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Clinical Implications of Autistic Features in Patients With a First Episode of Psychosis.

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Title: Clinical Implications of Autistic Features in Patients With a First Episode of Psychosis.
Authors: Bioque, Miquel (AUTHOR), Pérez‐Ramos, Anaid (AUTHOR), Llorca‐Bofí, Vicent (AUTHOR), Penadés, Rafael (AUTHOR), Forte, M. Florencia (AUTHOR), García‐Rizo, Clemente (AUTHOR), Amoretti, Silvia (AUTHOR), Pina‐Camacho, Laura (AUTHOR), Parellada, Mara (AUTHOR), Cuesta, Manuel J. (AUTHOR), Martinez‐Sadurní, Laura (AUTHOR), de la Serna, Elena (AUTHOR), Puig, Olga (AUTHOR), Mezquida, Gisela (AUTHOR), Madero, Santiago (AUTHOR), Guasch‐Capella, Nora (AUTHOR), Baeza, Inmaculada (AUTHOR), Castro‐Fornieles, Josefina (AUTHOR), Galvañ, Joaquín (AUTHOR), Rapado‐Castro, Marta (AUTHOR)
Source: Acta Psychiatrica Scandinavica. Jun2026, Vol. 153 Issue 6, p636-648. 13p.
Subjects: Autism, Psychoses, Neural development, Cognition disorders, Schizophrenia, Treatment effectiveness
Abstract: Introduction: Schizophrenia and autism share neurobiological mechanisms and overlapping clinical features, often resulting in the emergence of autistic traits in early stages of psychosis. The PANSS Autism Severity Score (PAUSS) provides a rapid measure of autistic features within the standard PANSS assessment. We aimed to determine the prevalence of autistic features in first‐episode psychosis (FEP), characterise their clinical, cognitive, and functional profile, and examine their impact on 2‐year outcomes. Methods: A total of 328 FEP patients were included from the PEPs multicentre cohort, followed for 2 years. Autistic features were rated using PAUSS (cut‐off ≥ 30), yielding autistic (n = 38) and non‐autistic (n = 290) groups. Sociodemographic, clinical, cognitive, and functional variables were analysed. Longitudinal analyses examined symptomatic remission rates and trajectories of psychopathology and functioning using logistic regression and mixed‐model ANOVA. Results: The autistic group represented 11.6% of the sample. At baseline, they exhibited lower birth weight, greater medication side effects, higher general psychopathology and depressive severity, and poorer global functioning. Cognitively, they showed significant deficits in working memory, social cognition, and cognitive reserve compared to the non‐autistic group. Over 2 years, this group was 3.6 times less likely to achieve symptomatic remission and consistently exhibited higher symptom severity and lower functioning across all follow‐ups. Conclusions: Autistic features in FEP identify a subgroup with a possible distinct profile of neurodevelopmental markers, greater cognitive and functional impairments, and poorer clinical outcomes. Early identification may guide more personalised interventions, although further research is needed to refine PAUSS specificity and develop targeted, tailored treatments. Summary: Significant Outcomes ○Approximately 12% of FEP patients showed prominent autistic features, associated with more severe psychopathology, cognitive deficits, poorer functioning, and lower remission rates.○PAUSS scores demonstrated a moderate correlation with negative symptoms without collinearity, despite limited long‐term reliability.○Autistic features were associated with a less favourable longitudinal 2‐year outcome, with persistent symptoms, poorer functional recovery, and lower remission rates.Limitations ○The reliance on the PAUSS, a scale not originally designed to assess autism, may limit specificity and contribute to overlap with negative symptoms of schizophrenia.○The inclusion of affective psychoses and paediatric patients may have introduced clinical heterogeneity.○Findings derive from a naturalistic design and may require replication in independent cohorts to confirm generalisability. [ABSTRACT FROM AUTHOR]
Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Clinical Implications of Autistic Features in Patients With a First Episode of Psychosis.
