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Psychopathological Differences Between Asperger Syndrome and Schizotypal Disorder in an Adult Sample

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ClinicalTrials.gov Identifier: NCT02800681
Recruitment Status : Recruiting
First Posted : June 15, 2016
Last Update Posted : March 21, 2018
Sponsor:
Collaborator:
The Danish Autism Centre
Information provided by (Responsible Party):
Maria Elisabeth Nilsson, Mental Health Services in the Capital Region, Denmark

Brief Summary:

The purpose of this study is to identify psychopathology (psychiatric symptoms) that can differentiate between Schizotypal Disorder (SD) and Asperger Syndrome (normal IQ, no language impairment Autism Spectrum Disorder) (AS) in young adults.

With our present knowledge, the differentiation between AS and SD can be difficult, as they both present with social difficulties, odd (but not psychotic) behaviour, and a 'feeling of not being as everyone else'. Studies suggest that adults with AS symptoms are either overlooked, or diagnosed within the schizophrenia spectrum in Adult Psychiatry.

A 'correct' diagnosis is important, as it is the first step towards the most optimal plan, treatment and rehabilitation for the patient. The only way to diagnose psychiatric illness is the description of present psychopathology.

To identify symptoms that can differentiate between the two disorders, we will use semi-structured interviews to explore present psychopathology in young adults with typical symptoms of SD and AS respectively, with special focus on presence of alterations in self-experience. Alterations in self-experience are typical for the schizophrenia spectrum, and are therefore not thought to be equally present in AS and SD.

The hypotheses are that the total level of altered experiences is higher in SD, than in AS, and with a different pattern of altered experiences in SD than in AS. If the hypotheses are true, an examination of altered self-experience will be valuable to aid clinical differentiation between the two disorders.


Condition or disease Intervention/treatment
Asperger Syndrome Autism Spectrum Disorder Schizotypal Personality Disorder Other: Expert panel evaluation Other: Semi-structured psychopathological interviews Other: Self-administered rating scales Other: Other general interviewer ratings

  Show Detailed Description

Study Type : Observational
Estimated Enrollment : 100 participants
Observational Model: Case-Control
Time Perspective: Cross-Sectional
Official Title: Psychopathological Differences Between Asperger Syndrome/Normal IQ, no Language Impairment Autism Spectrum Disorder and Schizotypal Disorder in an Adult Sample
Study Start Date : June 2016
Estimated Primary Completion Date : August 2018
Estimated Study Completion Date : March 2019

Resource links provided by the National Library of Medicine


Group/Cohort Intervention/treatment
Asperger syndrome
  1. Expert panel evaluation for identification of participants with typical symptoms
  2. Semi-structured psychopathological interviews for general psychopathology, psychopathology within the schizophrenia spectrum, and psychopathology within the autism spectrum
  3. Self-administered rating scales for assessment of autistic traits, schizotypal personality and subjective psychological well-being
  4. Other general interviewer ratings for assessing functioning and severity of psychopathology
Other: Expert panel evaluation

From the medical records, described social and psychiatric history and observed psychiatric symptoms will be summarized and presented to two senior psychiatric consultants. The panels evaluation ensures the identification of subjects with typical symptoms, according to a best estimate clinical consensus.

The panel divides the participants into 4 groups: 'participant with symptoms typical of AS', 'participant with symptoms typical of SD', 'participant with inconclusive/non typical symptoms' and 'non eligible participant'.


Other: Semi-structured psychopathological interviews
Included participants are asked for a detailed social and developmental history and interviewed with 3 semi-structured interviews: 1. Schedules for Assessment in Neuropsychiatry (SCAN); Covering psychopathology and behaviour associated with the major psychiatric disorders. 2. Autism Diagnostic Observation Schedule (ADOS), module 4; An assessment to identify symptoms within the autism spectrum. 3. Examination of anomalous self-experience (EASE); A checklist for exploration of experiential anomalies. The Ph.D.-student will obtain social and developmental history and carry out SCAN and EASE interviews. ADOS will be carried out by a consultant psychologist at The Danish Autism Centre.

