I meant that there could be a common etiological mechanism(s) for both disorders or alternatively, the bad luck of having both in much the same way that children have ADHD and asthma; because both disorders frequently occur in children, but with no common etiology. Dogs can have fleas and tics. Both alternatives are possible. Clinically, I see less co-occurring autism and schizophrenia in the more classical Kanner's type of autism cases vs. more spectrum cases. I see more evidence of emerging psychosis and real psychosis in the higher functioning PDD-NOS/Asperger cases.

I am following several patients clinically that have ASD and have developed psychosis. In each case the psychosis improved significantly on Risperdal 2 to 4 mg. There was no distinct prodromal phase prior to the psychosis. I am also following patients that only appear to demonstrate negative symptoms with no active psychosis. I suspect this group is larger than the group that develops psychosis. I also suspect the prevalence of psychosis is greater than we used to believe.

I follow several as well, and also suspect that the incidence of psychosis is higher than we thought, but to be clear, it is not at all ubiquitous in autism.

Hi Both,

Thank you for your comments and sharing your clinical expertise.

That is quite interesting, from my own clinical experience I have seen people with Autism exhibit delusions \ positive symptoms of Psychosis.

The Autism-Psychosis model proposes that an individual can only have one or the other (Psychosis or Autism). This suggests that the psychosis experienced by people with Autism is phenomenologically different to those who experience it in say, Schizophrenia. Although I do believe this is a weaker response, I am actually wondering how far off the Autism-Psychosis model is explaining such a phenomenon....

I do think there is some physiological overlap, glutamatergic pathology is common to both, for example, but the model I think overstates the clinical overlap.

Hi all,

I am looking into the neurobiology of both. There are some interesting common issues - altered synaptic plasticity, altered GABAergic inhibition, and apparent developmental delays in onset. But also some of the contrasts may provide insights - there are differences between the neuroplastic processes around 2 years old (relevant to autism) and the neuroplastic processes in adolescence (relevant to schizophrenia onset).

Hi. I would like to suggest You to look at these two meetings of italian health institute about autism, the first Data : 02 aprile 2014

007D14 - 2 aprile, Giornata Mondiale per la Consapevolezza dell'Autismo. I disturbi dello spettro autistico, dalla diagnosi precoce alla vita adulta

Scadenza iscrizione: 31 marzo 2014

Crediti ECM: non previsti

Contattaci: MARIA LUISA SCATTONI, ALDINA VENEROSI ([email protected], [email protected])

Telefono: 06-49903104/3502 Fax: 06-4957821

Sede: Sala della Protomoteca, Palazzo del Campidoglio, Piazza del Campidoglio 55, Roma

Quota d'iscrizione: Gratuita

Scheda [PDF - 22.92 kbytes] Iscrizione [PDF - 23.59 kbytes] Programma [PDF - 597.69 kbytes] Pubblicato il 12-03-2014, aggiornato al 24-03-2014

and the second willbe in rome, 12 and 13 june 2014. look at this in www.iss.it

greetings

tiberio damiani

Remember that Pervasive Developmental Disorder was a term created once it was clear that child onset schizophrenia was different from what was referred to as early onset psychosis (autism). There was an effort to get away from the idea that early onset psychosis was the same as later onset psychosis. The term PDD was developed to capture the early onset group. So, from the early 70s the idea that autism and schizophrenia were different was generally held to be true. So its possible that there is some common mechanisms in both early and late onset (autism and child onset schizophrenia), that autism increases vulnerability to schizophrenia (about 50% of early onset schizophrenia met criteria for PDD prior to the onset of the schizophrenia) or that some people with autism are just unlucky and develop schizophrenia with roughly the same 1% chance as the general population. Child schizophrenia is associated with gray matter loss. I would suggest investigating whether this is true for persons who had PDD (Autism spectrum) diagnoses prior to the onset of the schizophrenia.

Especially in response to Allan Lincoln:

You said, "So its possible that there is some common mechanisms in both early and late onset (autism and child onset schizophrenia), that autism increases vulnerability to schizophrenia (about 50% of early onset schizophrenia met criteria for PDD prior to the onset of the schizophrenia) or that some people with autism are just unlucky and develop schizophrenia with roughly the same 1% chance as the general population."

Based on my knowledge or experience (that spans most of my life, but is limited in many respects) I am wondering if the level of stress might be a mechanism that encourages the timing of the expression of the early or late onset of the conditions. I also wonder if the genetic information for both of these conditions map closely together in an area of genetic instability.

