Investigation of autistic characteristics in psychotic patient group in terms of disease outcomes

Aim: There is an increasing amount of literature indicating a substantial overlap between autism and psychotic disorders in relation to their clinical presentation and etiopathogenesis. The rate of autistic characteristics in psychotic populations is markedly higher than in the general population. However, the clinical relevance of this association has not been sufficiently investigated. Understanding the clinical significance of autistic traits is essential for patients to receive the most appropriate diagnosis and treatment. Materials and Methods: The study included 125 patients who had experienced at least one psychotic episode that had a significant effect on the course of the disease and who had used or were using antipsychotic drugs for most of the treatment period. Based on interviews conducted with patients, a socio-demographic information and anamnesis form was completed, including informations about age, gender, marital status, educational level, age of onset of initial psychiatric symptoms, timing of the first psychiatric admission, duration of time between onset of psychotic symptoms and initiation of antipsychotic medication, number of psychiatric hospitalizations, total duration of hospitalizations in psychiatric services, number of psychotic episodes, received psychotropic treatments, medical and neurological comorbidities, history of legal incidents, alcohol-substance and tobacco use and experiences of peer bullying. In addition, the researcher administered the Modified Morisky Medication Compliance Scale (MMS) to assess the patient's treatment compliance, the Personal and Social Performance Scale (PSP) and the General Assessment of Functioning Scale (GAD) to assess the patient's functionality, and the Three Components of Insight Scale to assess the level of insight, Clinical Global Impression Scale (CGI) to determine the severity of illness, Positive and Negative Syndrome Scale (PANSS) to evaluate the severity of positive and negative symptoms, Hamilton Anxiety Scale (HAM-A) and Hamilton Depression Scale (HAM-D) to determine the severity of anxiety and depression respectively, Columbia Suicide Severity Rating Scale (C-SSRS) to evaluate suicidal behaviour. The scales completed by the patient can be listed as follows; Autism Spectrum Quotient (AQ) to assess autistic features, World Health Organisation Quality of Life Assessment-Short Form (WHOQOL-BREF) to assess quality of life and Toronto Alexithymia Scale (TAS) to assess severity of alexithymia. Results: Our study demonstrated a negative correlation between autistic traits and functionality, quality of life, and subjective treatment benefit. Additionally, a positive correlation was found between autistic traits and alexithymia, family criticism, severity of illness, anxiety and depression, positive and negative symptoms, suicidal ideation and behaviour and the number of psychotic episodes. There was a notable differrence in autistic trait level between the group with high motivation and the one with low motivation in terms of medication adherence. No significant difference was found between the group with a high level of knowledge and the one with a low level. Notably, smokers had fewer autistic traits in the communication subscale of AQ when compared to non-smokers. Although a statistically significant negative correlation was discovered between the age at the onset of psychiatric symptoms and the AQ attention shifting subscale score, no significant correlation was established between variables such as the age at the initial psychiatric admission, the duration between the first occurrence of psychotic symptoms and the commencement of antipsychotic medication, the total number and duration of psychiatric hospitalisations, gender, marital status, parental status, alcohol and substance use, the current antipsychotic medication, insight level, and autistic traits. Conclusions: Taken together, our results show the significance of autistic traits in the group of patients with psychosis. It is evident that there exists a significant lack of clinical knowledge about the correlation between autism and psychosis, and as such, more advanced diagnostic tools and treatment options are required. Given the cross-sectional nature of our research, the potential for speculation on causality is confined, suggesting that further prospective investigations are required. Keywords: Psychotic Disorders, Autism Spectrum Disorder, Autistic Traits, Dimensional Approach, Functionality