OBJECTIVE:To present a comparison of pre-neuropsychological and post-neuropsychological test findings in adolescents (aged 11 to 18 y) who were treated with electroconvulsive therapy (ECT) for a severe and/or treatment-resistant psychiatric disorder. METHODS:Forty-five participants (Nfemale=31; 68.9%) received ECT (mean age ± SD at the time of starting ECT=15.9 ±1.4). Comprehensive psychiatric evaluation and standardized neuropsychological assessment were done as part of the clinical protocol. RESULTS:The most common diagnostic reason for receiving ECT was refractory mood disorder (n=41; 91%). The mean number of ECT treatments in the index course was 20 ±10.8, and the mean number of continuation treatments among 36 participants was 8.5 ± 9.2. The mean interval between the end of ECT and the neuropsychological evaluation was 65.52 days. Analysis showed no statistically significant decline (P >0.08) in intelligence, academic achievement, learning, memory, and executive functioning. Self-ratings of depression measured by the Beck Depression Inventory were reduced at the post-ECT time-point relative to pre-ECT (declined from "severe" to "moderate") (p = 0.019). CONCLUSIONS:Standardized neuropsychological measures did not reveal a significant decline in a range of neurocognitive domains. These findings challenge the notion that adolescents may be more vulnerable to cognitive side effects of ECT. Reduction in self-reported depression symptoms was also found.

To present a comparison of pre-neuropsychological and post-neuropsychological test findings in adolescents (aged 11 to 18 y) who were treated with electroconvulsive therapy (ECT) for a severe and/or treatment-resistant psychiatric disorder. Forty-five participants (N female =31; 68.9%) received ECT (mean age ± SD at the time of starting ECT=15.9 ±1.4). Comprehensive psychiatric evaluation and standardized neuropsychological assessment were done as part of the clinical protocol. The most common diagnostic reason for receiving ECT was refractory mood disorder (n=41; 91%). The mean number of ECT treatments in the index course was 20 ±10.8, and the mean number of continuation treatments among 36 participants was 8.5 ± 9.2. The mean interval between the end of ECT and the neuropsychological evaluation was 65.52 days. Analysis showed no statistically significant decline ( P >0.08) in intelligence, academic achievement, learning, memory, and executive functioning. Self-ratings of depression measured by the Beck Depression Inventory were reduced at the post-ECT time-point relative to pre-ECT (declined from “severe” to “moderate”) ( p = 0.019). Standardized neuropsychological measures did not reveal a significant decline in a range of neurocognitive domains. These findings challenge the notion that adolescents may be more vulnerable to cognitive side effects of ECT. Reduction in self-reported depression symptoms was also found.

This study investigates the co-occurrence between autism spectrum disorder (ASD) and major depressive disorder (MDD) in pediatric populations, focusing on prevalence rates, comorbid psychiatric conditions, and their impact on clinical presentation and treatment outcomes. We conducted a retrospective study of children and adolescents (ages 3–17) referred for psychiatric care to ambulatory care clinics (pediatric psychopharmacology [N = 2,307] and specialized autism spectrum disorder [N = 416] programs) at a major academic medical center. Psychopathology was assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Epidemiologic Version and the Child Behavior Checklist (CBCL). ASD was diagnosed using DSM criteria. Our findings revealed a co-occurrence and bidirectional relationship between ASD and MDD (55

Autism, psychosis and catatonia were once considered part of schizophrenia. While both autism and catatonia have been “detached” from schizophrenia, co-occurrence of the three conditions may be suspected in some cases, because of overlapping features, leading to challenges in diagnosis and treatment. This review provides an overview of the literature regarding the co-occurrence of autism, psychosis and catatonia. A scoping review of peer-reviewed original research articles that simultaneously described all the three diagnostic constructs (autism, psychosis and catatonia) was performed. Using PRISMA-ScR guidelines, the review was based on MedLine, Scopus, PsycInfo and Cinahl databases. Studies included patients of all ages, races and both genders. A Qualitative Content Analysis (QCA) of the contents of the articles was also performed. Seventeen articles (n = 17) out of a total of 752 (after removing duplicates) met inclusion criteria, most of which (65

