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laplantain
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03 Jan 2008, 1:50 am

I know this has been covered before, but can someone in a nutshell tell me what the differences are between the two? I have been searching but can't seem to find anything that compares the two.



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03 Jan 2008, 1:58 am

This won't be a thorough reply, but schizophrenia is a mental illness, which AS is not. I guess a schizophrenic being "cut off from reality" is a bit comparable to Aspies feeling cut off from the rest of the world, but schizophrenia actually impairs one's ability to think rationally or logically, which I seriously doubt applies to many aspies. I for one have never heard voices, but I guess that doesn't apply to all schizophrenics.


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03 Jan 2008, 2:00 am

Through the 1970s, all children on the spectrum (including aspies), were diagnosed with schizophrenia, childhood type.

These days, the definition of schizophrenia has been greatly narrowed. Schizophrenics have difficulty distinguishing reality from illusion and may have delusions of grandeur or auditory hallucinations. Those conditions are not a part of the spectrum of autisms.

There are some psychiatric patients right groups which argue that schizophrenia simply does not exist - and that mental illness does not exist. Many of them rely upon the views of Thomas Szasz, M.D.:

http://www.szasz.com/


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03 Jan 2008, 2:46 am

My mother has said that Aspies are at risk of developing schizophrenia, and I wasn't surprised. I could easily see myself being one of them. Getting so confused trying to figure the world around me and myself out with perfect logic that I become schizophrenic, or give up, have a breakdown and think nothing is everything and everything is nothing and then become schizophrenic. I had the nothing is everything, everything is nothing thing before, it was terrible and scary but I figured it out and was perfectly happy. :)



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03 Jan 2008, 4:12 am

nominalist, that's not exactly true; Dr. Kanner had his criteria running before then (circa 1967), just that it was "narrow" in its requirements, so many individuals didn't fit it who are deemed to be on the autistic spectrum nowadays.

Those on the spectrum tended to fit schizophrenia for a variety of reasons, the negative symptoms: lack of voice modulation/inflection in autism that can give an appearance of the "flat" effect (voice peculates are very common in ASD), social withdrawal and whatnot. Then you have those with an ASD who take things literally and perceive things differently to normal people, i.e., '...do you hear voices?'

It can all add up to a misdiagnosis.



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03 Jan 2008, 4:59 am

Ana54 wrote:
My mother has said that Aspies are at risk of developing schizophrenia, and I wasn't surprised. I could easily see myself being one of them. Getting so confused trying to figure the world around me and myself out with perfect logic that I become schizophrenic, or give up, have a breakdown and think nothing is everything and everything is nothing and then become schizophrenic. I had the nothing is everything, everything is nothing thing before, it was terrible and scary but I figured it out and was perfectly happy. :)


I strongly identify with this post... in fact one of the reasons why I think I have AS is that I am almost certain that I have either AS, schizophrenia, or bipolar disorder, and I don't really fit the symptoms of bipolar disorder (my moods swing almost by the minute and do not remain constant for long periods). The only reason why I don't think I have schizophrenia is that I don't really have hallucinations and I always know what is real. Otherwise, I have disordered thinking, delusions, and generally a mind haunted by many fears. I have gotten way better about most of it as I have recognized it as being a very real part of my life, but I was very close to losing it completely for a while there. I couldn't handle the idea of death, I couldn't handle relationships, the permanence of the past or the uncertainty of the future... I was melting into nothingness. Luckily, two things - reading the book Be Here Now by Ram Dass and discovering AS - really turned things around and allowed me to better understand myself as an existing human being, and things have been pretty much going up up up ever since :)



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03 Jan 2008, 5:47 am

Danielismyname wrote:
nominalist, that's not exactly true; Dr. Kanner had his criteria running before then (circa 1967), just that it was "narrow" in its requirements, so many individuals didn't fit it who are deemed to be on the autistic spectrum nowadays.


Hi, Daniel:

I was basing it on reading the DSM-I:

http://www.psychiatryonline.com/DSMPDF/dsm-i.pdf

Autism is only listed with
  1. schizophrenic reaction, childhood type
  2. schizophrenic reaction, paranoid type and
  3. schizoid personality disorder.
Using the DSM-I, I was personally diagnosed with #1 around 1962, was hospitalized, given electroconvulsive treatments, etc. When I chatted with my old child psychiatrist on the phone (the one who diagnosed me), now in his 80s, he said that he would have diagnosed with Asperger's (and OCD) if I were walking into his office today.

