Is Asperger's Syndrome worse than Schizophrenia

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schizoid PD isn't in the next DSM 5, also because many researchers belief that it's just (depending on the case) avoidant PD, ASD or schizotypal PD. So officially it wouldn't exist in the futur anymore. It's the same with schizophrenia symplex, Michael Fitzgerald beliefs that it was mainly used in the past to diagnose people with ASD. There is getting researched (sadly not enough in my opinion) about the differences of ASD and schizotypal PD and how it looks like there is a big overlapp and many people for whom both diagnostic criteria apply. Also in families both disorders (also Bipolar) is a lot more common, so there seems to be a genetic overlapp.
Of course we still need more research, but there is clearly a high overlapp.
But I'm sure Christopher Gillberg can identify ASD, also in people with schizophrenia. Officially they are two seperat disorders, but with a big overlapp and Gillberg is not the first one who noticed that. But I agree that we need a lot more reasearch in that area.

Last edited by Raziel on 16 May 2013, 1:53 am, edited 1 time in total.

Wow that makes sense!
I think schizophrenia and autism are even more similar neurologically than people think so for me schizoids is still it's own category because I always understood they were close to the autism spectrum (and other things). If it clears things up it's good fixing diagnoses like that. There's probably a lot where they haven't sorted out the co-morbids from the main thing, probably in ASD too (and wtf is up with schizoaffective and MCDD? )

Yes, I think so too that ASD and schizophrenia are simmilar. Also in puperty especially people with AS get more often psychosis or in general under stress paranoia. The ICD-10 even mentions in Asperger's that psychotic can appear especially in young adulthood.

Comming to schizoaffective and McDD:
They wanted to remove schizoaffective from the next DSM because in theory schizophrenia and bipolar are highly overlapping, but two different conditions that can occour together more often, but the problem is that very often it is not clear what a person has, so they just diagnose schizoaffective, or they really have both. But they made the diagnostic criteria more strict. So it mostly has practical reasons why it's in the next DSM 5.

McDD is not in the next diagnostic system of the DSM or ICD at all. It seems to be closer to the schizophrenic spectrum than to the autistic. There is not much research done, but some belief it is schizotypal PD in childhood. Also because schizotypal PD is more closer to the schizophrenic spectrum and not really a PD, it's not even listed in the ICD-10 under the PDs, but under the schizophrenic spectrum. But there still need to be a lot more research done and sadly those who don't really fit into any diagnostic cathegory or just in those who aren't in the ICD or DSM, there isn't a lot of research done. So far I read on the Yale site, they think that McDD is something different than schizophrenia, because you always have those symptoms and not just in psychotic episodes, but you also have them from early one. Usually you don't have a speech delay in McDD, so it seems it's not just a mixture out of ASD and the schizophrenic spectrum. I personally also think it could be childhood onsed schizotypy, but I'm not 100% certain.

Last edited by Raziel on 16 May 2013, 4:13 am, edited 2 times in total.

I did not read the DSM-5 (I don't know if it is already avaliable to the public), but, according to the American Psychiatric Association (in December 2012), Schizoid PD will be there:

http://www.psych.org/File%20Library/Adv ... AL--3-.pdf

"DSM-5 will maintain the categorical model and criteria for the 10 personality disorders included in DSM-IV"

They will change the entire PD-system and just: avoidant, antisocial, narcissistic (they first wanted to remove this one too), borderline, obsessive compulsive and schizotypal PD will remain: http://www.dsm5.org/Documents/Personali ... 5-1-12.pdf
But you can just get diagnosed with traits from each category in the future, so that you end up with your own symptoms. But I still don't totally get it how it is supposed to work.

I think that proposal was abandoned.

https://www.aacp.com/pdf%2F0213%2F0213ACP_Editorial.pdf

Last edited by TPE2 on 16 May 2013, 4:14 am, edited 1 time in total.

I don't think so, but we'll see.

More exactly, I think that, in main body of the DSM-5, the personality disorders will appear like in the DSM-IV; but it will be an appendix where PDs will be presented like in the original proposal, and I think that clinician will could choose the system they prefer to make diagnosis.

If it will be like that, I think these mean that will be THREE simultaneos classification systems - the categorical approach of the DSM-IV/main body of the DSM-5; the specific types of the appendix of the DSM-5; and the dimensional traits of the appendix of the DSM-5.