Catatonia is a neuropsychiatric disorder characterized by abnormalities of movement, communication, and behavior, often accompanied by a disturbance of mood, thought and perception. If untreated, it may lead to serious complications, including death. Although often described in adults with schizophrenia and severe mood disorders, it can also occur in persons with neurodevelopmental disorders (NDD), particularly autism spectrum disorder (ASD). Since its diagnosis is more likely to be missed by clinicians with limited experience, we attempted to determine if experienced psychiatrists can make a reliable diagnosis of catatonia in a group of patients with NDD. Twenty patients with catatonia with ASD/NDD (12 males 8 females; age range 13-34 years; mean 17.5; SD 4.8), diagnosed by two American psychiatrists, were re-evaluated by a group of Swedish psychiatrists. In the initial round, agreement was reached in 15 (75%) cases. However, a careful review of additional material and several virtual discussions were required to reach agreement in the remaining 5 (25%) of cases. The diagnosis of catatonia in individuals with NDD is challenging, even for experienced clinicians. Reasons for the lack of diagnostic agreement in the five patients are discussed to highlight the barriers for accurately diagnosing catatonia in patients with NDD.

There is a dearth of information about patients with autism spectrum disorder (ASD) or intellectual disability (ID) who seek emergency psychiatric care. Given this backdrop, this retrospective study aims to explore clinical, demographic, and disposition-related information about this patient population over a 10-year period. This study includes individuals with ASD or ID (n = 1461) and had presented to a psychiatric emergency department between 2012 and 2021. Data were extracted using a structured chart review methodology, and included demographic, clinical and visit information. Bivariate and multivariate logistic regressions were estimated to explore associations between key variables and dispositions of interest. Sample was predominantly White (77.21

There is a growing recognition that a select number of patients diagnosed with developmental delays may benefit from ECT. This study presents an IRB-approved retrospective chart review of patients with ASD, who were treated with ECT at an academic center, between 2001 and 2020. Descriptive statistics were utilized to assess clinical outcomes and duration of ECT treatment. A total of 54 patients diagnosed with ASD who received ECT were reviewed (male = 30; female = 24; White = 42; Mage = 16.79 ± 4.9 years). Comorbid diagnoses included mood disorder (n = 39) and catatonia with a mood disorder (n = 21). Intellectual disability was present in 33 patients (61.11%). Regarding ECT, bilateral electrode placement was used for 50 patients (92.5%). The mean number of treatments in the index course was 57.12 (SD = ±66.7); the mean number of maintenance treatments was 24.9 (SD = 46.5). Eight patients received ongoing ECT. The overall mean duration of treatment in days was 300.5 (SD = 322.3). Preassessments and postassessments were completed prior to starting ECT, at 3 months and 12 months (irrespective of whether one received maintenance ECT). Relative to baseline, mean global function scores improved (baseline = 23.7 ± 10.0; 3 months = 41.8 ± 14.3; 12 months = 47.2 ± 15.0); Bush Francis Catatonia scores were reduced (baseline = 14 ± 7.0; 3 months = 11.4 ± 10.2; 12 months = 9.1 ± 5.7); improved food intake was noted (difficulty with food intake at baseline identified among = 5 [9.6]; at 3 months = 3 [6.1]; at 12 months = 2 [4.3]); fewer patients displayed suicidality (pre-ECT baseline = 19 [36.5]; 3 months = 12 [25.5]; 12 months = 7 [19.4]); and also fewer patients displayed self-injurious behaviors (pre-ECT baseline = 22 [44]; 3 months = 12 [26.6]; 12 months = 5 [12.5]). Patients with a diagnosis of ASD predominantly received bilateral ECT for mood disorder and/or catatonia; index and maintenance courses of ECT were relatively long. Clinical improvement was progressive and noted in multiple areas.

