Longitudinal Course of Bipolar Disorder in Youth With High-Functioning Autism Spectrum Disorder

Abstract

Objective To provide the first longitudinal characterization of mood and psychosocial functioning in youth with comorbid bipolar (BD) and autism spectrum (ASD) disorders. Method The Course and Outcome of Bipolar Youth study followed 368 youth (7–17 years) with DSM-IV bipolar I (BP-I), -II, or Not Otherwise Specified (NOS) for, on average, 9 years using the Longitudinal Interval Follow-up Evaluation. This subgroup analysis compared youth with and without ASD on clinical presentation, percentage of time with mood symptomatology, and psychosocial functioning. Results Thirty youth (~8%) met DSM-IV criteria for Asperger disorder or pervasive developmental disorder-NOS (referred to here as ASD). Lifetime worst episode severity was similar in both groups, but youth with both BD and ASD (BD+ASD) had elevated rates of comorbid attention-deficit/hyperactivity and obsessive-compulsive disorders, were younger at intake, and had an earlier onset of mood symptoms. Over time, in both groups, the proportion of predominantly euthymic youth increased, and episode recurrence decreased. Compared to youth with BD, the clinical presentation of youth with BD+ASD more frequently involved distractibility, racing thoughts, depressed mood, social withdrawal, and low reactivity of negative mood states. ASD-related symptomatic differences were generally strongest early and decreased over time. Youth with BD+ASD had significantly greater impairment in friendships throughout follow-up. Conclusion Youth with BD+ASD exhibit typical BD mood symptoms but with earlier onset, mixed symptom presentation, and additive functional impairments. Significant amelioration of clinical symptoms occurred over time, suggesting that early recognition and treatment of mood disorders in youth with ASD may improve clinical outcomes.

The Comorbidity of Schizophrenia Spectrum and Mood Disorders in Autism Spectrum Disorder

“…Studies show that the majority of ASD individuals are diagnosed with at least one or more accompanying disorders [Croen et al, 2015; Hossain et al, 2020; Houghton, Liu, & Bolognani, 2018; Mazefsky et al, 2012] and are associated with increased risk of severe mental illness such as psychosis spectrum and bipolar spectrum disorders [Selten, Lundberg, Rai, & Magnusson, 2015]. The comorbidities between ASD and schizophrenia spectrum disorder (SSD), bipolar disorder (BD), or major depressive disorder (MDD) often indicate a less favorable outcome [Croen, Shankute, Davignon, Massolo, & Yoshida, 2017; Gurney, McPheeters, & Davis, 2006; Helles, Gillberg, Gillberg, & Billstedt, 2017], higher risk of suicide and early mortality [Borue et al, 2016; Cassidy, Bradley, Shaw, & Baron‐Cohen, 2018], and a need of more intensive and longer medical treatment [Mandell et al, 2008].…”

Autism and mood disorders

“…Likewise, individuals with autism with co-occurring bipolar disorder exhibit similar mood symptoms to those with bipolar but not autism, though with more mixed features (depression and mania) and fewer episodes of euphoric mood (Borue et al, 2016;Sapmaz et al, 2018;Vannucchi et al, 2014). As an example, mood lability, restlessness, irritability/aggression and psychotic symptoms appear to be frequently present in those individuals with autism diagnosed with bipolar disorder.…”

“…Nevertheless, as compared to other commonly cooccurring psychiatric conditions, like anxiety, research focussing on mood disorders in ASD remains notably lacking (Smith & White, 2020). Adequately powered studies investigating bipolar disorder are particularly sparse (Borue et al, 2016). In future research, largescale longitudinal studies that include individuals with autism diverse in sex, developmental and cognitive ability are required to characterise individual differences in the presentation and aetiologies for mood symptoms in autism, aiding earlier and more accurate identification.…”

nArgBP2-SAPAP-SHANK, the core postsynaptic triad associated with psychiatric disorders

“…For example, comorbid BD and OCD are relatively common among patients with a primary diagnosis of BD 78 . Studies have also found that as many as 27% of those with ASD also have symptoms of BD 79 , 80 . Similarly, there is a strong positive correlation between measures of the severity of both depression and anxiety symptoms 81 .…”