Verification of the utility of the social responsiveness scale for adults in non-clinical and clinical adult populations in Japan.

BACKGROUND: Recently great attention has been paid to the still unmet clinical needs of most adults with autism spectrum disorder (ASD) who live in the community, an increasing number of whom visit psychiatric clinics to seek accurate diagnosis and treatment of concurrent psychiatric symptoms. However, different from the case of children diagnosed with ASD in childhood, it is difficult in adults to identify the ASD symptoms underlying psychopathology and to differentiate ASD from other psychiatric disorders in general psychiatric practice. This study aimed to verify the utility of the Social Responsiveness Scale-Adult version (SRS-A), a quantitative measure for identifying ASD symptoms, in non-clinical and clinical adult populations in Japan. METHODS: The total sample aged 19 to 59 years consisted of a non-clinical population (n =592) and clinical population with and without ASD (n =142). We examined score distributions of the Japanese version of the scale, and the effects of gender, age, and rater on the distribution. We analyzed factor structure and internal consistency in the non-clinical normative sample, and analyzed convergent, divergent, and discriminative validities in the clinical sample. We applied receiver operator characteristic (ROC) analysis to determine optimal cutoff scores discriminating the ASD clinical population from the non-ASD clinical population. RESULTS: The score distributed continuously, which replicated findings in children. For non-clinical adults, except in men aged 19 to 24 years, we found no or few gender, age, or rater effects. Both single- and two-factor models were supported for adults. Total SRS-A scores demonstrated high internal consistency and capably discriminated adults with ASD from those with non-ASD psychiatric disorders such as major depressive disorder, schizophrenia, and bipolar disorder with an overlap across diagnoses. Moderate to high correlations of the SRS-A with other-rated ASD measures indicated sufficient convergent validity. Based on the ROC analysis, we recommend cutoff points by gender for use in clinical settings. CONCLUSION: This study provides additional supportive evidence that the Japanese version SRS-A can reliably and validly measure ASD symptoms in non-clinical and clinical adult populations, and thus can serve as a useful tool for ASD research as well as for secondary screening in Japanese adults.

[Psychiatric issues of children and adults with autism spectrum disorders who remain undiagnosed].

Individuals of normal intelligence with autism spectrum disorders (ASD) tend to be diagnosed with ASD late in childhood or sometimes in adulthood, despite a persistent symptomatology. When such patients visit psychiatric clinics for co-occurring psychiatric symptoms, the diagnostic procedure can be challenging due to a lack of accurate developmental information and a mixed clinical presentation. The same is true for those with subthreshold autistic symptoms. Although individuals with subthreshold ASD also have social adjustment difficulties of a similar degree to those with ASD, the relative clinical significance of this population is unclear. Here, data from a large national population sample of schoolchildren were examined to determine the psychiatric needs of children with threshold and subthreshold autistic symptoms. First, autistic symptoms or traits assessed by the Social Responsiveness Scale (SRS), a quantitative behavioral measure, showed a continuous distribution in the general child population (n = 22,529), indicating no evidence of a natural gap that could differentiate children diagnosed with ASD from subthreshold or unaffected children. Second, data from 25,075 children demonstrated that having threshold autistic symptoms predicted a high psychiatric risk, as indicated by higher scores on the Strengths and Difficulties Questionnaire (SDQ; odds ratio [OR] 200.52, 95% confidence interval [CI]: 152.12-264.33), and that having subthreshold autistic symptoms indicated the same (OR 12.78, 95% CI: 11.52-14.18). Having threshold autistic symptoms predicted emotional problems (OR 20.19, 95% CI: 17.00-24.00), as did having subthreshold autistic symptoms (OR 5.90, 95% CI: 5.29-6.58). Third, among 2,250 children at a high psychiatric risk, most had threshold or subthreshold autistic symptoms (21 and 44%, respectively). These findings have important implications for the comprehensive psychiatric and developmental evaluation and treatment of this patient population, whose diagnosis and treatment are often delayed, and a further in-depth study is warranted.

Case Report: An Outbreak of Food-Borne Typhoid Fever Due to Salmonella enterica Serotype Typhi in Japan Reported for the First Time in 16 Years.

For the first time in 16 years, a food-borne outbreak of typhoid fever due to Salmonella enterica serotype Typhi was reported in Japan. Seven patients consumed food in an Indian buffet at a restaurant in the center of Tokyo, while one was a Nepali chef in the restaurant, an asymptomatic carrier and the implicated source of this outbreak. The multiple-locus variable-number tandem repeat analysis showed 100% consistency in the genomic sequence for five of the eight cases.

Autistic-like traits in adult patients with mood disorders and schizophrenia.

Autism spectrum disorder often co-occurs with other psychiatric disorders. Although a high prevalence of autistic-like traits/symptoms has been identified in the pediatric psychiatric population of normal intelligence, there are no reports from adult psychiatric population. This study examined whether there is a greater prevalence of autistic-like traits/symptoms in patients with adult-onset psychiatric disorders such as major depressive disorder (MDD), bipolar disorder, or schizophrenia, and whether such an association is independent of symptom severity. The subjects were 290 adults of normal intelligence between 25 and 59 years of age (MDD, n=125; bipolar disorder, n=56; schizophrenia, n=44; healthy controls, n=65). Autistic-like traits/symptoms were measured using the Social Responsiveness Scale for Adults. Symptom severity was measured using the Positive and Negative Symptoms Scale, the Hamilton Depression Rating Scale, and/or the Young Mania Rating Scale. Almost half of the clinical subjects, except those with remitted MDD, exhibited autistic-like traits/symptoms at levels typical for sub-threshold or threshold autism spectrum disorder. Furthermore, the proportion of psychiatric patients that demonstrated high autistic-like traits/symptoms was significantly greater than that of healthy controls, and not different between that of remitted or unremitted subjects with bipolar disorder or schizophrenia. On the other hand, remitted subjects with MDD did not differ from healthy controls with regard to the prevalence or degree of high autistic-like traits/symptoms. A substantial proportion of adults with bipolar disorder and schizophrenia showed high autistic-like traits/symptoms independent of symptom severity, suggesting a shared pathophysiology among autism spectrum disorder and these psychiatric disorders. Conversely, autistic-like traits among subjects with MDD were associated with the depressive symptom severity. These findings suggest the importance of evaluating autistic-like traits/symptoms underlying adult-onset psychiatric disorders for the best-suited treatment. Further studies with a prospective design and larger samples are needed.