Asperger's autism was categorized by Hans Asperger, but it did not make it into the DSM until 1994.

Quote:
Those on the spectrum tended to fit schizophrenia for a variety of reasons, the negative symptoms: lack of voice modulation/inflection in autism that can give an appearance of the "flat" effect (voice peculates are very common in ASD), social withdrawal and whatnot. Then you have those with an ASD who take things literally and perceive things differently to normal people, i.e., '...do you hear voices?'


To my understanding, he diagnosed me on the basis of what would now be called Asperger's and OCD.


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03 Jan 2008, 6:11 am

To support Daniel;

LFA's weren't being DXed with schizophrenia. They were the ones getting either the correct DX or getting lumped with MR (mental retardation). Sometimes HFA was also nailed (by the doctors who were schooled in Kanner's work properly). It was the rest of the Spectrum that got lumbered with Schizophrenia - although having said that there were certainly quacks around who put Eugene Bleuler's 1912 interpretation of Autism ahead of Kanner's (hence the problem until the DSM-IV in 1994) and DXing schizophrenia like clockwork.

The aspect of schizophrenia that hasn't been mentioned is split personality. When a child Aspie develops a fantasy world it will include "friends". This is of course not unknown in the NT world either - but with Aspie children it is highly detailed. Now the difference is the Aspie child is aware that their world is seperate to the real world. Those with schizophrenia can't make that distinction, so the different personalities become a part of them as such. This doesn't happen to Aspies.



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03 Jan 2008, 6:19 am

As I said, Kanner [and Rutter] had an early criteria [before the DSM-III] that wasn't standardized across the field, kinda like how some institutions use Gillberg's criteria to diagnose AS now. DSM-III had atypical autism too, I think, i.e., late onset, not meeting all the requirements for autism (I don't know if AS would fit this or not).

Like with your experience, there wasn't anything around for those with a specific type of autism (AS) until recently, it was the stereotypical presentation of "classic autism"; a lack of social contact/affective contact and repetitive behaviors at an early age, or something else.



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03 Jan 2008, 9:04 am

My adopted brother has schizophrenia, and I have AS, so I hope I can illuminate.
Schizophrenia is often marked by bouts of mental confusion, lack of clarity, word salad (where speech is random and makes no logical sense), auditory and visual hallucinations, and delusions. AS is marked by social problems and issues with sensory input (we are very, VERY sensitive to textures, lights, sounds, etc). Schizophrenics tend to lack organization, though Aspies are obsessed with order and patterns.
Big differences.


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03 Jan 2008, 9:33 am

That must be why I hear voices, sometimes.


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03 Jan 2008, 9:36 am

TLPG wrote:
Those with schizophrenia can't make that distinction, so the different personalities become a part of them as such.


TLPG,

The statement about the inability to distinguish between fantasy and reality is true (usually, though there are milder forms of schizophrenia that don't involve this), but I'm afraid the one about multiple personalities is not really accurate. This is a popular misconception about schizophrenia, that people with this condition have several alternating personalities, a la Jekyll/Hyde. However, in reality, this is part of a dissociative disorder called multiple personality disorder, which belongs to the same group of distirbances as conversion disorders, fugue, episodic psychogenic amnesia etc. It has nothing to do with schizophrenia.

In schizophrenia, the personality does "split", or deteriorate, if you like, but in a completely different way. It falls apart in a sense, so that its separate functions are no longer coordinated well enough; unconscious phenomena suddenly surface into the conscious mind, overwhelming it, and seem to gain a life of their own. On the other hand, in multiple personality disorder the each of the personalities the patient exhibits is intact and whole, but their characteristics are different.



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03 Jan 2008, 9:56 am

TLPG, Danielismyname:

I'm not sure what was happening in the West because I haven't read enough about this, but in Russia, there was (and still is, I think) a theory which regarded autism as a type of childhood psychosis. Classic autism was considered distinct from the cases that were definitely diagnosed as "childhood schizophrenia", and placed in a separate category, but it was still treated as a specific type of childhood psychotic disorder. Parallels were drawn deliberately between autism and schizophrenia - for example, most forms of self-stimulation were seen as "rudimentary catatonic symptoms" (e.g. the rocking or hand-flapping), impulsive running or sudden tantrums in autistic children were seen as synonymous to similar-looking symptoms in catatonic adults, and it was even supposed, judging by the external behavior of autistic people, that they hallucinate. Functional inability to speak and typical LFA behavior in older autistic children or adults was always seen as a sign of "oligophrenic defect", that is, a state resembling mental retardation which follows after a severe psychotic episode.