Yes they'll keep the other once in the appendix, but like in the other DSMs, the appendix is rarely used. And scizotypal PD will be moved: "Not actually to be classified as a personality disorder; classified instead as a form of schizophrenia-spectrum disorder.", so schizotypal PD (or "schizotype disorder" how it is called in the ICD-10) has then the same status as in the ICD-10, not as a PD anymore, but as a supform of the schizophrenic spectrum, what's very intersting if McDD will remain (I know it's not in the DSM or ICD, but sometimes used), because then schizotype disorder is not considered as a personality disorder anymore and could then also be diagnosed in childrenw if I understand that right. Because that's the situation in the ICD-10 we already have.

No more histrionic personality disorder? Why?

Because they hope it works better that way.
I'm not sure what to think about it, maybe it really works better. We'll see I guess.

The initial ideia was to simply abandon all the concept of "[X] Personality Disorder", and to have only "Personality Disorder" as a diagnosis, and them describe the PDs of specifical individuals according to the Big Five theory of the personality.

After that, they changed the plan - the PDs that match several factors of the personality will to continue to exist as separate diagnosis, and only the PDs that are connected only with one factor (like schizoid PD, who was seens as a extreme case of Introvertion) will be subsumed with the general diagnosis of "Personality Disorder". Probably they also concluded that HPD only affected one factor, or something like that.

In the end, they decided to mantain everything like in the DSM-IV, but giving the option using the proposed (and semi-abandoned) new system.

I think the primary outcomes for both Asperger's syndrome and schizophrenia can be indisputably inconclusive according to both clinical psychologists and psychiatrists, as both can vary substantially in terms of symptomatic intensity (including those dually diagnosed with AS and a schizophrenic spectrum disorder), and there may be dissentious conflict amongst the professional mental health and psychology community. Both groups are socially withdrawn, negatively stereotyped, and prejudiced by the mass media, although schizophrenics tend be more ostracized because of their diminished ability to differentiate reality from delusional fantasies, whereas people with AS are more likely to venerated.

Some people who are quickly diagnosed with schizophrenia can sometimes recover with convenient treatment after being afflicted with just one chronic psychotic episode (initial onset of the psychotic disorder), and often live highly productive lives; whereas in other cases, prognostication can be unfortunately immutable and the schizophrenic patient is highly unlikely to maintain their adaptive behavioral skills or ever recover from short-term treatment devised by psychiatric wards, as a result, they may be detained indefinitely under some form of mental health legislation and require permanent psychiatric care within a specialised and controlled institutional environment. Individuals who recover or are deemed competent enough to regulate their mental illness may reside back with their family, in a group home, or seek for apartments on their own.

Upon entering adulthood, most people with Asperger's syndrome develop self-coping skills, and some often lead relatively independent lives, although some may require individualized support services from a government service or developmental disabilities agency (social security benefits, employment support etc.). The co-occurrence of schizophrenia juxtaposed with Asperger's syndrome is only marginally greater in comparison with the general population; however, individuals with a dual diagnosis (AS + schizophrenia) are more likely to face a poorer prognosis than those without schizophrenia or another severe psychotic disorder, and these individuals are more likely to a show a declivity of daily living skills. It is therefore reasonable for them to be deemed eligible for community mental health services (CMHS) like assisted housing or psychiatric wards, or to reside in a group home for the developmentally disabled. It is imperative to note that although AS is at the high-functioning end of the autistic spectrum, and schizophrenia is at the severe end of the schizophrenia spectrum; individuals with Schizoid and Schizotypal personality disorder by prominent accounts, have generally ameliorated adjustment or outcomes for independence, and neither groups are disconnected from reality - nor do they usually hallucinate or present with the hallmarks of psychosis. There is slight increase of the commitment of suicide by individuals with AS compared with the general population, but based on anecdotal substantiations, the rates of suicide are far more prevalent in schizophrenia in comparison with AS and other high-functioning autism spectrum disorders.

