualization of ASD and SSD as oscillopathies, we introduce an integrated perspective that ascribes the maladjustments of the predictive mechanism to dysregulation of neural synchronization. According to this proposal, disturbances in the oscillatory profile do not allow the appropriate trade-off between descending predictive signal, overweighted in SSD, and ascending prediction errors, overweighted in ASD. These opposing imbalances both result in an ill-adapted reaction to external challenges. This approach offers a neuro-computational model capable of linking predictive coding theories with electrophysiological findings, aiming to increase knowledge on the neuronal foundations of the two spectra features and stimulate hypothesis-driven rehabilitation/research perspectives.

Reciprocal Social Behavior and Related Social Outcomes in Individuals at Clinical High Risk for Psychosis

Reciprocal social behavior (RSB) deficits have been noted in formal psychotic disorders and may play a role in the clinical high-risk for psychosis (CHR) syndrome. The present study examined RSB deficits and clinical and social functioning correlates in 45 individuals meeting criteria for a CHR syndrome and 47 healthy comparisons (HC). Further, this study examined associations with number of friends, problematic social Internet use, and perceived social support. Compared to the HC group, the CHR group exhibited greater deficits in total RSB and in all RSB subdomains. Total RSB deficits were associated with greater negative but not positive symptom severity in the CHR group, and greater social functional impairment. RSB deficits also may have related to fewer friendships, more problematic social Internet use, and less perceived belonging and tangible social support, although relationships with Internet use and perceived social support did not survive FDR-correction. These findings provide further evidence that RSB is impaired in the CHR syndrome and suggest specific social outcomes that may be affected. Further investigations with larger, diverse samples and repeated measures can confirm these findings.

Evidence of shared and distinct functional and structural brain signatures in schizophrenia and autism spectrum disorder

Schizophrenia (SZ) and autism spectrum disorder (ASD) share considerable clinical features and intertwined historical roots. It is greatly needed to explore their similarities and differences in pathophysiologic mechanisms. We assembled a large sample size of neuroimaging data (about 600 SZ patients, 1000 ASD patients, and 1700 healthy controls) to study the shared and unique brain abnormality of the two illnesses. We analyzed multi-scale brain functional connectivity among functional networks and brain regions, intra-network connectivity, and cerebral gray matter density and volume. Both SZ and ASD showed lower functional integration within default mode and sensorimotor domains, but increased interaction between cognitive control and default mode domains. The shared abnormalties in intra-network connectivity involved default mode, sensorimotor, and cognitive control networks. Reduced gray matter volume and density in the occipital gyrus and cerebellum were observed in both illnesses. Interestingly, ASD had overall weaker changes than SZ in the shared abnormalities. Interaction between visual and cognitive regions showed disorder-unique deficits. In summary, we provide strong neuroimaging evidence of the convergent and divergent changes in SZ and ASD that correlated with clinical features.

Predictors of social functioning and quality of life in schizophrenia and autism spectrum disorder

Schizophrenia (SZ) and Autism Spectrum Disorder (ASD) show overlap in social cognitive and functioning impairments. Proposed predictors of social functioning (SF) and quality of life (QL) have been symptom severity, IQ and social cognition. Empathy has rarely been compared between ASD and SZ and its predictive power on functional outcomes is unclear. We investigated general, affective, and cognitive empathy in 46 SZ, 30 ASD and 51 healthy controls (HC) and examined their relationship to SF and QL in addition to IQ and symptoms. SZ and ASD shared deficits in general and cognitive empathy, and personal distress, but only SZ showed deficits in affective empathy. Both groups showed lower performance-based empathy scores and only ASD showed slower responses compared to HC. Negative symptoms predicted QL in both groups, the more negative symptoms the worse QL (ASD t=-3.22; SZ t= -3.43; p<0.01), and only in ASD, IQ predicted QL, the higher the IQ the higher QL (t = 2.1; p<0.05). In ASD only, negative symptoms predicted SF, the greater negative symptoms the worse SF (t=-3.45; p<0.01), and communication deficits predicted SF, the higher deficits, the higher SF (t = 2.9; p<0.01). Negative symptoms but not empathy were the shared predictors of functioning across ASD and SZ.

Autistic traits as a potential confounding factor in the relationship between schizotypy and conspiracy beliefs

BACKGROUND

Conspiracy Theories (CT) are complex belief systems that view the world as being manipulated by multiple actors collaborating in the pursuit of malevolent goals. Although culture, education and sociological factors have been implicated in their development, psychological factors are recognized as important. Certain individual differences, including schizotypy and cognitive processing style, have been shown to make some individuals susceptible to CTs. However, the finding that schizotypy often co-occurs with autism spectrum disorder raises a question as to the relative and potentially confounding role of autistic traits in increasing vulnerability to CT beliefs.

METHOD

A total of 508 adults were recruited from an international online panel. The study included measures of conspiracy beliefs, schizotypy and autistic traits as well as measures of information searching and cognitive style.