Other: Self-administered rating scales
1.The Autism Quotient (AQ), a 50 question scale, for the assessment of autistic traits, 2. The Schizotypal Personality Questionnaire (SPQ), a 74 item scale, for the assessment of schizotypal personality, 3. The WHO-5 Well-Being Index (WHO-5), a 5 item scale, for the assessment of subjective psychological well-being.

Other: Other general interviewer ratings
1. Global Assessment of Functioning (GAF), a numeric scale (1 through 100) for assessing social, occupational, and psychological functioning, 2. The Clinical Global Impressions scale (CGI-Severity), an assessment of the clinician's global view of the patient's severity of psychopathology on a 7 point scale.

Schizotypal disorder
  1. Expert panel evaluation for identification of participants with typical symptoms
  2. Semi-structured psychopathological interviews for general psychopathology, psychopathology within the schizophrenia spectrum, and psychopathology within the autism spectrum
  3. Self-administered rating scales for assessment of autistic traits, schizotypal personality and subjective psychological well-being
  4. Other general interviewer ratings for assessing functioning and severity of psychopathology
Other: Expert panel evaluation

From the medical records, described social and psychiatric history and observed psychiatric symptoms will be summarized and presented to two senior psychiatric consultants. The panels evaluation ensures the identification of subjects with typical symptoms, according to a best estimate clinical consensus.

The panel divides the participants into 4 groups: 'participant with symptoms typical of AS', 'participant with symptoms typical of SD', 'participant with inconclusive/non typical symptoms' and 'non eligible participant'.


Other: Semi-structured psychopathological interviews
Included participants are asked for a detailed social and developmental history and interviewed with 3 semi-structured interviews: 1. Schedules for Assessment in Neuropsychiatry (SCAN); Covering psychopathology and behaviour associated with the major psychiatric disorders. 2. Autism Diagnostic Observation Schedule (ADOS), module 4; An assessment to identify symptoms within the autism spectrum. 3. Examination of anomalous self-experience (EASE); A checklist for exploration of experiential anomalies. The Ph.D.-student will obtain social and developmental history and carry out SCAN and EASE interviews. ADOS will be carried out by a consultant psychologist at The Danish Autism Centre.

Other: Self-administered rating scales
1.The Autism Quotient (AQ), a 50 question scale, for the assessment of autistic traits, 2. The Schizotypal Personality Questionnaire (SPQ), a 74 item scale, for the assessment of schizotypal personality, 3. The WHO-5 Well-Being Index (WHO-5), a 5 item scale, for the assessment of subjective psychological well-being.

Other: Other general interviewer ratings
1. Global Assessment of Functioning (GAF), a numeric scale (1 through 100) for assessing social, occupational, and psychological functioning, 2. The Clinical Global Impressions scale (CGI-Severity), an assessment of the clinician's global view of the patient's severity of psychopathology on a 7 point scale.




Primary Outcome Measures :
  1. Level of altered experiences [ Time Frame: Assessed within 1,5 years from study inclusion start ]
    Total score, Examination of Anomalous Self Experience (EASE)

  2. Pattern of most occurring altered experiences [ Time Frame: Assessed within 1,5 years from study inclusion start ]
    Pattern of individual items, Examination of Anomalous Self Experience (EASE)


Secondary Outcome Measures :
  1. Autism Spectrum symptom load [ Time Frame: Assessed within 1,5 years from study inclusion start ]
    Total score, Autism Diagnostic Observation Schedule (ADOS), module 4

  2. Schizophrenia Spectrum symptom load [ Time Frame: Assessed within 1,5 years from study inclusion start ]
    Score, Schedules for Assessment in Neuropsychiatry (SCAN)

  3. Self-reported Autism Spectrum symptom load [ Time Frame: Assessed within 1,5 years from study inclusion start ]
    Score, The Autism Quotient (AQ)

  4. Self-reported Schizotypia symptom load [ Time Frame: Assessed within 1,5 years from study inclusion start ]
    Score, Schizotypal Personality Questionnaire (SPQ)

