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Asperger syndrome or schizophrenia, or both? Case identification of 12 adults in a specialized psychiatric inpatient unit

Abstract Background: Asperger syndrome (AS) may be difficult to distinguish from psychosis in the schizophrenia spectrum (PSS), as the two conditions share core features. Aim: The aim of this paper is to identify symptoms which are useful in the differential diagnostic process, and which symptoms cause confusion in the assessment. Methods: Twelve patients, consecutively referred to a specialized psychiatric inpatient unit for re-diagnostic assessment, were recruited in a 3-year period. The patients were systematically assessed for both AS and for psychotic disorder in the schizophrenia spectrum. Results: Symptoms that caused misdiagnosis in the present sample were especially idiosyncratic speech taken for delusions (or the reverse), dysfunction related to self-care, task solving, and relationships, and social impairment taken for negative symptoms (or the reverse). Useful areas were symptom onset, symptoms of disorganized speech, occurrence of hallucinations, and occurrence of relapses. The latter contributed to diagnostic clarity related to PSS only. Conclusion: Patients with both AS and PSS may show severe symptoms which usually are difficult to distinguish. When both AS and PSS are suspected in severely impaired adult patients, comprehensive assessment including both AS and PSS is required. Symptoms that may differentiate PSS from AS are age of onset, presence of hallucinations, presence of disorganized speech and behaviour, and occurrence of relapses. Confusing symptoms include social impairments, and idiosyncratic opinions in persons with AS, which may be mistaken for delusions (or the reverse). Also bizarre behaviour and general dysfunction may be wrongly attributed to AS or PSS.