RESULTS

The results confirmed that both autistic and schizotypy traits were positively associated with CT beliefs, but that schizotypy traits were the strongest predictor. Exploratory analyses of cognitive style measures indicated potential avenues for further investigation in relation in differences in cognitive processes that might underlie the development of CTs for in people with autistic traits as opposed to schizotypal traits.

LIMITATIONS

The study was based on a self-report methodology and did not utilise a clinical sample.

CONCLUSION

Both schizotypal and autistic traits are reliable predictors of conspiracy beliefs, but schizotypy appears to be the stronger predictor and that autistic traits are not a strong confounding factor in this relationship. However, autistic traits may pose an additional risk factor for CT beliefs.

Social Cognitive Performance in Schizophrenia Spectrum Disorders Compared With Autism Spectrum Disorder: A Systematic Review, Meta-analysis, and Meta-regression

IMPORTANCE

Schizophrenia spectrum disorders (SSDs) and autism spectrum disorder (ASD) both feature social cognitive deficits; however, these disorders historically have been examined separately using a range of tests and subdomain focus and at different time points in the life span. Moving beyond diagnostic categories and characterizing social cognitive deficits can enhance understanding of shared pathways across these disorders.

OBJECTIVE

To investigate how deficits in social cognitive domains diverge or overlap between SSDs and ASD based on the extant literature.

DATA SOURCES

Literature searches were conducted in MEDLINE, PsycInfo, Embase, and Web of Science from database inception until July 26, 2020.

STUDY SELECTION

Original research articles were selected that reported performance-based measures of social cognition in both SSDs and ASD samples. Selected articles also had to be published in English and use International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, DSM-IV, or more recent diagnostic criteria.

DATA EXTRACTION AND SYNTHESIS

This systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology reporting guidelines, including data extraction and quality assessment using a modified version of the Newcastle-Ottawa Scale. Data were pooled using a random-effects model.

MAIN OUTCOMES AND MEASURES

Effect sizes were calculated as Hedges g (SSDs vs ASD). The primary outcomes were performance on emotion processing tasks, theory of mind (ToM) tasks, and the Reading the Mind in the Eyes Test (RMET) in SSDs compared with ASD. Meta-regressions were performed for age difference, publication year, quality assessment scores, and antipsychotic medication use.

RESULTS

Of the 4175 screened articles, 36 studies directly comparing social cognitive performance in individuals with SSDs vs ASD were included in the qualitative analysis (n = 1212 for SSDs groups and n = 1109 for ASD groups), and 33 studies were included in the quantitative analyses (n = 1113 for SSDs groups and n = 1015 for ASD groups). Most study participants were male (number of studies [k] = 36, 72% [878 of 1212] in SSDs groups and 82% [907 of 1109] in ASD groups), and age (k = 35) was older in SSDs groups (mean [SD], 28.4 [9.5] years) than in ASD groups (mean [SD], 23.3 [7.6] years). Included studies highlighted the prevalence of small, male-predominant samples and a paucity of cross-disorder clinical measures. The meta-analyses revealed no statistically significant differences between SSDs and ASD on emotion processing measures (k = 15; g = 0.12 [95% CI, -0.07 to 0.30]; P = .21; I2 = 51.0%; 1 outlier excluded), ToM measures (k = 17; g = -0.01 [95% CI, -0.21 to 0.19]; P = .92; I2 = 56.5%; 1 outlier excluded), or the RMET (k = 13; g = 0.25 [95% CI, -0.04 to 0.53]; P = .10; I2 = 75.3%). However, SSDs vs ASD performance differences between studies were statistically significantly heterogeneous, which was only minimally explained by potential moderators.

CONCLUSIONS AND RELEVANCE

In this analysis, similar levels of social cognitive impairment were present, on average, in individuals with SSDs and ASD. Cross-disorder studies of social cognition, including larger samples, consensus batteries, and consistent reporting of measures, as well as data across multiple levels of analysis, are needed to help identify subgroups within and across disorders that may be more homogeneous in etiology and treatment response.

Single and Cross-Disorder Detection for Autism and Schizophrenia

Detection of mental disorders from textual input is an emerging field for applied machine and deep learning methods. Here, we explore the limits of automated detection of autism spectrum disorder (ASD) and schizophrenia (SCZ). We compared the performance of: (1) dedicated diagnostic tools that involve collecting textual data, (2) automated methods applied to the data gathered by these tools, and (3) psychiatrists. Our article tests the effectiveness of several baseline approaches, such as bag of words and dictionary-based vectors, followed by a machine learning model. We employed two more refined Sentic text representations using affective features and concept-level analysis on texts. Further, we applied selected state-of-the-art deep learning methods for text representation and inference, as well as experimented with transfer and zero-shot learning. Finally, we also explored few-shot methods dedicated to low data size scenarios, which is a typical problem for the clinical setting. The best breed of automated methods outperformed human raters (psychiatrists). Cross-dataset approaches turned out to be useful (only from SCZ to ASD) despite different data types. The few-shot learning methods revealed promising results on the SCZ dataset. However, more effort is needed to explore the approaches to efficiently training models, given the very limited amounts of labeled clinical data. Psychiatry is one of the few medical fields in which the diagnosis of most disorders is based on the subjective assessment of a psychiatrist. Therefore, the introduction of objective tools supporting diagnostics seems to be pivotal. This paper is a step in this direction.