The whole theory roughly amounted to stating that autism is a kind of schizophrenia (while AS is schizoid personality disorder).

Bashina, for instance, states that she feels it unnecessary and inaccurate to diagnose autistic adults with Kanner's syndrome, since to her they are no different from schizophrenic ones, and she thinks schizophrenia is the more suitable diagnosis for them. In effect, she believes autism to result from a psychotic process which either ends early in childhood, leaving lasting residual symptoms, or which continues in a milder form with periodic relapses throughout adulthood.

(for those who are interested and speak Russian, there are interesting details on this in Bashina's book, availiable on www.psychiatry.ru)

So that, at least in this case, it is not about misdiagnosis.



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03 Jan 2008, 10:19 am

DSM-IV criteria
(from http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm):

Quote:
Diagnostic criteria for Schizophrenia

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

(1) delusions

(2) hallucinations

(3) disorganized speech (e.g., frequent derailment or incoherence)

(4) grossly disorganized or catatonic behavior

(5) negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Classification of longitudinal course (can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms):

Episodic With Interepisode Residual Symptoms (episodes are defined by the reemergence of prominent psychotic symptoms); also specify if: With Prominent Negative Symptoms

Episodic With No Interepisode Residual Symptoms

Continuous (prominent psychotic symptoms are present throughout the period of observation); also specify if: With Prominent Negative Symptoms

Single Episode In Partial Remission; also specify if: With Prominent Negative Symptoms

Single Episode In Full Remission

Other or Unspecified Pattern

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association


Quote:
Diagnostic criteria for 299.80 Asperger's Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(2) failure to develop peer relationships appropriate to developmental level
(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
(4) lack of social or emotional reciprocity

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(2) apparently inflexible adherence to specific, nonfunctional routines or rituals
(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994 American Psychiatric Association


Quote:
Diagnostic criteria for 299.00 Autistic Disorder

A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:
(a) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
(b) failure to develop peer relationships appropriate to developmental level
(c) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication as manifested by at least one of the following:
(a) delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic language
(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional routines or rituals
(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(d) persistent preoccupation with parts of objects

B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.

C. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994 American Psychiatric Association



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03 Jan 2008, 10:32 am

ixochiyo_yohuallan,

The thing is, hand-flapping, rocking and other motor mannerisms in autism are due to emotional upset (good or bad), "normal" people do these too, it's just far more prevalent in those with autism due to our emotional disturbances. Tantrums are the same.

This is a good website that explains the differential diagnoses of Asperger's and the differences between the conditions.



ixochiyo_yohuallan
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03 Jan 2008, 12:07 pm

Danielismyname wrote:
ixochiyo_yohuallan,

The thing is, hand-flapping, rocking and other motor mannerisms in autism are due to emotional upset (good or bad), "normal" people do these too, it's just far more prevalent in those with autism due to our emotional disturbances. Tantrums are the same.

This is a good website that explains the differential diagnoses of Asperger's and the differences between the conditions.


Danielismyname,

Of course. :) What I meant was the fact that, at some point, there was (or is) an official medical approach that tried to find similarities between autism and schizophrenia or to treat them as altogether synonymous, regardless of how far this could be from the truth. I think it was this that nominalist and some others were discussing - the historical approaches dealing with these two conditions, rather than the actual state of things.

You had brought up misdiagnosis and mentioned that it was basically the only reason why autism has been mistaken for schizophrenia (due to superficial similarities such as the resemblance between odd voice prosody or lack of body language in ASDs and schizophrenia's negative symptoms, etc.), and I remembered this whole approach and felt like pointing out that sometimes it goes deeper than just making a mistake - that there were/are diagnostic criteria that make no substantial difference whatsoever between the two conditions.



Last edited by ixochiyo_yohuallan on 03 Jan 2008, 12:29 pm, edited 1 time in total.