A Predictive Coding Account of Psychotic Symptoms in Autism Spectrum Disorder

2017 ◽  
Vol 47 (5) ◽  
pp. 1323-1340 ◽  
Author(s):  
Gerrit I. van Schalkwyk ◽  
Fred R. Volkmar ◽  
Philip R. Corlett
Keyword(s):  
Autism Spectrum Disorder ◽  
Predictive Coding ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Psychotic Symptoms

scholarly journals An audit into the use of psychotropic medications in patients with autism spectrum disorder in a high security psychiatric hospital

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S68-S68
Author(s):  
Elliott Carthy ◽  
David Murphy
Keyword(s):  
Autism Spectrum Disorder ◽  
Personality Disorder ◽  
Psychiatric Hospital ◽  
Autism Spectrum ◽  
Psychotropic Medications ◽  
Spectrum Disorder ◽  
Psychotic Symptoms ◽  
High Security ◽  
Psychotropic Medicines ◽  
Appropriate Prescribing

AimsAutism Spectrum Disorder (ASD) is a common neurodevelopmental disorder associated with difficulties in social communication and language development, preoccupations, a need for routine, sensory sensitivities and emotional dysregulation. People with autism who have violently offended may be prescribed psychotropic medications to treat comorbidities, or off-license to manage aggressive or challenging behaviours. However, the evidence base for their use remains scarce.MethodThis was a retrospective audit at Broadmoor Hospital, a high security psychiatric hospital in the United Kingdom, into the safe and appropriate prescribing of psychotropic medicines in those with an ASD compared to guidance from the National Institute for Health and Care Excellence (CG142): “Autism spectrum disorder in adults: diagnosis and management”. This first cycle was undertaken during May and June 2020 and included all patients with a confirmed or equivocal diagnosis of ASD in the preceding five years.ResultA total of 22 participants were included in this study. Of these, 17 participants had a confirmed diagnosis of ASD and five participants had a suspected diagnosis of ASD, but without formal confirmation with neurocognitive testing. A total of 13 (76.5%) participants with confirmed ASD were prescribed antipsychotic medication, nine of whom had an established comorbid mental disorder with psychotic symptoms. Of the remaining four, three had a diagnosis of a personality disorder. Three participants in this study had a confirmed diagnosis of ASD without any additional comorbid mental health diagnoses. No patients were prescribed psychotropic medicines for the core symptoms of ASD. The specific documentation of off-license use of antipsychotic medicines in those without a diagnosis of a psychotic disorder was poor. This was not recorded in any such participant in the preceding 12 months.ConclusionThis audit highlighted that dual diagnoses of ASD alongside non-affective psychosis and personality disorder are over-represented in this high security setting. The NICE clinical guidelines CG142 guidelines state that “antipsychotic medications should only be used for behaviour that challenges if …. the risk to the person or others is very severe”. By definition, all patients admitted to high security are deemed to be a grave and imminent risk to the public. Psychotropic medicines may therefore be clinically indicated at a much earlier stage than in community patients, instigated alongside appropriate psychosocial interventions and treatment of comorbid conditions. It may be that catered guidelines need to be formulated to support the safe and appropriate prescribing of psychotropic medicine in forensic settings.

Evaluation and Treatment of New-Onset Psychotic Symptoms in a Patient with Autism Spectrum Disorder and Multiple Autoimmune Disorders

2021 ◽  
Vol 29 (5) ◽  
pp. 378-387
Author(s):  
Christina L. Macenski ◽  
Allison Kimball ◽  
Meredith Gansner ◽  
Michael Levy ◽  
Eve Megargel ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Autism Spectrum ◽  
Autoimmune Disorders ◽  
Spectrum Disorder ◽  
Psychotic Symptoms ◽  
New Onset

Psychotic Symptoms and Catatonia in a Preadolescent Boy with Autism Spectrum Disorder

2014 ◽  
Vol 24 (5) ◽  
pp. 288-292 ◽  
Author(s):  
Presenters: Khiela J. Holmes ◽  
Molly M. Gathright ◽  
Edwin M. Morris ◽  
Discussant: Barbara Coffey
Keyword(s):  
Autism Spectrum Disorder ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Psychotic Symptoms

scholarly journals Atypical cortical connectivity in autism spectrum disorder (ASD) as measured by magnetoencephalography (MEG)

2019 ◽  
Author(s):  
Robert A. Seymour ◽  
Paul Sowman ◽  
Klaus Kessler
Keyword(s):  
Autism Spectrum Disorder ◽  
Sensory Processing ◽  
Perspective Taking ◽  
Predictive Coding ◽  
Gamma Oscillations ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Alpha Oscillations ◽  
Oscillatory Power ◽  
Phase Amplitude