I hypothesize based on very limited information that these conditions could be the result of an emerging evolutionary genetic attempt to develop new characteristics in man that would be beneficial to the species. Many Asperger's and high functioning autistic individuals are extremely bright in their chosen area of study and are very useful members of society especially if care is taken to properly socialize these individuals early. I postulate that the instability in the genetic material (that allows the construction of new characteristics in individuals over time) could be compared to the instability (view as a spectrum disorder) in persons with these conditions. The gene clusters could be different sets defining each of two separate conditions either closely linked or one in the same set of gene clusters "under construction" in the area where evolving genes are located, (making your suggestion of autism increasing vulnerability to schizophrenia---I think this may be true and I postulate that the extreme pressure of stress on those predisposed to autism, especially Asperger's syndrome or high functioning autism can lead to the expression of bipolar disorder, schizoaffective disorder, or schizophrenia); or entirely separate sets of genes, not closely linked that leads to your suggestion that " some people with autism are just unlucky and develop schizophrenia with roughly the same 1% chance as the general population." I think in the subtelomeric areas of chromosomes based on the linear chromosome of streptomyces spp and the novel genetic evolution of these organisms in the subtelomeric areas of the linear chromosome; personal observations in persons having the "psychological conditions" mentioned above; and years of both experience and observation in both my field of study, and my study of people, as well as a predisposition for pattern thinking have led me to my current thinking.

I am not sure I understand this juxtaposition: Autism increasing vulnerability to schizophrenia and unlucky and develop schizophrenia with roughly the same 1% chance as the general population. These two statements seem contradictory unless you mean that the one % of autistic persons overlaps largely with the 1% of the bipolar/schizophrenic population?

"I hypothesize based on very limited information that these conditions could be the result of an emerging evolutionary genetic attempt to develop new characteristics in man that would be beneficial to the species"

The most interesting thing about autism and schizophrenia is that both are new human conditions. I am not sure that there are any cases of schizophrenia pre-19th C, and although I have found about 20 cases of autism pre WWII, these were clearly very rare and confined to higher social classes. I think the simplest and probably correct explanation is that those with genetic predispositions died from infection in infancy.

Anthony, your comment is very interesting. What you have said reinforces my belief that these conditions are on a spectrum, maybe evolving into a trait that would be beneficial to man. People with Asperger's syndrome are extremely bright in a narrow or a few narrow areas and are extremely honest. While the later can make them very vulnerable in this society the former can make them exceedingly valuable members. If Asperger's is in the middle and the spectrum is evolving by eliminating the extremes, then this could be one way that human brains are evolving---to have deeper and focused knowledge in a limited range and more cooperative rather than politically/competitive working relationships. I know from reading "The Autistic Brain", by Temple Grandin and Richard Panek that one "compelling example of a genetic predisposition (for autism)is in the DRD4 gene, which codes for a receptor that regulates the level of dopamine in the brain. Some people possess a variant of the DRD4 gene called DRD4-7R, the 7R for "7 repeat allele"...people who possess the 7R version of the DRD4 gene are less sensitive to dopamine (affects brain processes involving movement, emotional response and the ability to experience pleasure and pain) putting them at risk for attention and conduct disorders" This allele has been linked through numerous studies to anxiety, depression, epilepsy, dyslexia, ADHD, migraines, obsessive-compulsive behavior, and autism. The 7 repeat allele means that this DNA is somewhat unstable and so in a position from my point of view to create a new type of brain. I just learned, in a book called "Dog Sense, How the New Science of Dog Behavior Can Make You a Better Friend to Your Pet" by John Bradshaw, the Foundation Director of the Anthrozoology Institute at the University of Bristol and previously the University Research Theme Leader for Animal Welfare and Behavior, that after canines "wolf" ancestor gradually became domesticated the evolution of different types of breeds was in an extremely short period of time, as evolution goes. The selections were concentrated towards the end as we know it now, but there are pressures working in today's society as well for working smarter and more cooperatively.

I meant that there could be a common etiological mechanism(s) for both disorders or alternatively, the bad luck of having both in much the same way that children have ADHD and asthma; because both disorders frequently occur in children, but with no common etiology. Dogs can have fleas and tics. Both alternatives are possible. Clinically, I see less co-occurring autism and schizophrenia in the more classical Kanner's type of autism cases vs. more spectrum cases. I see more evidence of emerging psychosis and real psychosis in the higher functioning PDD-NOS/Asperger cases.

