Meer suïcidale gedachten bij personen met stoornis van Asperger

Asperger's Syndrome Linked to Suicidal Thoughts

Laird Harrison

July 03, 2014

Adults with Asperger's syndrome are 9 times more likely to experience suicidal thoughts compared with those in the general population, a new study shows.

"Our findings confirm anecdotal reports that adults with Asperger syndrome have a significantly higher risk of suicide in comparison to other clinical groups, and that depression is a key risk factor in this," said Sarah Cassidy, PhD, of the Autism Research Centre at Cambridge University, the United Kingdom, in a media release.

The study was published online June 25 in the Lancet Psychiatry.

The study surveyed 374 individuals (256 men and 118 women) diagnosed with Asperger's syndrome as adults between 2004 and 2013 at the Cambridge Lifetime Asperger Syndrome Service clinic.

The researchers defined Aspberger's syndrome as "a subgroup on the autism spectrum, showing core symptoms in the absence of language delay or intellectual disability."

(The American Psychiatric Association formerly used the term "Asperger's disorder," but in 2013 it folded this diagnosis into the broader category of "autism spectrum disorder.")

The study showed that 66% of adults with Asperger's syndrome have suicidal ideation. Previous studies have shown that 17% of the general population and 59% of those with psychosis have such thoughts, the researchers said.

In addition, the new study showed that 35% of adults with Asperger's syndrome had planned or had attempted suicide during their lifetime.

Suicidal thoughts and behaviors were significantly more common in adults with Asperger's syndrome who had a history of depression.

Among adults with Asperger's syndrome, those with depression were 4 times more likely to experience suicidal thoughts and were twice as likely to plan or attempt suicide, compared with individuals with Asperger's syndrome but who did not have history of depression.

A second risk factor for suicide plans or attempts was a higher level of autistic traits.

Adults with Asperger's syndrome often suffer from secondary depression, owing to social isolation, loneliness, social exclusion, lack of community services, underachievement, and unemployment, the researchers said.

But they added that appropriate support can alleviate this depression and reduce the risk for suicide.

"This study should be a wake-up call for the urgent need for high-quality services, to prevent the tragic waste of even a single life," said coauthor Simon Baron-Cohen, PhD, also of the Autism Research Centre.

The study was funded by the Three Guineas Trust, the Baily Thomas Foundation, the Medical Research Council, NIHR-CLAHRCEoE, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), and the Autism Research Trust. The authors have disclosed no relevant financial relationships.

Lancet Psychiatry. Published online June 25, 2014. Full text

Mindfulness en CGT verminderen angst en depressie bij volwassenen met ASS

Mindfulness, CBT Cut Anxiety, Depression in Adult Autism

Pam Harrison

May 27, 2014

ATLANTA ― Mindfulness-based stress reduction (MBSR) therapy as well as cognitive-behavioral therapy (CBT) are both effective in reducing comorbid anxiety and depression in adults with autism spectrum disorder (ASD), Dutch investigators report.

Investigators at the Center for Developmental Disorders, Dimence Institute of Mental Health, Deventer, the Netherlands, observed significant reductions in both anxiety and depression in adults with ASD who underwent treatment with either MBSR techniques or CBT. Both approaches were modified to match the capabilities of adults with ASD.

"ASD in adults is an emerging field of interest [but] most research has focused on treating the presumed core symptoms of ASD as outcome measures," lead investigator Bram Sizoo, MD, PhD, told Medscape Medical News.

"This is regrettable because anxiety and depressive symptoms are known to be prevalent in adults with ASD and can be treated provided the treatment methods used take into consideration the way people with ASD understand and process information."

The study was presented here at the 13th Annual International Meeting for Autism Research (IMFAR).

Ready for Use

For the study, the Dutch group randomly assigned 90 adults with ASD in equal numbers to the MBSR program, to CBT, or to treatment as usual.

Mindfulness has been defined as paying attention to experiences in the present moment in a nonjudgmental way.

It is thought that by teaching people to accept thoughts and feelings as they appear, "avoidance strategies can be countered effectively, which reduces ruminative thinking and consequently also anxiety and negative mood," Dr. Sizoo explained.

To adapt the mindfulness protocol for adults with ASD, researchers removed as many cognitive elements as possible and made the text clear and unambiguous.

The CBT protocol was also modified so that it was very structured and tailored to a pace that people with ASD can generally handle.

However, Dr. Sizoo pointed out, "the relation between event, emotion, thought, and action is generally perceived as 'very logical' by people with ASD, and this, in fact, leads to a better recognition and labeling of their own emotions."