Dopamine in Autism Spectrum Disorders-Focus on D2/D3 Partial Agonists and Their Possible Use in Treatment

Autism spectrum disorders (ASD) are a group of disorders characterized by impairment in social communication and repetitive and stereotyped behaviors. ASD etiology is very complex, including the effect of both genetic and environmental factors. So far, no specific treatment for the core symptoms of ASD has been developed, although attempts have been made for the treatment of repetitive behavior. The pharmacological treatment is aimed at treating non-specific symptoms such as irritability and aggression. Recent studies pointed out to the possible role of altered dopamine signaling in mesocorticolimbic and nigrostriatal circuits in ASD. In addition, several research pointed out to the association of dopamine receptors polymorphism and ASD, specifically repetitive and stereotyped behavior. In this paper, we will provide a review of the studies regarding dopamine signaling in ASD, existing data on the effects of D2/D3 partial agonists in ASD, possible implications regarding their individual receptor profiles, and future perspectives of their possible use in ASD treatment.

Oxytocin-MCH circuit regulates monosynaptic inputs to MCH neurons and modulates social recognition memory

Oxytocin regulates social behaviors and has been linked to the etiology of autism and schizophrenia. Oxytocin and another hypothalamic neuropeptide, melanin concentrating hormone (MCH), share several physiological actions such as emotion, social behavior and recognition, maternal care, sexual behavior and stress, which suggests that these two systems may interact, however, how they would do it is not known. Here, we study the interactions between the oxytocin and MCH systems in behaviors related to autism and schizophrenia. Specifically, we examined the synaptic inputs of the oxytocin-to the MCH neurons. We selectively deleted oxytocin receptors (OXTR) from MCH neurons (OXTR-cKO mice) using a Cre/loxP recombinase-technology, and used rabies-mediated circuit mapping technique to reveal the changes in the direct monosynaptic inputs to MCH neurons. We examined the behavioral responses of OXTR-cKO mice. Deletion of OXTR from MCH neurons induced a significant decrease in the primary inputs received by MCH neurons from the paraventricular nucleus and the lateral hypothalamus, and from the nucleus accumbens and ventral tegmental area. While OXTR-cKO mice exhibited similar social interactions as control mice, they displayed significantly impaired social recognition memory and increased stereotypic behavior. Our study identifies a selective role for the oxytocin-MCH pathway in social recognition memory and stereotyped behavior that are relevant to psychiatric disorders such as schizophrenia and autism, and warrant further investigation of this circuit to uncover potential benefit of targeting the oxytocin-MCH circuit as a novel therapeutic target for treatment of social recognition deficits in these two disorders.

Aripiprazole monotherapy as transdiagnostic intervention for the treatment of mental disorders: An umbrella review according to TRANSD criteria

Aripiprazole is approved in different countries as treatment for several mental disorders, but its transdiagnostic potential has not yet been assessed according to established criteria such as the recently proposed TRANSD criteria. The present work aims to test whether aripiprazole monotherapy could be considered a transdiagnostic intervention. An umbrella review of meta-analyses of randomized controlled trials (RCTs) of aripiprazole monotherapy vs placebo was conducted for any disorder defined according to standard diagnostic criteria. Primary outcomes were levels of psychiatric disease-specific symptoms. TRANSD criteria were applied to assess transdiagnosticity, while the AMSTAR -2 tool was used to assess the quality of eligible meta-analyses. Four pairwise meta-analyses and three network meta-analyses were included, consisting of 25 RCTs of aripiprazole monotherapy vs. placebo (N=5469). Aripiprazole outperformed placebo on primary outcomes in Alzheimer's disease with behavioral disturbance (AD) (neuropsychiatric symptoms SMD 0.20, 95%CI 0.05-0.35, max 15 mg/day), autism spectrum disorder (ASD) (severity of symptoms SMD 0.39, 95%CI 0.30-0.48, max 15 mg/day), bipolar I disorder (BD) (severity of manic symptoms SMD 0.30, 95%CI 0.12-0.47, max 30 mg/day), and schizophrenia/schizoaffective disorder (response rate RR 0.84, 95%CI 0.78-0.92, max 30 mg/day). TRANSD criteria were met (pooled SMD 0.25, 95%CI 0.09-0.41) across these disorders Quality was high in all the included meta-analyses according to AMSTAR-2. According to TRANSD criteria, aripiprazole monotherapy is a (dose-specific) transdiagnostic intervention to treat psychiatric disease-specific symptoms across 5 diagnoses (AD, ASD, BD (mania), schizophrenia/schizoaffective disorder), across four DSM-5 diagnostic groups (neurocognitive disorders, neurodevelopmental disorders, bipolar and related disorders, schizophrenia spectrum and other psychotic disorders).