  5. Self-reported well-being [ Time Frame: Assessed within 1,5 years from study inclusion start ]
    Score, World Health Organization Well-Being Index (WHO-5)


Other Outcome Measures:
  1. Global severity of symptoms assessment [ Time Frame: Assessed within 1,5 years from study inclusion start ]
    Score, Clinician Global Impressions Scale (CGI)

  2. Global functioning assessment [ Time Frame: Assessed within 1,5 years from study inclusion start ]
    Score, Global Assessment of Functioning (GAF)



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 30 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Only already diagnosed participants are recruited, from specialised units. This is essential, as inclusion of participants with typical symptoms, reduces confounding of the results by diagnostic uncertainty.

Participants with SD will be recruited from OPUS-teams (a specialized treatment program for patients with first episode of schizophrenia spectrum disorder), within the Mental Health Services in the Capitol Region of Denmark, and participants with AS from The Danish Autism Centre (a non-profit organization for people with ASD).

Criteria

Inclusion Criteria:

  • ICD-10 diagnosis of Asperger syndrome (F84.5) or infantile autism (F84.0) with normal IQ and no language impairments or schizotypal disorder (F21)
  • Age 18-30 (both inclusive)

Exclusion Criteria:

  • Known non-verbal IQ < 80 (verbal IQ < 70) or an educational level corresponding to <9 years of primary education
  • Diagnosed with both Schizophrenia Spectrum Disorder and Autism Spectrum Disorder
  • Psychotic symptoms (< 1 day of duration, lifetime)
  • Severe physical illness (life-limiting, or limiting interview capacity)
  • Organic brain disorder (corresponding to ICD-10 chapter F00-09)
  • Active heavy alcohol or substance abuse (corresponding to ICD-10 definitions)
  • Not fluent in the Danish language
  • Forensic patients

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02800681


Contacts
Contact: Maria Nilsson, MD +4540266967 maria.elisabeth.nilsson@regionh.dk
Contact: Jessica Carlsson Lohmann, MD, Ph.d. +4538645135 jessica.carlsson.lohmann@regionh.dk

Locations
Denmark
Mental Health Centre Ballerup, Mental Health Services, The Capitol Region, Copenhagen Recruiting
Ballerup, Copenhagen, Denmark, 2750
Contact: Maria Nilsson, MD    +4540266967    maria.elisabeth.nilsson@regionh.dk   
The Danish Autism Centre Recruiting
Herlev, Denmark, 2730
Contact: Maria Nilsson, MD    +4540266967    maria.elisabeth.nilsson@regionh.dk   
Sponsors and Collaborators
Mental Health Services in the Capital Region, Denmark
The Danish Autism Centre
Investigators
Study Chair: Sidse Arnfred, MD, dr.med. Mental Health Services, Region Zealand, Denmark
Study Chair: Peter Handest, MD, Ph.d. Mental Health Services, the Capitol Region, Denmark

Responsible Party: Maria Elisabeth Nilsson, MD, PhD-student, Mental Health Services in the Capital Region, Denmark
ClinicalTrials.gov Identifier: NCT02800681     History of Changes
Other Study ID Numbers: E-61120-06
First Posted: June 15, 2016    Key Record Dates
Last Update Posted: March 21, 2018
Last Verified: March 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Maria Elisabeth Nilsson, Mental Health Services in the Capital Region, Denmark:
Asperger Syndrome
Autism Spectrum Disorder
Schizotypal disorder
Schizophrenia Spectrum Disorder
Psychopathology
Examination of Anomalous Self Disorder
Autism Diagnostic Observation Schedule
Phenomenology
Differential diagnosis
Young Adult

Additional relevant MeSH terms:
Syndrome
Asperger Syndrome
Disease
Autistic Disorder
Autism Spectrum Disorder
Child Development Disorders, Pervasive
Personality Disorders
Schizotypal Personality Disorder
Pathologic Processes
Neurodevelopmental Disorders
Mental Disorders