**3. Autism and schizophrenia**

Schizophrenia and bipolar disorder are now seen as neurodevelopmental disorders with a widening of the neurodevelopmental spectrum.

Evans [5] states that the diagnosis of "schizophrenia, psychosis and autism in children, were largely interchangeable during the 1940s and 1950s" [6]. They were described as separate by Kolvin et al. [7]. This view was not supported [8].

According to Scull [9], Steven Hyman, the former director of NIMH stated that DSM 5 "was totally wrong in the way it's authors could not have imagined. So in fact, what they produced was an absolute scientific nightmare. Many people who got one diagnosis got five diagnoses, but they did not have five diseases—they have one underlying condition". Thomas Insel [9], who was also the director of the NIMH stated that DSM 5 showed "a lack of validity … as long as the research community takes DSM 5 to be a bible, we will never make progress. People think that everything has to match DSM 5 criteria, but what you know … biology never the book, and he went on to point out that in future the NIMH would be, "re-orientating into research away from DSM 5 categories … patients with mental illness deserve better". Indeed, the NIMHS, under their director, Insel, gave up on this and aimed at a transdiagnostic study of psychiatric problems, and further studies should be based on biomarkers, neuroimaging and laboratory tests. This is a good aspiration and research efforts are being made in that direction. Clearly, Hyman and Insel were absolutely correct. He [9] proposed Research Domain Criteria to collect "genomic, cellular, imaging, social and behavioural information", and he also recommended focusing on the brain and "connectopathies". Thomas Insel noted that psychiatrists "actually believe, (that their diagnoses) are real, but there's no reality. They are just constructs". The first step is to analyse the huge spectrum of empathy and diagnosis.

Rutter [10] states that "the concept of autism as a variety of schizophrenia is very probably wrong". The real answer is that they overlap and are not watertight categories. Rutter [11] stated that "infantile autism is not anything to do with schizophrenia, is not primarily a disorder of social relationship". This is incorrect because they do overlap and autism is primarily a disorder of social relationships. Sullivan et al. [8] point out that "ASD, schizophrenia and bipolar disorder share common aetiological factors". This would be supported by Abel [12] who points out that "it has been suggested that, (as for common genetic variants), many of the candidate genes identified may not be coding for schizophrenia per se, but for a broader construct such as psychosis, or neurocognitive deficits which occur in schizophrenia and other conditions". Rapaport et al. [13] states that many individually rare genetic abnormalities affect common pathways containing hundreds of genes that affect neuronal development and regulation. Carroll et al. [14] point out that some of the specific genetic loci implicated encode proteins, such as neurexins and neuroligins, which function in synaptic development and plasticity and therefore represent a common biological pathway for disorders. Fatemi [15] points out the pathological involvement of Reelin gene or its protein product in autism and schizophrenia.

**5**

patient settings.

currently being updated.

*The Future of Psychiatry and Neurodevelopmental Disorders: A Paradigm Shift*

Reelin is a glycoprotein that helps guide brain development in an orderly fashion [15]. Fatemi [15] notes that Reelin deficits may cause abnormal corticogenesis and alter synaptic plasticity. In addition, Burbach et al. [16] note that contact in associated protein affects receptor/signalling units and are thought to mediate neuronglial cell interactions, neuron migration and dendritic orientation. Contactin is a member of the neurexin family, and there are deletions and disruptions in neurexin

Rutter [17] points out that "adult schizophrenia is rare in both parents and brothers and sisters of autistic children". This is incorrect. Stone et al. [18] pointed out that there's evidence that parental diagnosis of schizophrenia was associated with elevated rates of autism offspring. Rapaport et al. [13] points out that familial

Both autism and schizophrenia can show formal thought disorder with poverty of content, illogical and loose associations. Solomon et al. [19] pointed out that when patients with first episode psychosis were compared to patients with ASD, they showed problems with semantics, syntax and coherence, although these deficits are more severe in ASD. They also noted that social interactional deficits are part of both conditions. Both have theory of mind deficits and problems with eye to eye gaze. In addition, they both have problems reading emotions from faces. Chris Frith [20] points out that "social withdrawal, stereotyped behaviour, and lack of communication are all typical features of childhood autism and chronic 'negative' schizophrenia". He emphasised mentalisation deficits in schizophrenia, which also occur in autism. In fact, they both show a disturbed sense of self. In comparison with schizophrenia, persons with autism show greater problems in reading faces, greater poverty of speech, as well as content and more perseveration of language, including echolalia and pronominal reversal, and more problems with set shifting and preservation of sameness. In comparison with autism, persons with schizophrenia show greater illogicality of thought, show more positive symptoms of psychosis, have mostly later onset (different from autism), run a more elapsing remitting course, show less stereotyped and repetitive behaviour, show less resistance to change, show less challenging behaviour as on an in-patient ward and show more jumping to conclusions. Craddock and Owen [21] discuss a gradient of neurodevelopmental psychopathology from mental retardation to autism to schizophrenia to schizoaffective disorder to bipolar disorder. Nevertheless, the developmental process underlying these similar end points in autism and schizophrenia may be very different. Sporn et al. [22] suggest that "autistic behaviour may be a non-specific response to a variety of early developmental insults, and thus pre-morbid PDD (Pervasive Developmental Disorder) features in early onset schizophrenia may be an exaggeration of neurodevelopmental abnormalities seen in adult schizophrenia" and that "autism may reflect a separate additive risk factor for schizophrenia with very early onset". Certainly, psychotic risk factors are very similar to autistic symptoms, as is the case with schizotaxia, schizo-

