Monday, November 17, 2008

Autism and Schizophrenia co-occurence

Socrates has raised an important point in one of the recent comments that if Autism and Schizophrenia are opposite poles , how do you explain their (rare) simultaneous co-occurrence?  This same question has been raised by other commentators (like Julia)  before and though I have responded in the comments, I'll like to highlight the earlier response here for the benefit of all readers. Here is one of my earlier responses to the prevalance of mCDD and I hope to stimulate some discussion on this:

One way to look at this (mCDD) would be to treat this as similar to mixed episodes in bipolar disorder. Here both symptoms of Mania and depression are present in the same individual though traditionally Mania and depression are thought of as opposite poles on a continuum. In effect though Autism and Schizophrenia/psychosis are opposite extremes, in some individuals both may be present. However, also note the differences form mixed episodes in bipolar; there the mixed state as well as mania and depression happen in the same individual over time; here the disorders itself are simultaneously present in the individual.

Another example I can think of is of recessive alleles for both disorder at the same gene locus. (lets for example consider that eye color is due to recessive alleles at the eye-color locus). Now suppose that recessive allele S confers risk of schizophrenia and N is the normal variant. so SS is schizophrenic; SN is on the continuum toward schizophrenia and normality, perhaps a schizotypal individual. Suppose also that recessive allele A at the same locus makes one susceptible to Autism (they are opposite poles so evidently should work on same locus / loci). Thus AA is autistic and AN is asperper's; now consider the rare scenario where one gets AS genotype ; in this case one might be asperger's and schizotypal; in rare scenario this may develop into full-blown child-onset schizophrenia and classified as PDD_NOS or McDD.

To test my theory one can see the frequencies of Autistic and Schizophrenics and also the McDD iondividuals. If there was no interaction, Autism and schizophrenia should be independently inherited and P(mcDD) = P(Autism) * p(schizophrenia) where P is probability of an individual in a population belonging to that disorder. As my theory predicts there should be some interaction (the gene locus is same), so P(mcDD) should be different from that calculated from above (though I lack the requisite math knowledge to come up with a good formula!)
 I believe I owe a bigger response to the questions raised, but I am hoping this to turn out as more of a conversation, then a one -sided defense of my pet theory,  and would encourage more and more readers to get involved and propose new and radical solutions to this conundrum that has been highlighted!  Also any statistics on the co-occurrence and individual occurrence and prevalence of Autism and schizophrenia would be more than welcome
 

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