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      A phenomenological approach to diagnosing psychosis in autism spectrum disorder and intellectual disability: a case series

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          Abstract

          Purpose

          The diagnosis of psychosis in individuals with autism spectrum disorder (ASD) poses a unique clinical challenge. The presence of intellectual disability (ID) further complicates the diagnostic picture. Reliable and timely diagnosis of psychosis in such individuals minimises the duration of untreated psychotic symptoms and the subsequent impact on the quality of life of the patients concerned. The paper aims to discuss this issue.

          Design/methodology/approach

          The authors present four patients with psychosis, ASD and ID, who have received care within forensic mental health and ID settings. These examples demonstrate the interaction between these conditions, as well as issues pertaining to diagnosis and management.

          Findings

          In all four patients, sustained use of antipsychotic medication was objectively associated with an improvement in psychotic symptoms and quality of life. In instances where autistic phenomena were accentuated upon development of psychosis, such features returned to the baseline levels evident prior to the onset of psychosis.

          Practical implications

          The discussion and related case examples could improve the understanding of the possibility of psychosis in individuals with ASD and ID, and increase awareness of this diagnostic possibility among healthcare professionals.

          Originality/value

          This is the first published case series illustrating the challenges of diagnosing psychosis in individuals with ASD and ID.

          Related collections

          Most cited references 15

          • Record: found
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          • Article: not found

          Problems of nosology and psychodynamics of early infantile autism.

           L Kanner (1949)
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            • Record: found
            • Abstract: not found
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            The challenge of adolescents and adults with Asperger syndrome

             Digby Tantam (2003)
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              • Record: found
              • Abstract: found
              • Article: not found

              Autistic disorder and schizophrenia: diagnostic overlaps.

              Data on 14 males with autism and 14 with schizophrenia were collected to examine symptom overlap. The Structured Clinical Interview (SCID), the schedule for positive symptoms (SAPS) and the schedule for negative symptoms (SANS) of schizophrenia, the Childhood Autism Rating Scale (CARS), and the DSM-III-R were administered. On the SCID, none of the men with paranoid schizophrenia met criteria for autism while 7 of those with autism met criteria for schizophrenia, disorganized type, showing negative symptoms. In addition, 5 showed positive symptoms on the SAPS and 6 negative symptoms on the SANS. As the difference in measured nonverbal intelligence was not significant, the effects could not be attributed to it. Although the findings continue to support the differentiation of autism and schizophrenia, they are also consistent with a comorbidity of the two disorders, mainly in those diagnosed with autism.
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                Author and article information

                Contributors
                Journal
                AIA
                10.1108/AIA
                Advances in Autism
                AIA
                Emerald Publishing Limited
                2056-3868
                03 April 2018
                : 4
                : 2
                : 39-48
                Affiliations
                Hertfordshire Partnership NHS Foundation Trust, Colchester, UK
                Leicestershire Partnership NHS Trust, Leicester, UK
                Department of Health Sciences, University of Leicester , Leicester, UK
                Department of Psychiatry, Partnerships in Care Learning Disability Services, St Johns House, Norfolk, UK
                Norwich Medical School, University of East Anglia , Norwich, UK
                Tizard Centre, University of Kent , Kent, UK
                Department of Psychiatry, St Johns House, Norfolk, UK
                Author notes
                Verity Chester can be contacted at: veritychester@priorygroup.com
                Article
                608392 AIA-01-2018-0004.pdf AIA-01-2018-0004
                10.1108/AIA-01-2018-0004
                © Emerald Publishing Limited
                Page count
                Figures: 0, Tables: 6, Equations: 0, References: 34, Pages: 10, Words: 5711
                Product
                Categories
                case-report, Case study
                cat-HSC, Health & social care
                cat-LID, Learning & intellectual disabilities
                Custom metadata
                yes
                yes
                JOURNAL
                included

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