[autismo-biologia] comorbilità psichiatrica

[daniela marianicerati]

Tra gli articoli pubblicati di recente segnalo il seguente
“J Autism Dev Disord. 2010 Feb 23. [Epub ahead of print]
Comorbid Psychiatric Disorders Associated with Asperger Syndrome/High-functioning Autism: A Community- and Clinic-based Study.
Marja-Leena Mattila • Tuula Hurtig • Helena Haapsamo • Katja Jussila •
Sanna Kuusikko-Gauffin • Marko Kielinen • Sirkka-Liisa Linna •
Hanna Ebeling • Risto Bloigu • Leena Joskitt • David L. Pauls • Irma Moilanen”

http://www.ncbi.nlm.nih.gov/pubmed/20177765?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1


Lo studio è stato compiuto su un campione di 50 soggetti di età compresa tra i 9 e i 16 anni con autismo o Asperger e con quoziente intellettivo nella norma, superiore in tutti a 75.

In questa, come in altre ricerche, si conferma un’alta prevalenza  di disturbi psichiatrici che si sovrappongono all’autismo.
“The results support common (prevalence 74%) and often
multiple comorbid psychiatric disorders in AS/HFA;
behavioral disorders were shown in 44%, anxiety disorders
in 42% and tic disorders in 26%.”

Dalla tabella seguente risulta la distribuzione dei diversi disturbi

Table 2 Current and lifetime comorbid psychiatric disorders in subjects with AS/HFA
Combined sample
[n/males = 50/38 (mean age 12.7, range 9.8–16.3)]
Current/lifetime
(n/n)
BEHAVIORAL DISORDERS 22 (44%)/25 (50%) 
Attention deficit/hyperactive disorder 19 (38%)b,c,d/22 (44%) 
Combined type (current) 13 (68%)b/15 
Inattentive type (current) 6 (32%)c, d/8 
Hyperactive type (current) 0 (0%)/3 
Conduct disorder 1 (2%)/1 (2%) 
Oppositional defiant disorder 8 (16%)/8 (16%) 
ANXIETY DISORDERS 21 (42%)/28 (56%) 
Separation anxiety disorder 1 (2%)/4 (8%) 
Panic disorder with agoraphobia 1 (2%)/1 (2%) 
Agoraphobia 1 (2%)/1 (2%) 
Social phobia 2 (4%)/3 (6%) 
Specific phobia 14 (28%)/17 (34%) 
Obsessive–compulsive disorder 11 (22%)/14 (28%) 
TIC DISORDERS 13 (26%)/19 (38%) 
Tourette’s syndrome 7 (14%)/7 (14%) 
Motor tics 3 (6%)/5 (10%) 
Vocal tics 3 (6%)/8 (16%) 
MOOD AND RELATED DISORDERS 3 (6%)/7 (14%) 
Major depressive disorder 3 (6%)/7 (14%) 
ENURESIS 1 (2%)/8 (16%) 
ENCOPRESIS 1 (2%)/3 (6%) 
INSOMNIA (current)e 18 (36%) 
Initial 17 (34%)f 
Middle 2 (4%)f 
Circadian 1 (2%)f 
Nonresto 1 (2%)f 

AS, Asperger syndrome; HFA, high-functioning autism; CI, confidence interval; ADHD, attention deficit/hyperactive disorder
a Combined sample = community-based sample ? clinic-based sample; eight outpatients overlapping between the community-based and the clinic-based sample
b One has changed from past ADHD inattentive type into current ADHD combined type
c Two have changed from past ADHD combined type into current ADHD inattentive type
d One has changed from past ADHD hyperactive type into current ADHD inattentive type
e None had terminal insomnia
f One had initial, middle, circadian and nonresto insomnia


La frase finale dell’articolo è la seguente   “In conclusion, we
emphasize the importance of routine comprehensive
comorbid psychiatric evaluation in children and adolescents
with AS/HFA in order to select the best means of
intervention and their combinations.”

La ricerca è una fotografia della situazione e sottolinea come la comorbilità associata all’autismo è pesante e grave anche in assenza di ritardo mentale.

Facendo un’analisi di quanto emerge dallo studio, si constata che l’insonnia interessa il 36% dei casi e di questo abbiamo già parlato ampiamente su questa lista.

Il deficit dell’attenzione/iperattività riguarda il 38% del campione come sintomo presente e il 44% nel corso della vita, con prevalenza del tipo combinato. 
A questo proposito ho trovato interessate e utile un contributo del gruppo dell’Università di Cagliari , di cui riporto titolo e abstract.
“IJ Child Adolesc Psychopharmacol. 2004 Summer;14(2):207-18.
Methylphenidate for pervasive developmental disorders: safety and efficacy of acute single dose test and ongoing therapy: an open-pilot study.
Di Martino A, Melis G, Cianchetti C, Zuddas A.
OBJECTIVE: The aim of this study was to investigate the effects of ongoing methylphenidate (MPH) on ADHD-related and autistic symptoms in Pervasive Developmental Disorders (PDD) in children who did not present any adverse effects to an initial acute dose administered at the clinic. METHODS: Participants included 13 subjects (12 males, with a mean age of 7.9 years) with PDD and moderate to severe hyperactivity/impulsivity. The severity of the symptoms assessment was based on Clinical Global Impression (CGI), Childhood Autism, Child Psychiatric and Conners Parent and Teacher Rating Scales (CPRS). Scores at baseline, and after 1 and 3 months of treatment, were compared to intent-to-treat analyses. RESULTS: One (1) hour after a single MPH dose (0.4 mg/kg), 5 subjects exhibited increased hyperactivity, stereotypes, dysphoria, or motor tics and were rated as minimally or much worse on the CGI Global Improvement Scale. They received no further treatment with
 MPH. Four (4) of the remaining subjects were rated as improved, and four as unchanged; they proceeded to a 12-week open trial of MPH. Two children remained unchanged: they discontinued treatment after 1 week on maximally tolerated doses. However, in group analyses, behavioral measures of hyperactivity and impulsivity improved significantly, while autism core symptom measures were unaffected. No significant adverse effects were observed in any of the 8 subjects. CONCLUSIONS: Administering a single MPH test dose may be useful in identifying children with PDD who may benefit from prolonged therapy.

Poter fare un test acuto per verificare se un farmaco è utile o dannoso è una cosa molto utile. Se il farmaco si rivela efficace, lo si prescrive. Se si rivela dannoso, si potenziano  le strategie comportamentali, senza aggiungere gli effetti collaterali del farmaco alla già grave situazione. 

Sulla restante comorbilità mi riservo di fare altre considerazioni in altri messaggi, in attesa di eventuali contributi da parte dei partecipanti alla lista
Alla prossima
   Daniela MC