A retrospective chart review to compare pre- and post-ECT neuropsychological test performance in adolescents between the ages of 11 and 18 years who were treated with ECT for a severe and/or treatment-resistant psychiatric disorder.

Background Patients with ‘underlying’ autism spectrum disorder (ASD) constitute a significant minority in adult out-patient psychiatry. Diagnoses of previously unrecognised ASD are increasing in adults. Characteristics of patients with autism within adult out-patient psychiatry have not been sufficiently explored, and there have not been any systematic comparisons of characteristics between patients with and those without autism within adult out-patient psychiatric populations. Aims To examine psychiatrically relevant characteristics in autistic adult psychiatric out-patients, and to compare the characteristics with non-autistic adult psychiatric out-patients. Method We assessed 90 patients who were referred to a Swedish psychiatric out-patient clinic and screened for ASD during 2019–2020. Sixty-three patients met the DSM-5 criteria for ASD or ‘subthreshold’ ASD. The 27 who did not meet the criteria for ASD were used as a comparison group. Assessments were made with structured and well-validated instruments, including parent ratings of developmental history. Results No differences were found between the groups regarding self-reported sociodemographic variables. The ASD group showed a higher number of co-occurring psychiatric disorders than the non-ASD group ( t (88) = 5.17, 95% CI 1.29–2.91, d = 1.19). Functional level was lower in the ASD group ( t (88) = −2.66, 95% CI −9.46 to −1.27, d = −0.73), and was predicted by the number of co-occurring psychiatric disorders. Conclusions The results underscore the need for thorough assessment of psychiatric disorders in autistic patients in adult psychiatric services. ASD should be considered as a possible ‘underlying’ condition in adult psychiatry, and there is no easy way of ruling out ASD in this population.

Eating disorders frequently accompany autism spectrum disorder (ASD). One such novel eating disorder is avoidant/restrictive food intake disorder (ARFID). This study compares the eating attitudes, quality of life, and sensory processing of typically developing children (TDC), autistic children, and autistic children with ARFID. A total of 111 children aged 4–10 with a diagnosis of ASD and ARFID (n = 37), ASD without ARFID (n = 37), and typical development (n = 37) were recruited. After an interview in which Childhood Autism Rating Scale (CARS) was administered, Child Eating Behavior Questionnaire (CEBQ), Pediatric Quality of Life Inventory (PedsQL), Social Responsiveness Scale (SRS) and Sensory Profile (SP) were completed by caregivers. Autistic children with ARFID had higher scores in CEBQ subscales relating to low appetite and lower scores on the subscales associated with weight gain. Both groups of autistic children scored lower than TDC on all PedsQL subscales and autistic children with ARFID had lower social QL scores than both groups. SRS scores were highest in autistic children with ARFID, followed by autistic and typically developing children. CARS scores were similar in both groups of autistic children, but higher than TDC. Auditory, vision, touch, multi-sensory, oral processing scores; as well as all quadrant scores, were significantly lower in autistic children with ARFID. Oral sensory processing scores were found to be the most significant predictor of ARFID comorbidity in ASD and reliably predicted ARFID in autistic children in the clinical setting. Autistic children with ARFID demonstrate differences in social functioning, sensory processing, eating attitudes, and quality of life compared to autistic and TD children.

Relatively little has been published about the prevalence of autism in adults with psychiatric disorders. In this study, all new patients referred to an adult psychiatric outpatient clinic in Sweden between November 2019 and October 2020 (n = 562) were screened for autism spectrum disorders using the Ritvo Autism and Asperger Diagnostic Scale Screen (RAADS-14). Out of the 304 (58%) responders, 197 who scored above the cut off (14) were invited to participate in an in-depth assessment. Twenty-six of the 48 that participated in the assessment met criteria for ASD and an additional eight had subthreshold ASD symptoms. We estimated the prevalence of ASD in this population to at least 18.9%, with another 5–10% having subthreshold symptoms.