schizophrenia like psychosis is a risk factor for "narrowly defined autism".

typal personality disorder and schizoid personality disorder.

Rutter [23] states that delusions and hallucinations "are quite rare in autistic children, even when they reach adolescence and early adult life". This has not been my clinical experience, having diagnosed about 5000 children and adults and currently being involved with over 100 persons with autism in in-patient and out-

Simple schizophrenia Kolb [24] is simply autism spectrum disorder. In my view, the so-called simple schizophrenia involves a disturbance of emotion, disturbance of interest, disturbance of activity, impoverishment of personality, shallowness of emotions and eccentricities. This would be classical high-functioning autism or what was called Asperger's syndrome in former classifications ICD 10 [25]. This is

*DOI: http://dx.doi.org/10.5772/intechopen.88540*

1 in autism and schizophrenia.

## *The Future of Psychiatry and Neurodevelopmental Disorders: A Paradigm Shift DOI: http://dx.doi.org/10.5772/intechopen.88540*

Reelin is a glycoprotein that helps guide brain development in an orderly fashion [15]. Fatemi [15] notes that Reelin deficits may cause abnormal corticogenesis and alter synaptic plasticity. In addition, Burbach et al. [16] note that contact in associated protein affects receptor/signalling units and are thought to mediate neuronglial cell interactions, neuron migration and dendritic orientation. Contactin is a member of the neurexin family, and there are deletions and disruptions in neurexin 1 in autism and schizophrenia.

Rutter [17] points out that "adult schizophrenia is rare in both parents and brothers and sisters of autistic children". This is incorrect. Stone et al. [18] pointed out that there's evidence that parental diagnosis of schizophrenia was associated with elevated rates of autism offspring. Rapaport et al. [13] points out that familial schizophrenia like psychosis is a risk factor for "narrowly defined autism".

Both autism and schizophrenia can show formal thought disorder with poverty of content, illogical and loose associations. Solomon et al. [19] pointed out that when patients with first episode psychosis were compared to patients with ASD, they showed problems with semantics, syntax and coherence, although these deficits are more severe in ASD. They also noted that social interactional deficits are part of both conditions. Both have theory of mind deficits and problems with eye to eye gaze. In addition, they both have problems reading emotions from faces. Chris Frith [20] points out that "social withdrawal, stereotyped behaviour, and lack of communication are all typical features of childhood autism and chronic 'negative' schizophrenia". He emphasised mentalisation deficits in schizophrenia, which also occur in autism. In fact, they both show a disturbed sense of self. In comparison with schizophrenia, persons with autism show greater problems in reading faces, greater poverty of speech, as well as content and more perseveration of language, including echolalia and pronominal reversal, and more problems with set shifting and preservation of sameness. In comparison with autism, persons with schizophrenia show greater illogicality of thought, show more positive symptoms of psychosis, have mostly later onset (different from autism), run a more elapsing remitting course, show less stereotyped and repetitive behaviour, show less resistance to change, show less challenging behaviour as on an in-patient ward and show more jumping to conclusions.

Craddock and Owen [21] discuss a gradient of neurodevelopmental psychopathology from mental retardation to autism to schizophrenia to schizoaffective disorder to bipolar disorder. Nevertheless, the developmental process underlying these similar end points in autism and schizophrenia may be very different. Sporn et al. [22] suggest that "autistic behaviour may be a non-specific response to a variety of early developmental insults, and thus pre-morbid PDD (Pervasive Developmental Disorder) features in early onset schizophrenia may be an exaggeration of neurodevelopmental abnormalities seen in adult schizophrenia" and that "autism may reflect a separate additive risk factor for schizophrenia with very early onset". Certainly, psychotic risk factors are very similar to autistic symptoms, as is the case with schizotaxia, schizotypal personality disorder and schizoid personality disorder.

