#3085 Relationship between variant connective tissue (hypermobility) and autism sensory processing: externally oriented thinking as a mediator

Objectives/Aims

Autism is a neurodevelopmental condition characterised by differences in sensory processing, social communication and restricted/repetitive behaviors. Joint hypermobility is a common connective tissue variant, reportedly overrepresented in Autism. Alexithymia is a personality construct characterised by altered emotional awareness which has notably high rates of overlap with autism spectrum disorder. This study tested whether hypermobility was associated with autistic traits and examined alexithymia as a mediator of this association.

Method

Forty-two people underwent eligibility assessment for a study of joint hypermobility and anxiety (ISRCTN17018615). Hypermobility was assessed using both the Brighton Criteria for Joint Hypermobilty Syndrome (JHS) and 2017 Hypermobile Ehlers Danlos Syndrome (hEDS) Criteria. Participants completed the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS R: sensory/motor, language, social relatedness and circumscribed interest domains) to quantify autistic traits. No participant had a prior diagnosis of Autism. Participants also completed the Toronto Alexithymia Scale (TAS-20) to measure alexithymia. The TAS-20 has three domains: difficulty describing feelings, difficulty identifying feelings and externally oriented thinking.

Results

All 42 participants met criteria for JHS, 26 participants also met criteria for hEDS. Strikingly, 22/42 (52.4%) scored above threshold for suspected Autism (26/42 in the sensory/motor domain; 22/42 in language domain; 22/42 in social relatedness domain; 17/42 in circumscribed interests domain). There were no significant differences in RAADS-R scores depending on hypermobility diagnosis. The number of connective tissue features (hEDS Criterion 2A) correlated with RAADS-R sensory/motor score (r = 0.418, p = 0.006) but not social relatedness nor circumscribed interests sub-scores. Full mediation of the relationship between the number of connective tissue features and RAADs sensory/motor score by TAS-20 externally oriented thinking was found using the method of Baron-Kenny (1986) and estimation of indirect effects (Hayes, 2018; bootstrapped confidence intervals (n = 5000, do not cross zero)). Difficulty identifying feelings and difficulty describing feelings domains did not mediate this relationship.

Conclusion

These results add to evidence linking variant connective tissue to neurodevelopmental conditions (including Autism) and interestingly, specifically to sensory processing differences. Our study provides a strong rationale for screening for neurodevelopmental conditions in people with hypermobility and motivates further to understand symptom expression in this group. Our results also provide an insight into the processes underlying this relationship, which maybe important for informing interventions for people with hypermobility and autistic traits.

Inflammatory bowel disease psychological support pilot reduces inflammatory bowel disease symptoms and improves psychological wellbeing

This prospective service evaluation aimed to determine if integrated psychological support for patients with inflammatory bowel disease (IBD) enhanced outcomes. 75 patients were assessed and treated by a specialist liaison psychiatric service between 2015 and 2017; 43 received psychiatric intervention alone, 32 were referred for psychological intervention by clinical health psychologist; 26 completed this. Pre-post data (n=15 available) included global impression, quality of life, and psychiatric and IBD symptom scores. Referrer/patient satisfaction and cost-effectiveness were retrospectively calculated. Psychological intervention led to reductions in IBD symptoms (ΔSIBD; p=0.003), alongside improvements in depression scores (ΔPHQ-9, p=0.006) and global impression (ΔCGI; p=0.046). Patient/referrer satisfaction was very high. Indicative data comparing service utilisation 1 year before and after engagement found reductions in outpatient appointments and in imaging. This small study suggests consideration of increased access to integrated psychological support services to improve outcomes and gather further evidence of efficacy.

Salmonella in the intestinal tract and associated lymph nodes of sheep and cattle

The distribution of salmonellas along the gastrointestinal tract and in associated lymph nodes were studied in 100 sheep and 100 cattle at slaughter. Animals were chosen from those slaughtered on the first day of the week, since this meant that they were likely to have been held at the abattoir for several days and thus to be at high risk of salmonella infection. The contents of the rumen, abomasum, ileum, caecum and rectum were sampled, together with the lymph nodes draining each of these sites. Of the cattle, 77 were carrying salmonellas, including 61 with infected lymph nodes, whereas only 43 sheep were infected, 14 of them with infections in the nodes. The lower prevalence in sheep than in cattle might be explained by a shorter time between leaving the property and slaughter. In both species, within the gastrointestinal tract salmonellas were most frequently found in the caecum and rectum and least frequently in the abomasum. In cattle salmonellas were frequently present, usually in large numbers, in the lymph nodes draining the ileum, caecum and colon, but rarely in the ruminal and abomasal nodes; however this difference was not apparent in sheep. Over 70% of infected animals yielded more than one serotype, the maximum number isolated from any one animal being ten.