Komorbide psychiatrische Störungen und Differenzialdiagnostik bei nicht-intelligenzgeminderten Erwachsenen mit Autismus-Spektrum-Störung

 

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Zusammenfassung

Autismus-Spektrum-Störungen (ASS) ohne Intelligenzminderung werden häufig erst im Erwachsenenalter diagnostiziert. Wenig ist bekannt über komorbide psychiatrische Störungen und differenzialdiagnostische Abgrenzung von ASS im Erwachsenenalter, insbesondere im Hinblick auf Persönlichkeitsstörungen (PS). Welche komorbiden psychiatrischen Störungen treten bei Personen mit ASS auf? Welches sind die häufigsten Differenzialdiagnosen zu ASS in einer Inanspruchnahmestichprobe? Bei 118 Erwachsenen mit Verdacht auf eine autistische Störung wurde eine autismus-spezifische Diagnostik angewandt und die Punktprävalenzen weiterer psychiatrischer Störungen erfasst. 59 (50%) erfüllten die Kriterien einer ASS. Von diesen lag bei 36% eine komorbide psychiatrische Störung der DSM-IV Achse-I vor, wobei Affektive Störungen (24%) und Soziale Phobien (14%) am häufigsten waren. Die häufigsten Differenzialdiagnosen waren Depression, Soziale Phobie, Paranoide PS, Selbstunsichere PS und Narzisstische PS.

Abstract

Autism spectrum conditions (ASC) without intellectual disability are often diagnosed late in life. Little is known about co-occurring psychia­tric disorders and differential diagnosis of ASC in adulthood, particularly with regard to personality disorders. What kind of comorbid psychia­tric disorders occur in ASC? Which are the most prevalent differential diagnoses in a sample of patients who seek autism specific clinical diagnostics? 118 adults who were referred with a presumed diagnosis of autistic disorder, were diagnosed with autism specific instruments and the prevalence of further psychiatric disorders was investigated. 59 (50%) fulfilled the criteria of ASC. 36% of the individuals with ASC fulfilled also criteria for a DSM-IV axis-I psychiatric disorder. Affective disorders (24%) and social phobia (14%) were the most prevalent comorbid disorders. The most frequent differential diagnoses were depression, social phobia, paranoid, avoidant and narcissistic personality disorder.