Indeed, both protocols are used routinely for adults with ASD in the Netherlands, he added.

Participants completed 13 sessions of the randomly assigned training protocol, each session lasting 1.5 hours in total.

Anxiety and depression scores were measured using the Hospital Anxiety and Depression Scale (HADS) at baseline and again after participants had completed the 13-week course and again at 3 months' follow-up.

Table. Average HADS Scores at Baseline After Completion of the 13-Week Course and at 3 Months' Follow-up*

	Anxiety†		Depression‡
	MBSR (n = 20)	CBT (n = 10)	MBSR (n = 20)	CBT (n = 10)
Baseline	11.3 (3.46)	14.0 (1.7)	8.7 (4.18)	8.7 (4.62)
Completion (13 weeks)	9.2 (3.11)	11.2 (4.16)	6.9 (5.00)	6.0 (4.50)
Follow-up (3 months)	8.8 (3.33)	10.3 (3.80)	5.8 (4.15)	6.2 (5.56)
* The treatment-as-usual group has not yet been analyzed. †Anxiety: significant reduction in anxiety score (F=14.39, P = .000, effect size =.34), no interaction with treatment type. ‡Depression: significant reduction in depression score (F=14.14, p=.000, effect size = .35), no interaction with treatment type.

As Dr. Sizoo noted, both modified protocols are ready for use in any center that provides services for adults with ASD.

In the Netherlands, however, training is recommended for facilitators who carry out the MBSR protocol.

For both modalities, facilitators also require a thorough understanding of ASD to ensure that adults are able to grasp and follow what is being said during each protocol.

"In most cases, the MBSR exercises were clear and easy to carry out, and we noticed that patients very quickly adapted mindfulness techniques for use in their daily lives to reduce stress," Dr. Sizoo observed.

"Unfortunately, the protocols are as yet only available in Dutch."

Clinically Important, Timely

Asked to comment on the study, Stefan Hofmann, PhD, director, social anxiety program, Boston University, in Massachusetts, told Medscape Medical News that the authors report "very promising results."

"ASD is a difficult-to-treat condition that is associated with many emotional and behavioral problems, including depression and anxiety, and few treatments are available for patients suffering from this debilitating disorder."

Inasmuch as CBT is an established treatment for many psychiatric disorders and MBSR is showing considerable promise as an alternative treatment, studying these 2 treatments in adult ASD is "clinically important and timely," Dr. Hofmann added.

"The study demonstrated that it is possible to modify and tailor both treatment approaches to this particular population," he said. "[And although] it was not possible to examine whether both treatments are equally effective, both interventions led to significant reductions in anxiety and depression."

Dr. Hofmann felt that there is a need for future studies with larger samples to examine not only whether MBSR and CBT are equally effective but whether there are any patient characteristics that might predict a better response to one or the other treatment or whether combining CBT and MBSR would be more effective than either as monotherapy.

Dr. Sizoo and Dr. Hofmann report no relevant financial relationships.

13th Annual International Meeting for Autism Research (IMFAR). Abstract 135.004. Presented May 16, 2014. 

Medscape Medical News © 2014  WebMD, LLC 

Send comments and news tips to news@medscape.net.

Cite this article: Mindfulness, CBT Cut Anxiety, Depression in Adult Autism. Medscape. May 27, 2014.

Autisme door mitochondriale dysfunctie?

Mitochondrial Dysfunction Evident in Some Patients With Autism Spectrum Disorder

By Will Boggs MD

April 15, 2014

NEW YORK (Reuters Health) - A significant proportion of patients with autism spectrum disorder (ASD) has evidence of mitochondrial dysfunction on magnetic resonance studies, in a study that one expert called "fascinating."

"We now have compelling evidence for the common presence of metabolic dysfunction in the brains of persons with ASD," Dr. Bradley S. Peterson from Columbia University Medical Center, New York told Reuters Health. "This provides vitally important information about the mechanisms of disease and clues for the development of new interventions in this very common, life-long, and highly debilitating illness."

Although mitochondrial disease is an established cause of syndromic autism, it remains unknown whether mitochondrial dysfunction is present in the brains of individuals with ASD and whether it plays a role in the core cognitive and behavioral symptoms of ASD.

Dr. Peterson and colleagues acquired proton magnetic resonance spectroscopic (MRS) imaging data to assess in vivo evidence of mitochondrial dysfunction in the brains of 75 adults and children with ASD and 96 typically developing controls matched by age and sex.

