New interview and observation measures of the broader autism phenotype: impressions of interviewee measure.

A 20 item observational measure of social functioning, the Impression of Interviewee rating scale, is one of three measures devised to assess the broader autism phenotype. The sample studied included families containing at least two individuals with autism spectrum disorder; observations were undertaken by the researcher who interviewed the subject. An exploratory factor analysis suggested a single factor was most appropriate (Cronbach's α of 0.78). There was a modest but significant retest correlation of 0.42. Correlations between live ratings and blind consensus ratings of vignettes were high (0.93). Correlations with the interview measures were moderate but statistically significant. In conclusion, the observational scale provides a promising start but further work is required before general use can be recommended.

A longitudinal study of gastrointestinal diseases in individuals diagnosed with infantile autism as children.

BACKGROUND: A number of studies have indicated a link between gastrointestinal (GI) diseases and autism spectrum disorders. METHOD: The objective of this study was to compare the prevalence and types of GI diseases in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with GI diseases in 336 matched controls from the general population, based on data from the nationwide Danish National Hospital Register (DNHR). The average observation time was 30.3 years (SD 0.4) (range 27-30 years), and mean age at the end of the observation period was 42.7 years (SD 7.7) (range between 27 and 57 years of age). RESULTS: Of the 118 individuals with IA, 97 (82.2%) had been in contact with a medical hospital (inpatient hospitalization or outpatient visits) during the observation period, compared with 312/336 (92.9%) in the control group (P= 0.001). A similar proportion of members from the case and comparison group had a diagnosis of any GI disease in the DNHR: 30.5% against 30.7%, but the nature of their diseases may be somewhat different. Only diseases of oral cavity were significantly associated with IA: 20.3% against 1.2%, P < 0.0001. Otherwise, specific GI diseases occurred with low frequency in both groups. CONCLUSION: Overall, no evidence was found that patients with IA were more likely than control persons without IA to have defined GI diseases during the 30.3-year observation period.

Psychiatric disorders in adults diagnosed as children with atypical autism. A case control study.

The prevalence and types of psychiatric disorders were studied in a clinical sample of 89 individuals with atypical autism (AA) first seen as children, and 258 matched controls from the general population using data from the nationwide Danish Psychiatric Central Register. The average observation time was 36.9 years, and mean age at follow-up 45.3 years. A total of 61 persons with AA (68.5%) had been in contact with psychiatric hospitals during the follow-up period, compared with 10.9% in the comparison group. A whole range of significantly elevated psychiatric disorders was found, so AA is not seen to be associated with any specific mental disorder. Schizophrenia spectrum disorders were the most commonly associated psychiatric disorders, diagnosed at least one time in 34.8% of the AA cases. Our findings underscore that it is important for clinicians working in adult psychiatric services to be aware that AA and a wide range of psychiatric disorders often co-exist.

A comparative study of genetic and neurobiological findings in disintegrative psychosis and infantile autism.

Although disintegrative psychosis (DP) was first described in 1908, the validity of the syndrome has not yet been fully documented. To investigate the validity of DP as defined in ICD-9, 13 cases of DP were compared with 39 cases of infantile autism with reference to lifetime parental psychopathology, neuroradiological findings and genetic abnormalities. The groups were matched for gender, age, intellectual level and social class. Apart from a significantly higher rate of electroencephalogram abnormalities in the disintegrative group there was very little in the neurobiological background to support a clear distinction between DP and infantile autism.

The natural history of somatic morbidity in disintegrative psychosis and infantile autism: a validation study.

In order to study the validity of disintegrative psychosis (DP) as defined in ICD-9, we compared the natural history of somatic morbidity of 13 patients given this diagnosis in childhood with a control group of 39 patients with infantile autism (IA) matched for gender, age, IQ and social class. Average follow-up time was 22 and 23 (11-33) years, respectively. Significantly more DP patients (85 versus 41%) had been admitted to a non-psychiatric hospital during the follow-up period. They also had significantly more admissions (3.6 versus 1.0) and stayed longer in hospital (78 versus 4 days) than patients with IA. Three of the DP individuals had an associated medical disorder and made extensive use of somatic services during the follow-up period. Altogether the DP group had utilised the medical health care system more than patients with IA suggesting that they had more medical symptoms than the IA group. On the whole our findings suggest that individuals with DP and IA should be conceptualised as essentially distinct and should be studied separately as regards aetiology, pathophysiology, course and treatment.

Psychiatric morbidity in disintegrative psychosis and infantile autism: A long-term follow-up study.