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition, characterised by impairments in social interaction and communication, the presence of repetitive behaviours, and multisensory hyper- and hypo-sensitives. This thesis utilised magnetoencephalography, in combination with robust analysis techniques, to investigate the neural basis of ASD. Based on previous research, it was hypothesised that cortical activity in ASD would be associated with disruptions to oscillatory synchronisation during sensory processing, as well as during high-level perspective-taking. More specifically, a novel framework was introduced, based on local gamma-band dysregulation, global hypoconnectivity and deficient predictive-coding. To test this framework, data were collected from adolescents diagnosed with ASD and age-matched controls.Using a visual grating stimulus, it was found that in primary visual cortex, ASD participants had reduced coupling between the phase of alpha oscillations and the amplitude of gamma oscillations (i.e. phase amplitude coupling), suggesting dysregulated visual gamma in ASD. These findings were based on a robust analysis pipeline outlined in Chapter 2. Next, directed connectivity in the visual system was quantified using Granger causality. Compared with controls, ASD participants showed reductions in feedback connectivity, mediated by alpha oscillations, but no differences in inter-regional feedforward connectivity, mediated by gamma oscillations. In the auditory domain, it was found that ASD participants had reduced steady-state responses at 40Hz, in terms of oscillatory power and inter-trial coherence, again suggesting dysregulated gamma. Investigating predictive-coding theories of ASD using an auditory oddball paradigm, it was found that evoked responses to the omission of an expected tone were reduced for ASD participants. Finally, we found reductions in theta-band oscillatory power and connectivity for ASD participants, during embodied perspective-taking. Overall, these findings fit the proposed framework, and demonstrate that cortical activity in ASD is characterised by disruptions to oscillatory synchronisation, at the local and global scales, during both sensory processing and higher-level perspective-taking.Keywords: Autism Spectrum Disorder; Magnetoencephalography; Oscillations; Phase Amplitude Coupling; Connectivity.

scholarly journals Clinical and autoimmune features of a patient with autism spectrum disorder seropositive for anti—NMDA-receptor autoantibody

2017 ◽  
Vol 19 (1) ◽  
pp. 65-70 ◽  
Keyword(s):  
Autism Spectrum Disorder ◽  
Nmda Receptor ◽  
Single Molecule ◽  
Neurodevelopmental Disorder ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Psychotic Symptoms ◽  
Direct Role ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by dysfunctions in social interactions resulting from a complex interplay between immunogenetic and environmental risk factors. Autoimmunity has been proposed as a major etiological component of ASD. Whether specific autoantibodies directed against brain targets are involved in ASD remains an open question. Here, we identified within a cohort an ASD patient with multiple circulating autoantibodies, including the well-characterized one against glutamate NMDA receptor (NMDAR-Ab). The patient exhibited alexithymia and previously suffered from two major depressive episodes without psychotic symptoms. Using a single molecule-based imaging approach, we demonstrate that neither NMDAR-Ab type G immunoglobulin purified from the ASD patient serum, nor that from a seropositive healthy subject, disorganize membrane NMDAR complexes at synapses. These findings suggest that the autistic patient NMDAR-Abs do not play a direct role in the etiology of ASD and that other autoantibodies directed against neuronal targets should be investigated.

scholarly journals Dysregulated Oscillatory Connectivity in the Visual System in Autism Spectrum Disorder

2018 ◽  
Author(s):  
R.A. Seymour ◽  
G. Rippon ◽  
G. Gooding-Williams ◽  
J.M. Schoffelen ◽  
K. Kessler
Keyword(s):  
Autism Spectrum Disorder ◽  
Visual Processing ◽  
Local Level ◽  
Predictive Coding ◽  
Gamma Oscillations ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Alpha Band ◽  
Feedback Information ◽  
Autism Spectrum Disorder Group