"compelling example of a genetic predisposition (for autism)is in the DRD4 gene"

All the latest genetic evidence is that there are a very large number of genes with small effect for schizophrenia and autism. In any case, if there were a small number of potent genes, these would take far too long to get fixed by natural selection. Not to mention the likihood of high infant mortality leading to massive dumping of thousands of genes.

"the evolution of different types of breeds was in an extremely short period of time, as evolution goes."

I realise Darwin devoted as lot of attention to domestication, but there is all the difference in the world between blind chance and human-directed evolution . My theory for human evolution of intelligence, autism, etc posits an intermediate positive feedback mechanism, whereby the intelligent mothers were more able to feed their infants competently and hence keep them alive, whereas thousands of genes were dumped in the dead babies of less able mothers.

Alan,

" I see more evidence of emerging psychosis and real psychosis in the higher functioning PDD-NOS/Asperger cases."

That is what I am seeing with one family group that I have either been observing or anecdotal evidence for three generations. It could be coincidental or there could be a link, but during the more stressed (dysfunctional behavior on the parents part) generations bipolar, or schizoaffective diagnoses occur while during the generations where the children of the dysfunctional caretakers have corrected the dysfunctional behavior through modeling of acceptable behavior and much therapy, or education the progeny exhibit Asperger's.

Anthony,

"My theory for human evolution of intelligence, autism, etc posits an intermediate positive feedback mechanism, whereby the intelligent mothers were more able to feed their infants competently and hence keep them alive, whereas thousands of genes were dumped in the dead babies of less able mothers."

Intelligence does not insure mothers that have common sense. Those mothers with common sense and intelligence would be the ones having the greatest success.

Alan,

"I meant that there could be a common etiological mechanism(s) for both disorders"

but is it possible that persons that did not actually have a predisposition to asperger's, but who look somewhat as though they have asperger's because they were raised by "wolves" (persons who were highly intelligent, possibly had some traits related to aspergers (or not), had poor social skills for whatever reason as well as the added complication of being severely abusive, thus adding continual stress on the offspring) and who eventually being conditioned to fear people and view them as a threat to develop signs such as paranoia, hallucinations, and psychosis? In other words normal brains rewired to resemble these conditions. Is it possible that these children of the original parents would have had normal development instead of looking like they had both or either of these conditions. I guess I am wondering if under these conditions could the progeny have had the wild type DNA rather than the predisposed mutations causing the conditions of asperger's or bipolar---schizophrenia.

Anthony,

" In any case, if there were a small number of potent genes, these would take far too long to get fixed by natural selection."

Even if these were synergistic genes that produced a new brain that was more socially functional while keeping the characteristics such as a deep potential for knowledge in a specific area while being very honest (blunt, maybe eventually a bit more diplomatic)? Wouldn't that be how evolution occurs? I think there is some selective pressure in the technical professions such as research and the programming areas to become that type of person (although is see a competing pressure to be doggedly competitive to the point of unscrupulous behavior). Technology is an important part of modern culture. I think that I see persons evolving to become more cooperative in these fields, ResearchGate is an example of that, who's to say that these person's are not descendents of person's having strong asperger's traits. If this spectrum is a continuum, couldn't this evolution be developing right before our eyes? If it is maybe this trend will not survive, but if it did maybe it would elevate humans to a new level.

"Even if these were synergistic genes that produced a new brain that was more socially functional"

No matter how technically adept, an autistic man still has to persuade a woman to bear his children. My impression is that criminals, psychopaths, sex offenders and violent men never have any trouble finding women willing to have a sexual relationship with them, whilst those with ASD find themselves right at the bottom of the list of potential mates.

