Autistic symptoms in people with schizophrenia: Neurocognitive, socio-cognitive, clinical and real-world functional characteristics of individuals without autistic features

Abstract

Objective: Autism spectrum disorders (ASD) symptoms are frequent in people living with schizophrenia spectrum disorders (SSD) and have a relevant impact on their daily life. However, current literature is mostly focused on investigating correlates of high levels of ASD symptoms, leaving largely unexplored the clinical, neurocognitive, socio-cognitive and functional characterization of individuals with minimal or absent ASD symptoms, which may represent a peculiar sub-population.

Methods: A total of 361 patients (mean age 41.7 years; 117 females) included in the SCOPE study were assessed with clinical, neurocognitive, socio-cognitive, functional capacity, social skills and real-world functioning measures. The severity of ASD symptoms was assessed with the PANSS Autism Severity Scale (PAUSS): individuals with a PAUSS score < 10 were considered without significant ASD symptoms.

Results: Seventy-two (19.95%) participants had no significant ASD symptoms and presented a less severe clinical status, as well as a better cognitive and socio-cognitive performance and functional profile. Lower non-autistic SSD symptoms severity and better social skills, functional capacity, global cognitive and Theory of Mind/Mental State Attribution (as measured by the Hinting task) performance and real-world social relationships emerged as predictors of non-ASD symptoms status in the logistic regression analyses.

Conclusion: Individuals without ASD symptoms represent a minority of people diagnosed with SSD that appears to be characterized by specific correlates, resulting in a less severe situation and more positive outcomes. As these factors could have a relevant impact on treatment response, assessing the severity of ASD symptoms could be an important step required to define a personalized treatment.

Keywords: Autism spectrum disorder; PAUSS; Real-world outcomes; Schizophrenia; Social cognition.