The basic psychopharmacological intervention for patients with a psychotic disorder that is implicated by a primary or an organic aetiology is anti-psychotic medication, which can have debilitating pharmacological effects on behavior, life expectancy, violence, seizure threshold, dopamine receptor activity, metabolism, body mass index (BMI), agitation, rigidity of thinking, mood control, cognition, and the mimicry of psychosis itself. I've heard of the popular popular misconception that people with schizophrenia are of lower intelligence in comparison with the general population, it is likely that some varieties of anti-psychotic medication may hinder one's short term memory, cognitive flexibility, and/or processing speed. MRI scans have demonstrated brain volume abnormalities in individuals who are heavily induced with anti-psychotics, and the volume levels show a conspicuous tendency to gradually decline.

If untreated in the short term, schizophrenics (paranoid sub-type) are often coercively adherent to the demands of the "voices" (auditory hallucinations) they hear, thus posing a detrimental threat towards others. Their total lack of social functionalities, and executive functioning are often counterpart with people with Asperger's syndrome, but a high proportion of formerly diagnosed individuals with schizophrenia are likely to gradually reattain their once lost social skills, and their executive functioning capacity prior to the initial stages of the disorder.

Personally on my individual account, Asperger's syndrome alone is undoubtedly more pleasant to live with as it's a neurological abnormality (central nervous system difference, not defect) that cannot and should not be treated or "cured" with pseudo-scientific therapies, and abhorrent pharmaceutical "medication" doesn't mix with it either. Self-acceptance, pride, rejection of the desire for normalcy, and coping skills are the real treatments. Schizophrenia, which although linked with creativity and giftedness like AS, is a cruel, yet devastating psychological illness that can have a profound effect on one's physical health, life expectancy, esteem, and inherent mind.

There is neuroscientific consensus that both Asperger's syndrome and Schizophrenia share a significant genetic link, heritability is prevalent and mono-zygotic twins (MZ) have a much higher concordance rate of AS and schizophrenia than dizygotic twins (DZ).

A scientific, systematic study has indicated a link between ASD and childhood onset schizophrenia, in terms of clinical features like social withdrawal, communicative deficits, delayed language acquisition and motor clumsiness.

http://www.psychiatrictimes.com/schizop ... 68/1822823
_________________
Diagnosed with "Classical" Asperger's syndrome in 1998 (Clinical psychologist).
Alexithymia Questionnaire Score: 166/185
Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): 231/240
Aspie score: 186 out of 200
Neurotypical (non-autistic) score: 12 out of 200
AQ: 48/50 EQ: 9/80
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Thank you so much for sharing all this information Raziel (in the other posts too), I find it very fascinating. I don't keep up with the news as I should.
I know McDD isn't a "proper" diagnosis but it is one of those "collection-diagnoses" that I thought hid different co-morbids under one name, like schizoaffective, but I see now that it probably is something much less simple than "just" that. It's really fascinating. I've seen some say that it is what happens to traumatized autistics (and who might have all the possible co-morbids to autism at the same time in varying degrees), and they might be right - because it seems we have a much more sensitive psyche for developing disorders after trauma as our brain is much younger in structure to our age than NTs, so any disorders a NT can develop after severe abuse in very very very early childhood, we might develop after any abuse ever as our brains are "immature" (as they call it), like the hippocampus where PTSD hits hardest. It's a recipe for disaster...
Though it's probably not "just" that either, it's more complex.

I like most of the changes of the DSM I've heard about. Let's hope they will include the neurological causes soon too as they said it would be able to get updated

Thank you.
It's a bit off-topic but that is very intersting you said about trauma and autism.
I've a trauma since 2 1/2 years (it's getting better since a fiew months) and I had the feeling that first NTs wouldn't necesserily found the experience traumatic, but out of my fiew it was and seconed I also hat the feeling that it's symptoms are a bit different than those of NTs and I think it has to do with autism. Many symptoms I experienced weren't that typical for adulthood trauma, but more for childhood trauma or also sever trauma, like dissoative symptoms or even close to psychotic once. The psychiatrists didn't belief me that they were from the trauma I had, but the intersting thing was, that they were very severe and so on, but as soon as I wasn't in the traumatic environment anymore and someone finally believed me that the symptoms got better just in a fiew months. My entire symptoms weren't that typical, but mor atypical for a trauma (eventhough I had a lot of typical once like flash backs and so on) and I think it's because of the autism.

I also think that our brains works different somehow and that ASD is also connected to many other different disorders and especially to ADHD and ADD and the schizophrenic spectrum.

So how will they diagnose histrionic PD in the futur?