Risk of psychosis in autism spectrum disorder individuals exposed to psychosocial stressors: A 9‐year chart review study
Riccardo Bortoletto, Lorenzo Bassani, Marco Garzitto, Marco Lamberti, Alessandro Simonati, Francesca Darra, Sagnik Bhattacharyya, Carla Comacchio, Matteo Balestrieri, Donatella Arcangeli, Marco Colizzi
Abstract
Abstract Psychosocial stressors have been suggested to precipitate psychotic episodes in patients with pre‐existing psychosis and otherwise healthy subjects. However, such a risk has never been formally investigated in individuals with autism spectrum disorder (ASD). Sixty‐nine autistic adolescents hospitalized for psychotic/manic symptoms (PSY) and other mental health issues (NPSY) over a 9‐year period were compared with reference to their previous exposure to psychosocial stressors. ASD diagnoses satisfied the International Classification of Diseases (ICD)‐10 criteria. Psychotic/manic symptom assessment followed the Kiddie Schedule for Affective Disorders and Schizophrenia (K‐SADS). Psychosocial stressor exposure was collected separately at each admission. Preliminarily, univariate between‐group comparisons were conducted. Then, a binomial model was adopted to investigate associations with previous exposure to psychosocial stressors. Results were reported with a change in AIC (ΔAIC). PSY patients presented with higher previous exposure to adverse life events (30.43% vs. 6.52%, OR = 6.079 [1.209, 40.926], p = 0.013) and school/work difficulties (30.43% vs. 8.70%, OR = 4.478 [0.984, 23.846], p = 0.034) than NPSY ones. Admissions for psychotic/manic symptoms occurred more likely in the context of family disturbances (OR = 2.275 [1.045, 5.045], p = 0.030) and adverse life events (OR = 3.489 [1.194, 11.161], p = 0.014). The fitted binomial model was found to be significant compared to the random effects model (ΔAIC = −1.962; χ 2 10 = 21.96, p = 0.015), with the risk of presenting psychotic/manic symptoms being increased by family disturbances ( z = +4.118) and school/work difficulties ( z = +2.455). The results suggest a potential psychosis‐inducing effect of psychosocial stressors in ASD, which has clinical and policy implications.