Rutter [23] states that delusions and hallucinations "are quite rare in autistic children, even when they reach adolescence and early adult life". This has not been my clinical experience, having diagnosed about 5000 children and adults and currently being involved with over 100 persons with autism in in-patient and outpatient settings.

Simple schizophrenia Kolb [24] is simply autism spectrum disorder. In my view, the so-called simple schizophrenia involves a disturbance of emotion, disturbance of interest, disturbance of activity, impoverishment of personality, shallowness of emotions and eccentricities. This would be classical high-functioning autism or what was called Asperger's syndrome in former classifications ICD 10 [25]. This is currently being updated.

*Neurodevelopment and Neurodevelopmental Disorder*

for diagnosis".

**3. Autism and schizophrenia**

empathy and diagnosis.

the problem of camouflaging because of treatment or just life experience which makes it more difficult to diagnose the adult with autism. They may have learned about eye contact, etc. School reports or home videos sometimes help. They will often present with comorbidities, for example, depression, (70%), anxiety (40%), attention deficit disorder or psychosis. Mazefsky and White [3] "caution against excessive reliance on ADOS (Autism Diagnostic Observation Scale), Lord et al. [4]

Schizophrenia and bipolar disorder are now seen as neurodevelopmental disor-

Evans [5] states that the diagnosis of "schizophrenia, psychosis and autism in children, were largely interchangeable during the 1940s and 1950s" [6]. They were

According to Scull [9], Steven Hyman, the former director of NIMH stated that DSM 5 "was totally wrong in the way it's authors could not have imagined. So in fact, what they produced was an absolute scientific nightmare. Many people who got one diagnosis got five diagnoses, but they did not have five diseases—they have one underlying condition". Thomas Insel [9], who was also the director of the NIMH stated that DSM 5 showed "a lack of validity … as long as the research community takes DSM 5 to be a bible, we will never make progress. People think that everything has to match DSM 5 criteria, but what you know … biology never the book, and he went on to point out that in future the NIMH would be, "re-orientating into research away from DSM 5 categories … patients with mental illness deserve better". Indeed, the NIMHS, under their director, Insel, gave up on this and aimed at a transdiagnostic study of psychiatric problems, and further studies should be based on biomarkers, neuroimaging and laboratory tests. This is a good aspiration and research efforts are being made in that direction. Clearly, Hyman and Insel were absolutely correct. He [9] proposed Research Domain Criteria to collect "genomic, cellular, imaging, social and behavioural information", and he also recommended focusing on the brain and "connectopathies". Thomas Insel noted that psychiatrists "actually believe, (that their diagnoses) are real, but there's no reality. They are just constructs". The first step is to analyse the huge spectrum of

Rutter [10] states that "the concept of autism as a variety of schizophrenia is very probably wrong". The real answer is that they overlap and are not watertight categories. Rutter [11] stated that "infantile autism is not anything to do with schizophrenia, is not primarily a disorder of social relationship". This is incorrect because they do overlap and autism is primarily a disorder of social relationships. Sullivan et al. [8] point out that "ASD, schizophrenia and bipolar disorder share common aetiological factors". This would be supported by Abel [12] who points out that "it has been suggested that, (as for common genetic variants), many of the candidate genes identified may not be coding for schizophrenia per se, but for a broader construct such as psychosis, or neurocognitive deficits which occur in schizophrenia and other conditions". Rapaport et al. [13] states that many individually rare genetic abnormalities affect common pathways containing hundreds of genes that affect neuronal development and regulation. Carroll et al. [14] point out that some of the specific genetic loci implicated encode proteins, such as neurexins and neuroligins, which function in synaptic development and plasticity and therefore represent a common biological pathway for disorders. Fatemi [15] points out the pathological involvement of Reelin gene or its protein product in autism and schizophrenia.

described as separate by Kolvin et al. [7]. This view was not supported [8].

ders with a widening of the neurodevelopmental spectrum.

**4**

Kanner [26] was correct when he pointed out that "the extreme isolation from people … infantile autism bears so close a resemblance to schizophrenic withdrawal that the relationship between the two conditions deserves serious consideration". Of course other times, he described them as very separate. Asperger [27] pointed out that "the schizophrenic patient seems to show progressive loss of contact, the children we diagnose (now called Asperger's syndrome), lack contact from the start". The problem here is that some of the patients with autism do follow this pattern, but others have regressive autism, where they develop normally and then regress with loss of language, etc. I've seen this occurring up to 3 or 4 years of age.

Rutter [11] states that "the social class of parents of autistic children is most unlike that of the parents of schizophrenics. A high proportion of the parents of autistic children are of above average intelligence and superior socio-economic states". This is incorrect, as shown by Gillberg and Schumann [28]. In my clinical practice, I constantly see patients from every social class with autism and observe schizophrenia, bipolar disorder, etc. in their family histories.
