Dall’universo dell’autismo allo spettro della catatonia

by Liliana Dell’Osso and Giulia Amatori

Recent scientific literature has highlighted the importance of spectrum approaches for optimizing the diagnosis and treatment of mental disorders. The application of the spectrum model provides a more realistic representation of clinical syndromes, including recognition of subclinical, prodromal, and subthreshold symptoms, which are essential for early diagnosis and prevention. Within this framework, the autism spectrum has been described as a trans-nosographic dimension, a matrix of vulnerability that represents the starting point for the development of various psychopathological trajectories 1.

Dall’universo dell’autismo allo spettro della catatonia (“From the universe of autism to the spectrum of catatonia”) by Professor Liliana Dell’Osso and her student Giulia Amatori, explores in detail the possible pathological trajectory that originates from the autism spectrum and culminates in one of the most severe manifestations of mental disorder: catatonia.

The psychopathological vulnerability associated with the autism spectrum is attributed, in particular, to the intense propensity to ruminate about traumatic events, functioning as a process of endless re-experiencing with dysregulation of emotions and vital functions. A process that, perpetrated over time, is likely to lead to a clinical picture comparable to that seen in borderline personality disorder, a mosaic of psychopathological dimensions associated with the frequent removal, reprocessing and exploitation of trauma. In the absence of adequate psychopharmacological treatment, the last stage of the illness trajectory described in the book, could then be characterized by the full-blown, or subthreshold, manifestations of catatonia. 

From this point of view, the authors propose three dimensional assessment tools developed at the psychiatric clinic of Pisa, in order to facilitate the recognition of subthreshold symptomatology and prevent the development of potentially preventable mental disorders. The questionnaires reported in the book are the Adult Autism Subthreshold Spectrum (AdAS Spectrum) for the autism spectrum, the Trauma and Loss Spectrum Self-Report (TALS-SR) for the trauma and loss spectrum and, finally, the Catatonia Spectrum (CS), a recently formulated questionnaire designed to investigate the symptoms of the catatonic spectrum: a concept advanced by the DSM-5 itself with the introduction of the category “catatonia without specification”.

The psychopathological trajectory described by the authors is also enriched with emblematic clinical cases, able to improve the understanding of the different stages of mental illness. 

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