• Literatur

• 1 American Psychiatric Association . Diagnostic and statistical manual of mental disorders. (4th ed.) Washington DC: American Psychiatric Press; 1994
  Google Scholar
• 2 World Health Organisation . International Classification of Diseases (ICD-10). Geneva: WHO; 1992
  Google Scholar
• 3 Brugha TS, McManus S, Bankart J et al. Epidemiology of autism spectrum disorders in adults in the community in England. Arch Gen Psychiatry 2011; 68: 459-466
  CrossrefPubMedGoogle Scholar
• 4 Fombonne E. Epidemiology of Pervasive Developmental Disorders. Pediatr Res 2009; 65: 591-598
  CrossrefPubMedGoogle Scholar
• 5 Bailey A, Le Couteur A, Gottesman I et al. Autism as a strongly genetic disorder: evidence from a British twin study. Psychol Med 1995; 25: 63-77
  CrossrefPubMedGoogle Scholar
• 6 Freitag CM, Staal W, Klauck SM et al. Genetics of autistic disorders: review and clinical implications. Eur Child Adolesc Psychiatry 2010; 19: 169-178
  CrossrefPubMedGoogle Scholar
• 7 Hallmayer J, Cleveland S, Torres A et al. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry 2011; 68: 1095-1102
  CrossrefPubMedGoogle Scholar
• 8 Newschaffer CJ, Croen LA, Daniels J et al. The epidemiology of autism spectrum disorders. Annu. Rev. Public Health 2007; 28: 235-258
  Google Scholar
• 9 Geschwind DH, Levitt P. Autism spectrum disorders: developmental disconnection syndromes. Curr Opin Neurobiol 2007; 17: 103-111
  CrossrefPubMedGoogle Scholar
• 10 Cederlund M, Hagberg B, Billstedt E et al. Asperger Syndrome and Autism: a comparative longitudinal follow-up study more than 5 years after original diagnosis. J Autism Dev Disord 2008; 38: 72-85
  CrossrefPubMedGoogle Scholar
• 11 Hofvander B, Delorme R, Chaste P et al. Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry 2009; 9: 35
  CrossrefPubMedGoogle Scholar
• 12 Howlin P. Outcome in adult life for more able individuals with autism or Asperger Syndrome. Autism 2000; 4: 63-83
  CrossrefPubMedGoogle Scholar
• 13 Renty J, Roeyers H. Quality of life in high-functioning adults with autism spectrum disorder. Autism 2006; 10: 511-524
  CrossrefPubMedGoogle Scholar
• 14 Engström I, Ekström L, Emilsson B. Psychosocial functioning in a group of Swedish adults with Asperger Syndrome or high-functioning autism. Autism 2003; 7: 99-110
  PubMedGoogle Scholar
• 15 Howlin P, Goode S, Hutton J et al. Adult outcome for children with autism. J Child Psychol Psychiatry 2004; 45: 212-229
  CrossrefPubMedGoogle Scholar
• 16 Gawronski A, Kuzmanovic B, Georgescu A et al. Erwartungen an eine Psychotherapie von hochfunktionalen erwachsenen Personen mit einer Autismus-Spektrum-Störung. Fortschr Neurol Psychiat 2011; 79: 647-654
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Michel TM, Sheldrick AJ, Frentzel TG et al. Evaluation of diagnostic and therapeutic services in German university hospitals for adults with autism spectrum disorder. Fortschr Neurol Psychiat 2010; 78: 402-413
  Google Scholar
• 18 Fangmeier I, Lichtblau A, Peters J et al. Psychotherapie des Asperger-Syndroms im Erwachsenenalter. Nervenarzt 2011; 82: 628-635
  CrossrefPubMedGoogle Scholar
• 19 Joshi G, Petty C, Wozniak J et al. The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: a large comparative study of a psychiatrically referred population. J Autism Dev Disord 2010; 40: 1361-1370
  CrossrefPubMedGoogle Scholar
• 20 de Bruin EI, Ferdinand RF, Meester S et al. High rates of psychiatric co-morbidity in PDD-NOS. J Autism Dev Disord 2006; 37: 877-886
  PubMedGoogle Scholar
• 21 Mattila ML, Hurtig T, Haapsamo H et al. Comorbid psychiatric disorders associated with Asperger Syndrome/high-functioning autism: a community- and clinic-based study. J Autism Dev Disord 2010; 40: 1080-1093
  CrossrefPubMedGoogle Scholar
• 22 Simonoff E, Pickles A, Charman T et al. Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry 2008; 47: 921-929
  CrossrefPubMedGoogle Scholar
• 23 Melville CA, Cooper SA, Morrison J et al. The prevalence and incidence of mental ill-health in adults with autism and intellectual disabilities. J Autism Dev Disord 2008; 38: 1676-1688
  CrossrefPubMedGoogle Scholar
• 24 Gillot A, Standen PJ. Levels of anxiety and sources of stress in adults with autism. J Intellect Disabil 2007; 11: 359-370
  CrossrefPubMedGoogle Scholar
• 25 Bradley EA, Summers JA, Wood HL et al. Comparing rates of psychiatric and behavior disorders in adolescents and young adults with severe intellectual disability with and without autism. J Autism Dev Disord 2004; 34: 151-161
  CrossrefPubMedGoogle Scholar