Ok

I am interested in this because I see a generational shift in a family group that I have been observing. The family of origin experienced great stress from loud sensory input and abusive behavior. In the next generation 1/2 of the progeny were subjected to quiet conditions with gentle teaching, while 1/2 of the progeny were subjected to loud sensory input and abusive behavior. (Including the family of origin numbering 7) 5 of the 10 persons subjected to loud sensory input and abusive disrespectful behavior were labelled bipolar or schizoaffective, The original parents of the clan show characteristics of High Functioning Autism and/or bipolar disorder ostensibly. The father, ostensibly a savant relative to numbers, and 1 grandchild show clear signs of Asperger's syndrome. None of the three was diagnosed but all appear to exhibit to varying degrees characteristics often seen in persons with Asperger's syndrome and/or bipolar disorder. In the more quiet and gentle teaching homes two of the three persons were diagnosed with Asperger's or High functioning autism, and one was not diagnosed but appears to have some traits (not a preponderance---possibly simply unusual and extreme introversion with minimal tolerance for social contact) associated with Asperger's syndrome. I am wondering if there is any link between these conditions, if they are on the same spectrum but undue stress can lead to an exaggerated or skewed result leading to the more severe outcome, or if this is a case of two different conditions inherited in the same family, or if persons with these two propensities are attracted to each other and so keep those unrelated characteristics in the same kind of cycling from generation to generation. This teasing apart of nature/nurture will never be untangled until genes for these two potentially related conditions are pinned down, and even then it may not be completely clear because the genotypes of all those being observed will not be known. I have a fascination with patterns and an interest in genetics, psychology, psychiatry, and relationships amongst different personality types. I am also interested in learning whether genes have been located in any of these conditions and where they are relative to the telomeres of the chromosomes.

"...the cause of the depression may be an understandable reaction to having Asperger's Syndrome, but in some cases there may be a biological predisposition. Research studies have suggested that there is a marginally greater incidence of depression or manic depression (bi-polar affective disorder) in families that have a child with autism or Asperger's Syndrome (Delong and Dwyer, 1988). One may argue that having such a child might make you feel depressed, but the studies have controlled for this factor."

from "Asperger's Syndrome, A Guide for Parents and Professionals", Tony Attwood, Eighth impression, 2000. copyright 1998.

Of the families that I know of having autism present, both have or appear to have mental illness associated with that condition present. One has profound autism diagnosed) in the third generation. The others ( in that family) presumably signs of mental illness, one from the second generation and one from the first generation, an uncle on the mother's side of the second generation, possibly being, from the description from his sister and a daughter of the presumably mentally ill members. These persons appear to potentially have bi-polar disorder, the uncle having delusions, paranoia and antisocial behavior and the grandmother having paranoia and hallucinations. These are either observations by myself, or first hand accounts from the sister/daughter of the first and second generations. The second generation family seems dysfunctional with a father who is essentially living in the home but absent by isolating and insulating himself from other members of the household as told by his wife who seems to be a very angry woman feeling the pressure of caring for a large (5 children) family largely by herself in many ways, ( observation over a four year period). The male children have trouble making friends (one is profoundly autistic, and one professes to be, and has been arrested for violent displays, an anarchist, the other two have either few if any friends, depression is a problem for at least one of those two and has been diagnosed, the other walks circling the perimeter of the house, my guess to calm anxiety, or deal with anger. He doesn't often talk and when he does it is one or two sentences. The two boys last mentioned are fraternal triplets with the third being the profoundly autistic sibling). The triplets were born when the parents were at least 36 years old, possibly older.

I am not formally well versed in these illnesses, but have done some reading and am a very good observer with an exceptional long term memory for patterns that interest me in human interaction.

If anyone has suggested books concerning any of the information that I have presented I would be grateful. I am not interested in journal articles at this time.

There seem to be strong general factors in the genetics of mental illness. So, whilst a family history of schizophrenia is a strong risk factor for schizophrenia, a FH of mental illness is an even stronger risk. This was recognized by psychiatrists in the old days, so I would have a look at Victorian and Edwardian psychiatry textbooks.

Thank-you for your suggestion

I just stumbled along a book called "The Imprinted Brain, How Genes Set the Balance Between Autism and Psychosis", by Christopher Badcock. It has a comment commending the book by Dr. Crespi, winner of T. Dobzhansky Prize and E. O. Wilson Award, Evolutionary Biology:

"Deeply Scholarly yet Absorbing narrative, "The Imprinted Brain" will change the way we view the human brain and its functions, evolution, and disordering in mental illness. Badcock has drawn evolutionary biology together with genetics, psychology, psychiatry, and neuroscience to demonstrate, for the first time, how genomic conflicts play a central role in how the human brain works, and how the brain becomes dysregulated in social-brain disorders including autism and schizophrenia."

I suffered a concussion in December and have been overdoing the reading and thinking. Unfortunately I am going to have to take a break before I read this book. I thought some of you might find it interesting, perhaps.

