Determination of psychosis-related clinical profiles in children with autism spectrum disorders using latent class analysis.

In children with autism spectrum disorders (ASD), high rates of idiosyncratic fears and anxiety reactions and thought disorder are thought to increase the risk of psychosis. The critical next step is to identify whether combinations of these symptoms can be used to categorise individual patients into ASD subclasses, and to test their relevance to psychosis. All patients with ASD (n = 84) admitted to a specialist national inpatient unit from 2003 to 2012 were rated for the presence or absence of impairment in affective regulation and anxiety (peculiar phobias, panic episodes, explosive reactions to anxiety), social deficits (social disinterest, avoidance or withdrawal and abnormal attachment) and thought disorder (disorganised or illogical thinking, bizarre fantasies, overvalued or delusional ideas). Latent class analysis of individual symptoms was conducted to identify ASD classes. External validation of these classes was performed using as a criterion the presence of hallucinations. Latent class analysis identified two distinct classes. Bizarre fears and anxiety reactions and thought disorder symptoms differentiated ASD patients into those with psychotic features (ASD-P: 51 %) and those without (ASD-NonP: 49 %). Hallucinations were present in 26 % of the ASD-P class but only 2.4 % of the ASD-NonP. Both the ASD-P and the ASD-NonP class benefited from inpatient treatment although inpatient stay was prolonged in the ASD-P class. This study provides the first empirically derived classification of ASD in relation to psychosis based on three underlying symptom dimensions, anxiety, social deficits and thought disorder. These results can be further developed by testing the reproducibility and prognostic value of the identified classes.

Lifetime prevalence of suicidal and self-injurious behaviors in a representative cohort of Slovenian adolescents with type 1 diabetes.

OBJECTIVE: To determine lifetime prevalence of suicidal and self-injurious behaviors in Slovenian adolescents with type 1 diabetes compared with healthy controls. RESEARCH DESIGN AND METHODS: Adolescents (14-19 yr) with type 1 diabetes were compared with a normative control group of healthy secondary school students by means of a self-reported questionnaire (according to Kienhorst) containing questions on demographic and family characteristics, suicidal ideation, intended suicide, attempted suicide, possible future suicide, and self-injurious behavior. Patients received the questionnaires at regular outpatient visits to the pediatric diabetes clinic, completed them in private, and returned them by mail. Questionnaires for control subjects were administered in classrooms. RESULTS: The responses of 126 eligible patients and 499 controls were analyzed. The control group trended toward higher lifetime prevalence of all suicidal behaviors and self-injurious behavior. The lowest prevalence of all suicidal behaviors and self-injurious behavior was reported by males with diabetes. Compared with male controls, the differences were statistically significant for suicidal ideation (p < 0.05) and intended suicide (p < 0.05). Compared with females with diabetes, the differences were statistically significant for suicidal ideation (p < 0.001), intended suicide (p < 0.01), attempted suicide (p < 0.05), and self-injurious behavior (p < 0.05). Females with diabetes reported highest prevalence of all suicidal but not self-injurious behaviors. More patients than controls reported receiving counseling the year preceding the study (p < 0.001). CONCLUSIONS: In the study, type 1 diabetes showed a protective effect for suicidal behavior in adolescent males but not in adolescent females. Professionals working with adolescents with type 1 diabetes should be alert to possible suicidality, especially among females.