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  Data: <searchLink fieldCode="AR" term="%22Bioque%2C+Miquel%22">Bioque, Miquel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pérez‐Ramos%2C+Anaid%22">Pérez‐Ramos, Anaid</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Llorca‐Bofí%2C+Vicent%22">Llorca‐Bofí, Vicent</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Penadés%2C+Rafael%22">Penadés, Rafael</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Forte%2C+M%2E+Florencia%22">Forte, M. Florencia</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22García‐Rizo%2C+Clemente%22">García‐Rizo, Clemente</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Amoretti%2C+Silvia%22">Amoretti, Silvia</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Pina‐Camacho%2C+Laura%22">Pina‐Camacho, Laura</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Parellada%2C+Mara%22">Parellada, Mara</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cuesta%2C+Manuel+J%2E%22">Cuesta, Manuel J.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Martinez‐Sadurní%2C+Laura%22">Martinez‐Sadurní, Laura</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22de+la+Serna%2C+Elena%22">de la Serna, Elena</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Puig%2C+Olga%22">Puig, Olga</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mezquida%2C+Gisela%22">Mezquida, Gisela</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Madero%2C+Santiago%22">Madero, Santiago</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Guasch‐Capella%2C+Nora%22">Guasch‐Capella, Nora</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Baeza%2C+Inmaculada%22">Baeza, Inmaculada</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Castro‐Fornieles%2C+Josefina%22">Castro‐Fornieles, Josefina</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Galvañ%2C+Joaquín%22">Galvañ, Joaquín</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rapado‐Castro%2C+Marta%22">Rapado‐Castro, Marta</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Acta+Psychiatrica+Scandinavica%22">Acta Psychiatrica Scandinavica</searchLink>. Jun2026, Vol. 153 Issue 6, p636-648. 13p.
– Name: Subject
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  Data: <searchLink fieldCode="DE" term="%22Autism%22">Autism</searchLink><br /><searchLink fieldCode="DE" term="%22Psychoses%22">Psychoses</searchLink><br /><searchLink fieldCode="DE" term="%22Neural+development%22">Neural development</searchLink><br /><searchLink fieldCode="DE" term="%22Cognition+disorders%22">Cognition disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Schizophrenia%22">Schizophrenia</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: Schizophrenia and autism share neurobiological mechanisms and overlapping clinical features, often resulting in the emergence of autistic traits in early stages of psychosis. The PANSS Autism Severity Score (PAUSS) provides a rapid measure of autistic features within the standard PANSS assessment. We aimed to determine the prevalence of autistic features in first‐episode psychosis (FEP), characterise their clinical, cognitive, and functional profile, and examine their impact on 2‐year outcomes. Methods: A total of 328 FEP patients were included from the PEPs multicentre cohort, followed for 2 years. Autistic features were rated using PAUSS (cut‐off ≥ 30), yielding autistic (n = 38) and non‐autistic (n = 290) groups. Sociodemographic, clinical, cognitive, and functional variables were analysed. Longitudinal analyses examined symptomatic remission rates and trajectories of psychopathology and functioning using logistic regression and mixed‐model ANOVA. Results: The autistic group represented 11.6% of the sample. At baseline, they exhibited lower birth weight, greater medication side effects, higher general psychopathology and depressive severity, and poorer global functioning. Cognitively, they showed significant deficits in working memory, social cognition, and cognitive reserve compared to the non‐autistic group. Over 2 years, this group was 3.6 times less likely to achieve symptomatic remission and consistently exhibited higher symptom severity and lower functioning across all follow‐ups. Conclusions: Autistic features in FEP identify a subgroup with a possible distinct profile of neurodevelopmental markers, greater cognitive and functional impairments, and poorer clinical outcomes. Early identification may guide more personalised interventions, although further research is needed to refine PAUSS specificity and develop targeted, tailored treatments. Summary: Significant Outcomes ○Approximately 12% of FEP patients showed prominent autistic features, associated with more severe psychopathology, cognitive deficits, poorer functioning, and lower remission rates.○PAUSS scores demonstrated a moderate correlation with negative symptoms without collinearity, despite limited long‐term reliability.○Autistic features were associated with a less favourable longitudinal 2‐year outcome, with persistent symptoms, poorer functional recovery, and lower remission rates.Limitations ○The reliance on the PAUSS, a scale not originally designed to assess autism, may limit specificity and contribute to overlap with negative symptoms of schizophrenia.○The inclusion of affective psychoses and paediatric patients may have introduced clinical heterogeneity.○Findings derive from a naturalistic design and may require replication in independent cohorts to confirm generalisability. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/acps.70079
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        Text: English
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        PageCount: 13
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      – SubjectFull: Autism
        Type: general
      – SubjectFull: Psychoses
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      – SubjectFull: Neural development
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      – SubjectFull: Cognition disorders
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      – SubjectFull: Schizophrenia
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      – SubjectFull: Treatment effectiveness
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