They used the presence of lactate doublets as an indication of mitochondrial dysfunction.

Lactate doublets were present in significantly more individuals with ASD (13%) than in typically developing controls (1%; p=0.001), they reported April 9th online in JAMA Psychiatry.

The presence of lactate doublets in the ASD group increased with age and was significantly more common in adults (20%) than in children (6%). Their location varied across individuals, but they seemed to aggregate preferentially within the cingulate gyrus.

Lactate doublets did not correlate with sex, ASD subtype, intellectual ability, Autism Diagnostic Observation Schedule total score or subscores, or the presence of comorbid neurological or psychiatric diagnoses.

"Regardless of its cause, our finding suggests that the inclusion of adults is important for understanding the complex role of mitochondrial dysfunction in ASD," the researchers say.

"Our strong evidence for the common presence of mitochondrial dysfunction in persons with ASD suggests that patients should undergo clinical evaluation for the presence of mitochondrial disease," Dr. Peterson said.

"Novel treatments for known mitochondrial diseases are under development and showing promise," Dr. Peterson said. "These might one day prove helpful in the treatment of mitochondrial dysfunction in persons who have ASD."

Dr. Richard E. Frye from the University of Arkansas for Medical Sciences in Little Rock recently reviewed mitochondrial dysfunction in ASD. He told Reuters Health, "It is not uncommon for children with autism to have mitochondrial disease, a disorder that has many potential treatments. Diagnosing mitochondrial disease in children with autism can lead to appropriate treatments that may substantially improve the child's life."

"This supports the notion that we should be screening children with autism for mitochondrial disease, especially if they have symptoms that are commonly reported in children with autism and mitochondrial disease, including seizures, gastrointestinal problems, gross motor delays, and regression," Dr. Frye said.

"More research is needed into this subgroup of children with autism so that we can provide appropriate treatment," Dr. Frye concluded.

Dr. Agustin Legido from Drexel University College of Medicine in Philadelphia recently reviewed mitochondrial dysfunction in autism. He told Reuters Health by email, "Every patient with autism should have an easy, nonaggressive evaluation of the mitochondrial respiratory chain."

"This should not be interpreted as the answer to autism," Dr. Legido cautioned. "It addresses another piece of the big and complex puzzle of the cause of autism."

Dr. Legido added, "The cause of autism is complicated. Mostly, the prenatal cases are due to genetic abnormalities involved in brain development. Acquired post-natal cases are due to damage of brain structures involved in brain functions of language, behavior and socialization (e.g. west syndrome or infantile spasms, tuberous sclerosis, etc.). The question is: what is the role of mitochondria and particularly of mitochondria genes and nuclear genes regulating mitochondria function? The fact of finding signs of abnormal mitochondria function is the tip of the iceberg."

Dr. Derrick Fraser MacFabe directs the Kilee Patchell-Evans Autism Research group at University of Western Ontario in London, Ontario, Canada. He told Reuters Health by email, "This initial study may lead to more careful studies/metabolic controls pointing to environmentally induced mitochondrial function from many environmental agents( PCPs, metals, organophosphates, inflammation-induced oxidative stress), but particularly (what we have proposed) from short chain fatty acids from an abnormal gut microbiome (i.e., history of early antibiotics/hospitalization/and/or altered host immune system)."

He continued, "This fascinating study points to autism as a systemic metabolic disease as opposed to a primary brain disorder, and to future metabolic biomarkers . . . or treatments (i.e., augmenters of mitochondrial function - e.g., carnitine, coenzyme Q10), and risk factors (gut dysbiosis, antibiotics, hospitalization) in at least a subset of patients."

SOURCE: http://bit.ly/1gxmLRM

JAMA Psychiatry 2014.

 

Reuters Health Information © 2014 

Cite this article: Mitochondrial Dysfunction Evident in Some Patients With Autism Spectrum Disorder. Medscape. Apr 14, 2014.

Mogelijk verband tussen blootstelling aan SSRIs tijdens zwangerschap en ASS

Prenatal SSRI Use May Be Linked to Autism Spectrum Disorder
Laurie Barclay, MDApril 14, 2014

Prenatal use of selective serotonin reuptake inhibitors (SSRIs) appears to be a risk factor for autism spectrum disorders (ASDs) and other developmental delays (DDs) in young children, but underlying maternal depression may be a confounder, according to findings of a population-based case-control study published online April 14 in Pediatrics.

