Clinical implications of autistic features in the psychosis spectrum: a cross-sectional study using path analysis

Despite the fact that there have been many studies on the connection between autism and psychosis, there are still many things that are unknown about the significance of this connection. Recent studies have highlighted the significant overlap between autistic traits and psychotic disorders, yet the clinical implications of these associations are not well understood. This study aims to address this knowledge gap by investigating the links between autistic features and various clinical, functional and behavioural outcomes in individuals with psychosis spectrum.

The study included 125 patients who had at least one psychotic episode and who had used antipsychotic medication for most of the treatment period. The clinician conducted face-to-face interviews to evaluate all other clinical characteristics, while self-report scales were employed to evaluate autistic features and quality of life. Complex associations were understood using path analysis.

Our study showed that there was a negative association between autistic features and functioning, quality of life and subjective treatment benefit; and a positive association with severity of disorder, severity of anxiety and depression, severity of positive and negative symptoms, suicidal ideation and behaviour, psychiatric comorbidity and number of psychotic episodes. Depression intensity mediated autistic features' effect on suicidal thoughts. Those who were non-smokers and bullied by peers reported more autistic traits.

Taken together, our results highlight the importance of autistic features in the psychosis spectrum. It is clear that there is a significant gap in clinical knowledge regarding the relationship between autism and psychosis and that further improvements in diagnostic tools and treatment options are needed. As our study is cross-sectional in design, speculation about causality is limited and further prospective research is needed.