• 26 LoVullo SV, Matson JL. Comorbid psychopathology in adults with autism spectrum disorders and intellectual disabilities. Res Dev Disabil 2009; 30: 1288-1296
  CrossrefPubMedGoogle Scholar
• 27 Lugnegard T, Hallerbäck MU, Gillberg C. Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger Syndrome. Res Dev Disabil 2011; 32: 1910-1917
  CrossrefPubMedGoogle Scholar
• 28 Ghaziuddin M, Weidmer-Mikhail E, Ghaziuddin N. Comorbidity of Asperger Syndrome: a preliminary report. J Intellect Disabil Res 1998; 42: 279-283
  PubMedGoogle Scholar
• 29 Anckarsäter H, Stahlberg O, Larson T et al. The impact of ADHD and Autism Spectrum Disorders on temperament, character, and personality development. Am J Psychiatry 2006; 163: 1239-1244
  CrossrefPubMedGoogle Scholar
• 30 Lugnegard T, Hallerbäck MU, Gillberg C. Personality disorders and autism spectrum disorders: what are the connections?. Compr Psychiatry 2012; 53: 333-40
  CrossrefPubMedGoogle Scholar
• 31 Bölte S, Rühl D, Schmötzer G et al. ADI-R. Diagnostisches Interview für Autismus – Revidiert. Deutsche Fassung des Autism Diagnostik Interview – Revised (ADI-R) von Michael Rutter, Ann Le Couteur und Catherine Lord. Bern: Huber; 2008
  Google Scholar
• 32 Rühl D, Bölte S, Feineis-Matthews S et al. ADOS. Diagnostische Beobachtungsskala für Autistische Störungen – Revidiert. Deutsche Fassung der Autism Diagnostic Observation Schedule (ADOS) von Catherine Lord, Michael Rutter, Pamela C. DiLavore und Susan Risi. Bern: Huber; 2008
  PubMedGoogle Scholar
• 33 Dziobek I, Rogers K, Fleck S et al. Dissociation of cognitive and emotional empathy in adults with Asperger Syndrome using the Multifaceted Empathy Test (MET). J Autism Dev Disord 2008; 38: 464-473
  CrossrefPubMedGoogle Scholar
• 34 Dziobek I, Fleck S, Kalbe E et al. Introducing MASC: a movie for the assessment of social cognition. J Autism Dev Disord 2006; 36: 623-636
  CrossrefPubMedGoogle Scholar
• 35 Sheehan DV, Lecrubier Y, Hernett-Sheehan K et al. The mini international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview. J Clin Psychiatry 1998; 59: 22-33
  Google Scholar
• 36 Ackenheil M, Stotz G, Dietzbauer R et al. M.I.N.I. Mini International Interview – German Version 5.0.0. München: Psychiatrische Universitätsklinik München; 1999
  Google Scholar
• 37 First MB, Spitzer RL, Gibbon M et al. Structured Clinical Interview for DSM-IV Axis II Personality Disorders – Clinical Version (SCID-CV). Washington, DC: American Psychiatric Association; 1997
  Google Scholar
• 38 Fydrich T, Renneberg B, Schmitz B et al. SKID-II Strukturiertes Klinisches Interview für DSM-IV. Achse II: Persönlichkeitsstörungen. Göttingen: Hogrefe; 1997
  PubMedGoogle Scholar
• 39 Kessler RC, Adler L, Gruber M et al. Validity of the World Health Organization Adult ADHD self-report scale (ASRS) screener in a representative sample of health plan members. Int J Methods Psychiatr Res 2007; 16: 52-65
  CrossrefPubMedGoogle Scholar
• 40 Kessler RC, Adler L, Ames M et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS). Psychol Med 2005; 35: 245-256
  CrossrefPubMedGoogle Scholar
• 41 Schmidt KH, Metzler P. Wortschatztest (WST). Weinheim: Beltz; 1992
  Google Scholar
• 42 Rutter M, Bailey A, Lord C. Social Communication Questionnaire-WPS (SCQ-WPS). Los Angeles, CA: Western Psychological Services; 2003
  Google Scholar
• 43 Bölte S, Poutska F. Fragebogen zur Sozialen Kommunikation – Autismus Screening (FSK). Bern: Verlag Hans Huber; 2006
  Google Scholar
• 44 Hedley D, Young R. Social comparison processes and depressive symptoms in children and adolescents with Asperger Syndrome. Autism 2006; 10: 139-153
  CrossrefPubMedGoogle Scholar
• 45 Sterling L, Dawson G, Estes A et al. Characteristics associated with presence of depressive symptoms in adults with autism spectrum disorder. J Autism Dev Disord 2008; 38: 1011-1018
  CrossrefPubMedGoogle Scholar
• 46 Lehnhard FG, Gawronski A, Volpert K et al. Das psychosoziale Funktionsniveau spätdiagnostizierter Patienten mit Autimus-Spektrum-Störung – eine retrospektive Untersuchung im Erwachsenenalter. Fortschr Neurol Psychiat 2012; 80: 88-97
  Article in Thieme ConnectPubMedGoogle Scholar
• 47 Sappok T, Dern S. Menschen mit Autismus: Barrierefreier Zugang zur Versorgung. Deutsches Ärzteblatt 2010; 108: 2326-2328
  PubMedGoogle Scholar
• 48 Tyson KE, Cruess DG. Differentiating High-Functioning Autism and Social Phobia. J Autism Dev Disord 2012; 42: 1477-1490
  CrossrefPubMedGoogle Scholar
• 49 Izuma K, Matsumoto K, Camerer CF et al. Insensitivity to social reputation in autism. Proc Natl Acad Sci USA 2011; 108: 17302-17307
  CrossrefPubMedGoogle Scholar