Even in the era of information "prosperity" in the form of databases and registries that compile a wealth of data, information about ASD and ADHD remains scattered and disconnected. These data systems are powerful tools that can inform decision-making and policy creation, as well as advancing and disseminating knowledge. Here, we review three types of data systems (patient registries, clinical trial registries and genetic databases) that are concerned with ASD or ADHD and discuss their features, advantages and limitations. We noticed the lack of ethnic diversity in the data, as the majority of their content is curated from European and (to a lesser extent) Asian populations. Acutely aware of this knowledge gap, we introduce here the framework of the Neurodevelopmental Disorders Database (NDDB). This registry was designed to serve as a model for the national repository for collecting data from Saudi Arabia on neurodevelopmental disorders, particularly ASD and ADHD, across diverse domains.

Background: We recently adapted the published National institute for Health and Care Excellence (NICE) Attention deficit hyperactivity disorder (ADHD) diagnosis and management guideline to the Saudi Arabian context. It has been postulated that adaptation of evidence-based clinical practice guidelines to the local healthcare context rather than de-novo development will improve their adoption and implementation without imposing a significant burden on resources. The objective of this paper is to describe the adaptation process methodology utilized for the generation of the first national guideline for management of people with ADHD in Saudi Arabia.Methods: We used the KSU-Modified-ADAPTE methodology for the guideline adaptation process. We describe the full process in detail including the three phases of set-up, adaptation, and finalization. The process was conducted by a multidisciplinary guideline adaptation group in addition to an external review for the clinical content and methodology.Results: The group adapted ten main categories of recommendations from one source CPG (NICE). The recommendations include; (i) service organisation and training, (ii) recognition, identification and referral, (iii) diagnosis, (iv) support, (v) managing ADHD, (vi) dietary advice, (vii) medication, (viii) maintenance and monitoring, (ix) adherence to treatment, and (x) review of medication and discontinuation. Several implementation tools were compiled and developed to enhance implementability including a clinical algorithm, quality measures, coding system, medication tables, translations, patient information, and online resources.Conclusions: The finalized clinical practice guideline provides healthcare providers with applicable evidence-based guidance for the management of people with ADHD in Saudi Arabia. The project also demonstrated the effectiveness of KSU-Modified-ADAPTE, and emphasized the value of a collaborative clinical and methodological expert group for adaptation of national guidelines.

The aim of this preliminary study was to identify the practice patterns and potential barriers to diagnosing autism in Bosnia & Herzegovina. 126 children aged 23 to 94 months with developmental concerns referred to treatment centers participated in the study. Although parents had reported developmental problems in their children usually around the age of 17 months, it took them 812 visits to professionals (> 6 visits per child) over several months (mean 16.8, range 2–52 months) to get diagnosed with any developmental disorder. Only 8 children (6.3%) received a diagnosis of autism. However, when we re-examined 110 of the 126 children, 90 of them (71%) were identified with autism. Implications of these findings are discussed.

Objective: Bainbridge-Ropers syndrome (BRPS) is a neurodevelopmental genetic disorder associated with mutations in the additional sex combs-like ASXL3 gene on chromosome 18q12.1. The objective of this study is to describe the comorbid psychiatric aspects of BRPS.Methods: A retrospective review was conducted of the electronic medical records of patients diagnosed with BRPS from 2013 to 2020 at an academic medical center. Results were deidentified and presented as frequencies and percentages.Results: Seven cases (5 White males and 2 White females) of BRPS were identified. The mean age at the time of referral was 12 years, while the mean age at diagnosis of BRPS was 7 years. Comorbid psychiatric symptoms and diagnoses associated with BRPS included global developmental delay: 6 (86%), sleep impairment: 5 (71%), autism spectrum disorder: 3 (43%), speech impairment: 2 (29%), disruptive behavior: 4 (57%), attention-deficit/hyperactivity disorder: 3 (43%), self-injurious behavior: 3 (43%), aggression: 4 (57%), and seizures: 3 (43%). All 7 patients (100%) had multiple DSM-5 diagnoses.Conclusions: These data highlight the need for awareness of the psychiatric comorbidity of BRPS. The findings also underscore the need for further research and emphasize the importance of multidisciplinary collaboration in the prompt assessment, diagnosis, and management of patients presenting with BRPS.

