Severity of autism-related symptoms in treatment-resistant schizophrenia: associations with cognitive performance, psychosocial functioning, and neurological soft signs — Clinical evidence and ROC analysis

• DOI: 10.1016/j.jpsychires.2025.03.040
• Publication Date: 2025-03-30T05:31:10Z
• Authors: Licia Vellucci; Annarita Barone; Elisabetta Filome...; Mariateresa Cicca...; Giuseppe De Simone; Federica Iannotta; Marta Matrone; Benedetta Mazza; Roberto Vitelli; Andrea de Bartolo...; Felice Iasevoli

Treatment-resistant schizophrenia (TRS) occurs when symptoms persist despite adequate antipsychotic treatment in terms of both timing and dosage. This severe condition is often overlooked, the existence guidelines, with an average delay 4-9 years before introduction clozapine, gold standard treatment. We hypothesized that patients autistic are more prone to develop TRS. To test this, we administered Positive Negative Syndrome Scale for Schizophrenia Autism Severity (PAUSS) 117 diagnosed schizophrenia. Our results revealed TRS clozapine non-responder (CLZ-nR) groups had higher rates than non-TRS patients. A machine learning model was developed examine relationship between PAUSS scores TRS, obtaining accuracy 0.65 AUC 0.67. Specifically, items N6 ("lack spontaneity flow conversation") N7 ("stereotypical thinking") emerged as most significant factors model. In addition, correlated cognitive social functions, well soft neurological signs, Autism-related were found predict variance motor coordination, verbal fluency, functional ability signs. These suggest autism-related may define a distinct subgroup unique neurobiological characteristics.