• 50 Kuusikko S, Pollock-Wurman R, Jussila K et al. Social anxiety in high-functioning children and adolescents with autism and Asperger Syndrome. J Autism Dev Disord 2008; 38: 1697-1709
  CrossrefPubMedGoogle Scholar
• 51 White SW, Oswald D, Ollendick T et al. Anxiety in children and adolescents with autism spectrum disorders. Clin Psychol Rev 2009; 29: 216-229
  CrossrefPubMedGoogle Scholar
• 52 Attwood T. Asperger’s syndrome: a guide for parents and professionals. London: Jessica Kingsley Publishers; 1998
  Google Scholar
• 53 Mandell DS, Walrath CM, Manteuffel B et al. The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child Abuse Negl 2005; 29: 1359-1372
  CrossrefPubMedGoogle Scholar
• 54 Greydanus DE, Omar HA. Sexuality issues and gynecologic care of adolescents with developmental disabilities. Pediatr Clin N Am 2008; 55: 1315-1335
  CrossrefPubMedGoogle Scholar
• 55 Sullivan P, Knutson J. Maltreatment and disabilities: a population-based epidemiological study. Child Abuse Negl 2000; 24: 1257-1273
  CrossrefPubMedGoogle Scholar
• 56 Russell AJ, Mataix-Cols D, Anson M et al. Obsessions and compulsions in Asperger Syndrome and high-functioning autism. Br J Psychiatry 2005; 186: 525-528
  CrossrefPubMedGoogle Scholar
• 57 Stahlberg O, Soderstrom H, Rastam M et al. Bipolar disorder, schizophrenia, and other psychotic disorders in adults with childhood onset AD/HD and/or autism spectrum disorders. J Neural Transm 2003; 111: 891-902
  PubMedGoogle Scholar
• 58 Munesue T, Ono Y, Mutoh K et al. High prevalence of bipolar disorder comorbidity in adolescents and young adults with high-functioning autism spectrum disorder: a preliminary study of 44 outpatients. J Affect Disord 2008; 111: 170-175
  CrossrefPubMedGoogle Scholar
• 59 Skokauskas N, Gallagher L. Psychosis, affective disorder and anxiety in autistic spectrum disorder: prevalence and nosological considerations. Psychopathology 2010; 43: 8-16
  CrossrefPubMedGoogle Scholar
• 60 Volkmar FR, Cohen DJ. Comorbid association of autism and schizophrenia. Am J Psychiatry 1991; 148: 1705-1707
  CrossrefPubMedGoogle Scholar
• 61 Dossetor D. All that glitters is not gold: misdiagnosis of psychosis in pervasive developmental disorders – a case series. Clin Child Psychol and Psychiatry 2007; 12: 537-538
  PubMedGoogle Scholar
• 62 Esterberg ML, Trotman HD, Brasfield JL et al. Childhood and current autistic features in adolescents with schizotypal personality disorder. Schizophr Res 2008; 104: 265-273
  CrossrefPubMedGoogle Scholar
• 63 Kalyva E. Comparison of Eating Attitudes between Adolescent Girls with and without Asperger Syndrome: Daughters’ and Mothers’ reports. J Autism Dev Disord 2008; 39: 480-486
  PubMedGoogle Scholar
• 64 Wolff S, McGuire RJ. Schizoid Personality in Girls: a follow-up study – what are the links with Asperger’s Syndrome?. J Child Psychol Psychiatr 1995; 36: 793-817
  CrossrefPubMedGoogle Scholar
• 65 Tantam D. Lifelong eccentricity and social isolation: Asperger’s Syndrome or Schizoid Personality Disorder?. Br J Psychiatry 1988; 153: 783-791
  CrossrefPubMedGoogle Scholar
• 66 Frith U. Emanuel Miller lecture: Confusion and controversies about Asperger Syndrome. J Child Psychol Psychiatry 2004; 45: 672-686
  CrossrefPubMedGoogle Scholar
• 67 Müller E, Schuler A, Yates GB. Social challenges and supports from the perspective of individuals with Asperger Syndrome and other autism spectrum disabilities. Autism 2008; 12: 173-190
  CrossrefPubMedGoogle Scholar
• 68 Fitzgerald M. Misdiagnosis of Asperger Syndrome as anankastic personality disorder. Letter to the editors. Autism 2002; 6: 435
  CrossrefPubMedGoogle Scholar
• 69 Hurst RM, Nelson-Gray RO, Mitchell JT et al. The relationship of Asperger’s characteristics and schizotypal personality traits in a non-clinical adult sample. J Autism Dev Disord 2007; 37: 1711-1720
  CrossrefPubMedGoogle Scholar
• 70 Barneveld PS, Pieterse J, de Sonneville L et al. Overlap of autistic and schizotypal traits in adolescents with autism spectrum disorders. Schizophr Res 2011; 126: 231-236
  CrossrefPubMedGoogle Scholar
• 71 Duerden EG, Oatley HK, Mak-Fan KM et al. Risk factors associated with self-injurious behaviors in children and adolescents with Autism Spectrum Disorders. J Autism Dev Disord 2012; 42: 2460-2470
  CrossrefPubMedGoogle Scholar
• 72 Ritter K, Dziobek I, Preissler S et al. Lack of empathy in patients with narcissistic personality disorder. Psychiatry Res 2011; 187: 241-247
  CrossrefPubMedGoogle Scholar
• 73 Meng-Chuan L, Lombardo MV, Pasco G et al. A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PloS ONE 2011; 6: 1-10
  PubMedGoogle Scholar