In order to study the validity of disintegrative psychosis (DP), the authors compared 13 patients given this diagnosis in childhood with a control group of 39 patients with infantile autism (IA) matched for sex, age, IQ and social class on measures of psychiatric morbidity. Almost the same proportion of the two groups had been admitted to a psychiatric hospital during a 22-year follow-up period. However, there was a slight tendency (statistically nonsignificant) for the DP group to utilize the psychiatric health care system more frequently than the IA group. They had more admissions and stayed longer in hospital than patients with IA suggesting that they had more psychiatric symptoms than the IA group. The original IA diagnoses were confirmed fairly consistently during the follow-up period, while the DP group was given more heterogenous diagnoses. No diagnosis of schizophrenia was made in either group.

Epilepsy in disintegrative psychosis and infantile autism: a long-term validation study.

This study aimed to investigate the validity of disintegrative psychosis (DP) as defined in the ICD-9. The history of epilepsy in 13 subjects with DP was compared with that of 39 subjects with infantile autism (IA) who were matched for sex, age, IQ, and socioeconomic status (SES). The average follow-up time was 22 and 23 years (range 11 to 33 years). A significant difference was found between the DP and IA groups in terms of incidence of epilepsy, 77% versus 33% respectively. The peak period of onset of epilepsy occurred before puberty in both groups. Different types of epilepsy were seen, but the psychomotor variant accounted for 50% in the DP group, while 46% of the IA group had the psychomotor and 62% had the grand mal variant. The types are not mutually exclusive. Individuals without epilepsy had significantly higher IQ scores than those with epilepsy, but only within the IA group. The increased risk of developing epilepsy in the DP group is most likely a reflection of an underlying early brain pathology probably present in most individuals with DP. On the whole our findings can be seen as a contribution to the validation of DP as separate from IA, as these two conditions could be distinguished in terms of the way they develop with reference to epilepsy.

Validity of childhood disintegrative psychosis. General findings of a long-term follow-up study.

BACKGROUND: Empirical evidence for the validity of the diagnostic label disintegrative psychosis is sparse. The issue of whether it is a separate form of infantile autism is unresolved. METHOD: To investigate the validity of disintegrative psychosis as defined in ICD-9, the natural history of 13 cases were compared with 39 matched cases of infantile autism on various outcome variables. Average follow-up time was 22 (11-33) years. RESULTS: Statistically significant differences were found between the two groups in terms of number of admissions to non-psychiatric departments, occurrence of comorbid epilepsy, social style, and score on the Global Assessment of Functioning scale. In most other areas assessed there was a tendency, although statistically insignificant, towards a better outcome in the infantile autism comparison group. CONCLUSIONS: Our findings provide some support for maintaining a diagnostic category of disintegrative psychosis as distinct from infantile autism.

Standardized mortality in eating disorders--a quantitative summary of previously published and new evidence.

Ten eating disorder (ED) populations were reviewed using the standardized mortality ratio (SMR) presenting new evidence for several studies. In eight of the ten samples, strong evidence (in one sample weak evidence and in one sample no evidence) supports an hypothesis of elevated SMR. We found strong evidence for an increase in SMR for anorexia nervosa (AN), whereas no firm conclusions could be drawn for bulimia nervosa (BN). Bias caused by loss to follow-up was quantified and found non-negligable in some samples (possible increase in SMR from 25% to 240%). We did not find a significant effect of gender or time period on SMR. Survival analysis showed a significant difference among the life-tables for males and females; female risk of death averaged 0.59% per year, whereas all male deaths occurred within the first 2 years after presentation. Weight at presentation had a highly significant effect on SMR, and lower weight at presentation was associated with higher SMR. Age at presentation exerted a significant unimodal effect on SMR; aggregate overall SMR was 3.6 for the youngest age group (< 20 years), 9.9 for those aged 20-29 years, and 5.7 for those aged > or = 30 years at presentation. Length of follow-up had a highly significant inverse effect on SMR; maximal SMR was 30 for female AN patients in the first year after presentation. A statistically significant increase in SMR was documented for at least up to 15 years after presentation. One study indicated a treatment effect on SMR. New evidence on causes of death suggests there are more deaths from suicide and other and unknown causes and fewer deaths related to ED than previously reported. Our findings have both research and clinical implications, with the most important clinical implication being the need for vigorous and well-directed treatment efforts from the initial presentation for treatment. An important research implication is that no single measure of mortality is sufficient; that is, only a combination of different statistics will maximize the available information.

Season of birth in infantile autism and other types of childhood psychoses.

Season of birth in 328 children with infantile autism and other types of childhood psychoses born between 1945 and 1980 was compared with that of a control population born in the same period. For some parts of the period (the years 1951-56, 1963-68 and 1975-80 combined) an excess of March born boys with infantile autism was found. For boys with autistic-like disorders, born in the same period a maximum occurred in November, while no seasonality was observed for a borderline sample.

Neurofibromatosis in infantile autism and other types of childhood psychoses.