This literature review evaluated early behavioral intervention studies of Autism Spectrum disorder (ASD) based on their participant exclusion criteria. The studies included were found through searching PsycINFO and PubMed databases, and discussed behavioral interventions for children up to 5 years of age with ASD and utilized a group research design. Studies reviewed were categorized into three groups: Restrictive exclusion criteria, loosely defined exclusion criteria, and exclusion criteria not defined. Results indicated that studies that used restrictive exclusion criteria demonstrated greater differences in terms of outcomes between experimental and control groups in comparison to studies that used loosely defined exclusion criteria and/or did not define any exclusion criteria. We discussed implications for the generalizability of the studies’ outcomes in relationship to exclusion criteria.

Purpose of Review Consanguinity can increase the risk for autosomal recessive conditions, along with autism spectrum disorder (ASD). Rarely outside of the genetics community is this discussed. Understanding its impact on the development of ASD and increasing awareness for physicians is important. Recent Findings ASD is a polygenic multifactorial disorder associated with morbidity and burden of care. Studies have confirmed its heritability, suspecting to an autosomal recessive transmission. Consanguinity increases the risk for uncovering recessive disorder and its role as an independent contributor for the development of ASD should be examined. With consanguinity being a known risk factor for autosomal recessive conditions, clinicians should routinely screen for it when evaluating for ASD, as this is inconsistently done. If suspected, genetic testing should be also recommended. Understanding current risk as well as future risk and providing families with the education to make the most informed decisions is necessary.

This study explored the physical and clinical phenotype of Bangladeshi children with autism spectrum disorder (ASD). A totally of 283 children who were referred for screening and administered Module 1 of the Autism Diagnostic Observation Schedule (ADOS) were included. Overall, 209 met the ADOS algorithmic cutoff for ASD. A trend for greater weight and head circumference was observed in children with ASD versus non-ASD. Head circumference was significantly (p < 0.03) larger in ASD males compared with non-ASD males. A trend was also observed for symptom severity, higher in females than males (p = 0.068), with further analyses demonstrating that social reciprocity (p < 0.014) and functional play (p < 0.03) were significantly more impaired in ASD females than males. The findings help understand sex differences in ASD.

MBOAT7 gene pathogenic variants are a newly discovered and rare cause for intellectual disability, autism spectrum disorder (ASD), seizures, truncal hypotonia, appendicular hypertonia, and below average head sizes (ranging from -1 to -3 standard deviations). There have been only 16 individuals previously reported who have MBOAT7-related intellectual disability, all of whom were younger than 10 years old and from consanguineous relationships. Thus, there is a lack of phenotypic information for adolescent and adult individuals with this disorder. Medical genetics and psychiatric evaluations in a 14-year-old female patient with a history of global developmental delay, intellectual disability, overgrowth with macrocephaly, metrorrhagia, seizures, basal ganglia hyperintensities, nystagmus, strabismus with amblyopia, ASD, anxiety, attention deficit hyperactivity disorder (ADHD), aggressive outbursts, and hyperphagia included a karyotype, methylation polymerase chain reaction for Prader-Willi/Angelman syndrome, chromosome microarray, and whole exome sequencing (WES), ADOS2, and ADI-R. WES identified a homozygous, likely pathogenic variant in the MBOAT7 gene (c.855-2A>G). This is the oldest known patient with MBOAT7-related intellectual disability, whose unique features compared with previously described individuals include overgrowth with macrocephaly, metrorrhagia, ophthalmological abnormalities, basal ganglia hyperintensities, unspecified anxiety disorder, and ADHD; combined type; and hyperphagia with the absence of appendicular hypertonia and cortical atrophy. More individuals need to be identified in order to delineate the full clinical spectrum of this disorder.