"Serotonin is critical in early brain development, creating concerns regarding prenatal exposure to factors influencing serotonin levels, like [SSRIs]," write Rebecca A. Harrington, PhD, MPH, from the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and colleagues. "Prenatal SSRI use was recently associated with autism; however, its association with other developmental delays is unclear."

Therefore, the investigators analyzed the possible associations between prenatal SSRI use and the likelihood of ASDs and other DDs in the offspring in a group of 966 mother–child pairs. The pairs were enrolled in the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study. Of those, 492 children had ASD, 154 had DD, and 320 had typical development (TD), according to standardized measures. The investigators interviewed the biological mothers regarding prenatal SSRI use, maternal mental health history, and sociodemographic factors.

Boys With ASD More Likely to Have Prenatal SSRI Exposure

Although children with TD had the lowest prevalence of prenatal SSRI exposure (3.4%), it was not statistically significantly different from the prevalence seen in children with ASD (5.9%) or DD (5.2%).

However, when the team analyzed boys separately, they found that boys with ASD were nearly 3 times as likely to have prenatal SSRI exposure compared with boys with TD (adjusted odds ratio [OR], 2.91; 95% confidence interval [CI], 1.07 - 7.93). This finding in boys with ASD was even more pronounced with first-trimester SSRI exposure (OR, 3.22; 95% CI, 1.17 - 8.84).

Boys with DD also had increased prenatal SSRI exposure compared with boys with TD (OR, 3.39; 95% CI, 0.98 - 11.75), but this only reached statistical significance in the second and third trimester (second trimester: OR, 4.41; 95% CI, 1.01 - 19.17; third trimester: OR, 4.98; 95% CI, 1.20 - 20.62). Among mothers with a history of anxiety or mood disorder, findings were similar but not statistically significant.

The authors note that the relatively small number of girls in the study precluded them as a separate subgroup (eg, just 17.5% of the children with ASD).

"This population-based case-control study in young children provides evidence that prenatal SSRI use may be a risk factor for autism and other developmental delays," the study authors write. "However, underlying depression and its genetic underpinnings may be a confounder."

Limitations of this study include difficulty in isolating SSRIs' effects from those of their indications for use, reliance on self-report with potential recall bias, lack of data on SSRI dosage precluding dose-response analyses, and a relatively small sample of DD children.

"In boys, prenatal exposure to SSRIs may increase susceptibility to ASD or DD," the authors conclude. "Larger samples are needed to replicate DD results. Because maternal depression itself carries risks for the fetus, the benefits of prenatal SSRI use should be carefully weighed against potential harms."

This research was supported by US National Institute on Environmental Health Sciences, the MIND Institute, and Autism Speaks. Funded by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online April 14, 2014.

Neurotoxines mede debet aan autisme en ADHD

Neurotoxische chemicaliën zijn mede oorzaak van de stijgende prevalentie van neurologische ontwikkelingsstoornissen als autisme, ADHD en dyslexie. Philippe Grandjean en Philip Landrigan van Harvard School of Public Health in Boston en de Icahn School of Medicine at Mount Sinai in New York concluderen dat in een overzicht van de bestaande onderzoeksliteratuur in The Lancet Neurology.

Op de lijst met chemicaliën waarvan bekend is dat ze een negatieve invloed hebben op de ontwikkeling van het menselijk brein staan momenteel 214 stoffen. Die komen voor in alledaagse producten als kleding, meubels en speelgoed. Grandjean en Landrigan noemen onder meer het oplosmiddel tetrachloorethyleen dat ze in verband brengen met hyperactiviteit, mangaan dat de ontwikkeling van cognitieve en motorische vaardigheden afremt, en bepaalde pesticiden die ook de cognitieve ontwikkeling vertragen.

Volgens beide onderzoekers blijft nu een pandemie van neurotoxische ontwikkelingsschade onopgemerkt. Van het merendeel van de chemicaliën waarmee mensen dagelijks te maken hebben, is bovendien onbekend wat de neurotoxische effecten zijn op foetus en kind. Vaststaat in ieder geval dat een kleine dosis al schade kan toebrengen aan de hersenen van (ongeboren) baby’s en kinderen.
Grandjean en Landrigan stellen daarom voor om te komen tot een internationale preventiestrategie en een internationaal agentschap dat producenten verplicht te laten zien welke risico’s verbonden zijn aan nieuwe chemicaliën. Dat voorstel komt niet voor het eerst, in 2006 deden ze ook al een poging.

Henk Maassen

www.thelancet.com/neurology http://www.ncbi.nlm.nih.gov/pubmed/24556010