Qualitative Differences in Attribution of Mental States to Other People in Autism and Schizophrenia: What are the Tools for Differential Diagnosis?

The differential diagnosis between schizophrenia spectrum disorders (SSD) and autism spectrum disorders (ASD) remains an important clinical question, because they have overlap in clinical diagnosis. This study explored the differences between ASD (n = 44) and SSD patients (n = 59), compared to typically developing peers (n = 63), in completing an advanced Theory of Mind (ToM) task. The outcome found several differences between groups. The SSD patients showed greater difficulty in understanding social scenarios, while ASD individuals understood the stories, but did not correctly identify the protagonist’s intention. The interesting aspect of the results is that some ToM stories are more informative about the mentalistic reasoning of the two clinical groups, namely, the stories that investigate pretend, persuasion, double bluff and ironic joke constructs.

Countercurrents: The Last Trial

If you have been around long enough, you will have heard more than once that an important clinical question is about to be resolved by a study that is soon to be published [...]

Unexplained chronic cytopenia: is it idiopathic cytopenia of undetermined significance or myelodysplastic syndrome

Idiopathic cytopenia is a condition where there is a decrease in peripheral blood counts causing either anaemia, leucopoenia and thrombocytopaenia. Most cases of cytopenia reveal a cause on further workup. But very rarely, in some cases, a definitive cause could not be identified. Unexplained cytopenia becomes challenging and poses difficulty in diagnosis and management. Discriminating these groups of bone marrow failure disorders from myelodysplastic syndrome (MDS) becomes an important clinical question. We describe a case of a middle-aged Hispanic woman who presented with pancytopenia and on extensive workup did not reveal any specific cause. Her bone marrow examination revealed severely reduced megakaryocytes but with normal haemopoiesis of other lineages. Cytogenetics, flow cytometry, comprehensive next-generation whole genomic analysis did not reveal any abnormalities. She fit the criteria for idiopathic cytopenia of undetermined significance rather than MDS. She remained asymptomatic and her counts never improved with immunosuppressives or thrombopoietin mimetics.

1. German Retrospect

Dr. Ripping, in the “Zeitschrift für Psychiatrie (Band xxxix., Heft 1), considers the important clinical question of the relation of the diseases of the sexual organs in women to mental alienation. While he admits that changes in the uterus and its appendages, whether physiological or pathological, have an effect upon the mental susceptibilities of women, he is doubtful whether this effect is profound enough to become a potent cause of insanity. He is rather disposed to place such affections in the second or third line of causes as adjuvantia. The uterine diseases and the mental disturbance are sometimes the result of a common cause. “I have never observed,” writes Dr. Ripping, “a single case in which the insanity was a pure reflex neurosis of disease of the genital organs.” If in some patients this seemed to be probable, it was found on more careful examination that there were other circumstances which gave an easy and unforced explanation of the mental derangement. It is only after uterine disorders which, from their severity, implicate the whole organism, or lower the strength, as in continued bleedings, that insanity can be held to supervene as a result.