Recent findings have suggested that the simultaneous occurrence of neurofibromatosis and childhood psychosis might be more than a coincidence. In this study of 341 children with infantile autism and other types of childhood psychosis seen as inpatients in two university clinics of child psychiatry in a 25-year period, only one case (0.3%) of concomitant occurrence of the disorders was found, which is a frequency no higher than expected by chance.

[Multiaxial diagnosis in 2 pediatric psychiatric departments]. / Multiaksial diagnostik på to børnepsykiatriske afdelinger.

A multiaxial diagnostic system (MAS-81) was employed for children referred to the day and inpatient departments for child psychiatry in The University Hospital in Copenhagen during a period of four years (117 children) and from the day and inpatient clinics for child psychiatry in Odense during a period of two years. The total number of children was 145. Clinical aspects are described and compared according to a definite system. A consumer investigation was carried out and this was compared with previous consumer investigations. The consumers expressed satisfaction with work with the multiaxial system. MAS is an employable diagnostic system which is in good agreement with the holistic approach employed by child psychiatrists. Attempts must still be made to improve the system, particularly the axes which register social factors. The system appears to be of value in the choice of correct therapeutic measures.

Anorexia nervosa and motherhood: reproduction pattern and mothering behavior of 50 women.

A follow-up carried out on an average 12.5 years after hospital contact of 151 patients with a former diagnosis of anorexia nervosa (AN), aimed at reproduction outcome. None of the 11 males had children. Fifty of the 140 women had given birth to a total of 86 children, which is approximately one third of the expected fertility. Involuntary childlessness was of the same size as found in the background population. The rate of prematurity among the offspring was twice the expected and perinatal lethality six times the expected. Mentally the mothers did well, both during pregnancy and the post partum period. They breast-fed their children for the same mean time as did other women, and the development of the children did not differ from that found in a background population. More women in the group of mothers than in the group of non-mothers had better scores of all-round functioning at follow-up.

The reliability of child psychiatric diagnosis. A comparison among Danish child psychiatrists of traditional diagnoses and a multiaxial diagnostic system.

The study was conducted to compare an experimental multiaxial diagnostic system (MAS) with traditional multicategorical diagnoses in child psychiatric work. Sixteen written case histories were circulated to 21 child psychiatrists, who made diagnoses independently of one another, using two different diagnostic systems. Diagnostic reliability was measured as percentage of interrater agreement. The highest diagnostic reliability was obtained in psychotic disorders, the lowest in personality disorders. The MAS implied improved diagnostic reliability of mental retardation, somatic disorders and developmental disorders. Adjustment reaction (reactio maladaptiva) was the diagnosis most commonly used, but with varying reliability in both systems. The reliability of the socio-economic and psychosocial axes were generally high.

Long-term outcome of 151 cases of anorexia nervosa. The Copenhagen Anorexia Nervosa Follow-Up Study.

One hundred and fifty-one patients (140 females - 11 males) with anorexia nervosa (AN) from three departments (child psychiatry, psychiatry, and internal medicine) were re-examined 4-22 years (average 12.5 years) after their first contact with the Rigshospital in Copenhagen. During the years 1960-76 the number of referrals was on the increase, and relatively more patients were treated in the psychiatric departments at the end than at the beginning of the period. Mean age was 16.6 years at onset, 19.0 years at primary contact. Mean weight loss was 32%. Mean duration of treatment was 12 months. Differences between the three departments concern especially age, sex, and duration of treatment. Mean age at follow-up was 31.0 years (range 16-63 years) for surviving probands. Follow-up information originated from semi-structured personal interviews (in 80% of surviving probands) together with register data on all probands, supplemented by extensive hospital data. Nine patients (6%), including six who committed suicide, died on the average 7.3 years after primary contact (average age 27.1 years). The mortality rate was 0.5% per year. At follow-up one fourth of the surviving probands had AN and one fourth suffered from other psychiatric disorders, while one half were free from mental illness. There were no significant differences in outcome between the three departments. As a whole, the group experienced a social decline. It is concluded that a substantial part of this group of AN patients had a poor prognosis with a tendency towards chronicity, despite relatively long and intensive treatment, but, on the other hand, about one half of the probands seemed to be healthy and well functioning.

Death and relapse in anorexia nervosa: survival analysis of 151 cases.

The traditional historic-prospective follow-up study of anorexia nervosa patients may be well served by recent methods of statistical analysis, the so-called models for the analysis of survival data. These models are particularly suited to the sort of incomplete observations usually produced a longitudinal studies. They include methods for estimating the probability of death and relapse as a function of time. This makes possible powerful comparisons among studies and among subsamples in single studies. In the present study, 151 patients were followed-up after 4-22 yrs. The hazard of death was on average 0.5% per year, the hazard of relapse 3% per year. With both measures, the risk declined steadily after therapeutic contact.