AbstractAutism Spectrum Disorder is increasingly associated with atypical perceptual and sensory symptoms. Here we explore the hypothesis that aberrant sensory processing in Autism Spectrum Disorder could be linked to atypical intra- (local) and inter-regional (global) brain connectivity. To elucidate oscillatory dynamics and connectivity in the visual domain we used magnetoencephalography and a simple visual grating paradigm with a group of 18 adolescent autistic participants and 18 typically developing controls. Both groups showed similar increases in gamma (40-80Hz) and decreases in alpha (8-13Hz) frequency power in occipital cortex. However, systematic group differences emerged when analysing intra- and inter-regional connectivity in detail. Firstly, directed connectivity was estimated using non-parametric Granger causality between visual areas V1 and V4. Feedforward V1-to-V4 connectivity, mediated by gamma oscillations, was equivalent between Autism Spectrum Disorder and control groups, but importantly, feedback V4-to-V1 connectivity, mediated by alpha (8-13Hz) oscillations, was significantly reduced in the Autism Spectrum Disorder group. This reduction was positively correlated with autistic quotient scores, consistent with an atypical visual hierarchy in autism, characterised by reduced top-down modulation of visual input via alpha-band oscillations. Secondly, at the local level in V1, coupling of alpha-phase to gamma amplitude (alpha-gamma phase amplitude coupling, PAC) was reduced in the Autism Spectrum Disorder group. This implies dysregulated local visual processing, with gamma oscillations decoupled from patterns of wider alpha-band phase synchrony (i.e. reduced PAC), possibly due to an excitation-inhibition imbalance. More generally, these results are in agreement with predictive coding accounts of neurotypical perception and indicate that visual processes in autism are less modulated by contextual feedback information.

scholarly journals Diagnostic and Therapeutic Challenges of Catatonia in an Adolescent With High Functioning Autism Spectrum Disorder: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Annalisa Traverso ◽  
Caterina Ancora ◽  
Silvia Zanato ◽  
Alessia Raffagnato ◽  
Michela Gatta
Keyword(s):  
Autism Spectrum Disorder ◽  
Neurodevelopmental Disorders ◽  
High Functioning Autism ◽  
Signs And Symptoms ◽  
Autism Spectrum ◽  
Sudden Onset ◽  
Spectrum Disorder ◽  
Psychotic Symptoms ◽  
High Functioning ◽  
Long Time

Catatonia is a psychomotor syndrome with specific clusters of speech, behavioral and motor features. Although potentially life-threatening, especially in its malignant form accompanied with autonomic dysregulation and medical complications, it is a treatable condition, when promptly identified. For a long time catatonia was considered a marker of schizophrenia, thus limiting the possibility of diagnosis and treatment. Due to growing awareness and studies on the subject, it is now known that catatonia can occur in the context of a number of diseases, including psychotic, affective and neurodevelopmental disorders. In recent years, there's been a renewed interest in the recognition and definition of catatonia in neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD), where the differential diagnosis poses great challenges, given the considerable overlapping of signs and symptoms between the conditions. We present the case of a 15 year old boy with High Functioning ASD with a sudden onset of severe catatonic symptoms and the co-existence of psychotic symptoms, whose complex clinical course raises many questions on the differentiation and relation of said disorders.

scholarly journals Electrophysiological alterations in motor‐auditory predictive coding in autism spectrum disorder

2019 ◽  
Vol 12 (4) ◽  
pp. 589-599 ◽  
Author(s):  
Thijs van Laarhoven ◽  
Jeroen J. Stekelenburg ◽  
Mart L.J.M. Eussen ◽  
Jean Vroomen
Keyword(s):  
Autism Spectrum Disorder ◽  
Predictive Coding ◽  
Autism Spectrum ◽  
Spectrum Disorder

scholarly journals A phenomenological approach to diagnosing psychosis in autism spectrum disorder and intellectual disability: a case series

2018 ◽  
Vol 4 (2) ◽  
pp. 39-48
Author(s):  
Rahul Rai ◽  
Samuel Tromans ◽  
Chaya Kapugama ◽  
Verity Chester ◽  
Ignatius Gunaratna ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Autism Spectrum Disorder ◽  
Intellectual Disability ◽  
Case Series ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Psychotic Symptoms ◽  
Related Case ◽  
Content Type

Purpose The diagnosis of psychosis in individuals with autism spectrum disorder (ASD) poses a unique clinical challenge. The presence of intellectual disability (ID) further complicates the diagnostic picture. Reliable and timely diagnosis of psychosis in such individuals minimises the duration of untreated psychotic symptoms and the subsequent impact on the quality of life of the patients concerned. The paper aims to discuss this issue. Design/methodology/approach The authors present four patients with psychosis, ASD and ID, who have received care within forensic mental health and ID settings. These examples demonstrate the interaction between these conditions, as well as issues pertaining to diagnosis and management. Findings In all four patients, sustained use of antipsychotic medication was objectively associated with an improvement in psychotic symptoms and quality of life. In instances where autistic phenomena were accentuated upon development of psychosis, such features returned to the baseline levels evident prior to the onset of psychosis. Practical implications The discussion and related case examples could improve the understanding of the possibility of psychosis in individuals with ASD and ID, and increase awareness of this diagnostic possibility among healthcare professionals. Originality/value This is the first published case series illustrating the challenges of diagnosing psychosis in individuals with ASD and ID.

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