Autism-spectrum traits in First Episode Psychosis: Psychopathological and prognostic considerations from a 2-year follow-up study

• Published in: Schizophrenia research Vol. 283; pp. 163 - 172
• Main Authors: Pelizza, Lorenzo, Leuci, Emanuela, Quattrone, Emanuela, Palmisano, Derna, Pupo, Simona, Paulillo, Giuseppina, Pellegrini, Clara, Pellegrini, Pietro, Menchetti, Marco
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2025
• Subjects: Adolescent; Adult; Autism questionnaire; Autism spectrum disorder; Autism Spectrum Disorder - diagnosis; Autism Spectrum Disorder - psychology; Early intervention; Female; First Episode Psychosis; Follow-up; Follow-Up Studies; Humans; Longitudinal Studies; Male; Prognosis; Psychiatric Status Rating Scales; Psychiatric/Mental Health; Psychopathology; Psychotic Disorders - complications; Psychotic Disorders - diagnosis; Psychotic Disorders - epidemiology; Psychotic Disorders - psychology; Psychotic Disorders - therapy; Severity of Illness Index; Young Adult; Early intervention; Psychopathology; Autism spectrum disorder; Autism questionnaire; First Episode Psychosis; Follow-up
• ISSN: 0920-9964; 1573-2509; 1573-2509
• DOI: 10.1016/j.schres.2025.07.014

There's a general lack of knowledge about autism attributes in early psychosis, although little initial evidence showed that having autistic features contributes to poorer recovery over time. The main aim of this examination was to compare sociodemographic and clinical variables between FEP patients with or without autistic characteristics treated within an “Early Intervention in Psychosis” (EIP) service both at entry and across 2 years of follow-up. We also examined the longitudinal course of autism severity levels in FEP to investigate whether they truly represented trait-like attributes. FEP participants completed the AQ-spectrum Questionnaire (AQ), the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) at baseline and over time. Inter-group comparisons were examined using Chi-Squared or Mann-Whitney test, Kaplan-Meyer survival analysis, mixed-design ANOVA, and binary logistic regression. AQ score longitudinal stability was explored using Wilcoxon test for repeated measures and Spearman correlation coefficient. 132 subjects were recruited (28 [21.20 %] scored above the AQ cut-off score of≥26). At presentation, they showed younger age and higher severity in psychopathology (especially negative symptoms). Across the follow-up, the AQ+ subsample had lower incidence rates of service disengagement, PANSS symptomatic remission, and GAF functional remission. AQ scores showed longitudinal stability over time. The AQ represents a valid instrument to assess “trait-like” autistic features in FEP subjects. Specifically, it captures a distinct FEP subgroup characterized by more severe clinical presentation, poorer clinical and functional outcomes, and specific therapeutic needs.