As I previously stated I just stumbled onto "The Imprinted Brain" I guess I didn't reread your commentary following your original question a second time. I had a concussion in December, and my brain felt over stimulated but I couldn't keep myself from trying to read this book. I am about 50% through the book. When I am finished maybe I can comment about the thesis.

"I had a concussion in December, and my brain felt over stimulated"

I maintain that concussion and the post-concussion syndrome are due to damage to the inner ear, not to the brain. Do you have any thoughts on this?

I don't disagree Anthony that a severe bump to a person's head could cause damage to the inner ear, but I don't think it it that simple. Mayo clinics definition of concussion:

"A concussion is a traumatic brain injury that alters the way your brain functions."

This discussion however is not about concussions.

Marcus,

Christopher Badcock's thesis laid out in "The Imprinted Brain, How genes Set the Balance Between Autism and Psychosis is brilliant! It certainly fits with my observations over three generations with extremes observed in and experienced in both mentalistic and mechanistic genetic traits present in a large family that I have intimately observed. I was skeptical until he finally reconciled the presence of both ASD (autistic spectrum disorders) and PSD (psychotic spectrum disorders) being present in single individuals in chapter 7, of his thesis. The chapter is titled: "Beyond the balanced brain". For years I have had a hunch that there was a connection between high functioning autism and manic depression and this thesis has linked these two conditions in a satisfying way both genetically and temperamentally for me and the unique opportunity I have had in observing this phenomenon. His thorough literature combing makes me feel comfortable in the conclusions he has drawn. My background is in molecular genetics, but my passion and lifelong pursuit has been to understand social interaction in our species. I have made great strides in this area with a stubborn single mindedness.

"I have had a hunch that there was a connection between high functioning autism and manic depression"

I am not aware of any evidence for such a link. However, many have noted a link between schizophrenia and autism.

In my humble opinion, in patients having both patterns of Asperger's syndrome early in life, and manic depression with paranoid/psychotic features in early midlife, at least in the primary family that I have talked about above, there is a conscious (or unconscious depending on the individual) intense and painful struggle concerning the two sides of the coin and for which parent allegiance (seemingly polar opposites in their union of mentalist and mechanistic traits) is given. It is expressed both genetically and as it plays out in the dynamics of the relationships in the family of origin as a psychological drama.

Anthony,

"I am not aware of any evidence for such a link. However, many have noted a link between schizophrenia and autism."

Read the book "The Imprinted Brain, How Genes Set the Balance Between Autism and Psychosis" I swear to you. It makes absolute sense from my unique perspective. I know that it is not the only possibility, but for me it is like the missing piece to a jigsaw puzzle, and is a very compelling argument.

Anthony,

The above book that I mentioned is laid out as a thesis. The following study is a tiny piece of evidence corroborating that thesis:

"Atypical Crosstalk between Mentalizing and Mirror Neuron Networks in Autism Spectrum Disorder" by Inna Fishman, PhD.; Christopher L. Keown, MS; Alan J. Lincoln, PhD; Jaime A. Pineda, PhD; Ralph-Axel Muller, PhD

JAMA Psychiatry. Published online April 16, 2014. doi:10.1001/jamapsychiatry.2014.83

Inna Fishman will download a PDF for you if requested, otherwise you must be a subscriber to JAMA Psychiatry

"you must be a subscriber to JAMA Psychiatry"

As an independent researcher, it is very hard to get access to journals and I am behind in my coverage of this one. However, any abnormal connectivity in autism is completely ambiguous as to whether it is a cause or consequence of the disorder.

"any abnormal connectivity in autism is completely ambiguous as to whether it is a cause or consequence of the disorder."

I guess what would be interesting would be if ToM and MNS of schizophrenics were affected (or causal) in an equal and opposite connection of the neuron networks.

This is an old thread but I have just read it.  What I have observed clinically is that people in the autism spectrum are vulnerable to time-limited episodes of psychosis when under stress.  This can be hard to differentiate from schizophrenia during the acute episode but it will frequently resolve completely and not require maintenance anti-psychotic medication.  There may be a mechanism similar to what is found in borderline personality disorder, when hyper-arousal under anxiety-provoking conditions elicits a brief psychotic reaction.  It is possible autism and psychosis may overlap in two different ways, chronically (i.e., with a comorbid schizophrenia-spectrum diagnosis) and more acutely under stress.