PDF(Pubmed)
Abstract：
High rates of co-occurring depression are commonly reported in youth with Autism Spectrum Disorder (ASD), especially in individuals without intellectual disability (ID). Depression in ASD undermines adaptive behavior and is associated with a higher risk of suicidality. Females with ASD may be particularly vulnerable due to their greater use of camouflaging strategies. Indeed, in comparison to males, ASD is underdiagnosed in females, despite higher rates of internalizing symptoms and suicidality. Trauma exposure may also play a role in the development of depressive symptoms in this population. Moreover, evidence for effective treatments of depression in autistic youth are lacking, with ASD individuals frequently experiencing low efficacy and side effects. We present the case of an adolescent female with previously undiagnosed ASD without ID, admitted for active suicidal plans and a treatment-resistant depression (TRD), occurred after a COVID-19 lockdown in the context of cumulative exposure to stressful life events. Comprehensive clinical assessments performed at intake confirmed severe depression with suicidality. Intensive psychotherapy and different changes in medications were carried out (SSRI, SNRI, SNRI + NaSSA, SNRI + aripiprazole), all of which were ineffective, with persistent suicidal thoughts, often requiring intensive individual monitoring. The patient was finally successfully treated with lithium augmentation of fluoxetine, with no side effects. During hospitalization she was also evaluated by an ASD specialized center, where a diagnosis of ASD was made according to the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) scores, as well as to clinical judgment of a senior psychiatrist. The present case report shows that clinicians should not overlook undiagnosed autism as a possible cause of TRD, especially in females without ID, where higher rates of under diagnosis may be in part related to their greater use of camouflage. It also suggests that ASD underdiagnosis and resulting unmet needs may be involved in vulnerability to stressful experiences, depression, and suicidality. Furthermore, it shows the complexity of providing care to TRD in youth with autism, suggesting that an augmentation therapy with lithium, a commonly recommended therapeutic strategy for refractory depression in typically developing samples, may also be effective in this population.
摘要：
在自闭症谱系障碍（ASD）的年轻人中，常见的并发抑郁症发生率很高，特别是在没有智力残疾（ID）的个人。ASD中的抑郁症破坏了适应性行为，并与自杀的高风险相关。患有ASD的女性可能由于更多地使用伪装策略而特别脆弱。的确,与男性相比，ASD在女性中诊断不足，尽管内化症状和自杀率较高。创伤暴露也可能在该人群中抑郁症状的发展中起作用。此外，缺乏有效治疗自闭症青年抑郁症的证据，ASD个体经常经历低疗效和副作用。我们介绍了一名青春期女性，患有先前未诊断的无ID的ASD，因积极的自杀计划和难治性抑郁症（TRD）而入院，在累积暴露于压力性生活事件的背景下，COVID-19封锁后发生。摄入时进行的综合临床评估证实了严重的抑郁症伴自杀。进行了强化心理治疗和不同的药物变化(SSRI，SNRI,SNRI+NaSSA,SNRI+阿立哌唑)，所有这些都是无效的，有持续的自杀念头，通常需要密集的个人监控。患者最终成功接受了氟西汀的锂增强治疗，没有副作用.在住院期间，她还接受了ASD专业中心的评估，根据自闭症诊断观察时间表（ADOS）和自闭症诊断访谈修订（ADI-R）评分进行ASD诊断，以及高级精神科医生的临床判断。本病例报告显示，临床医生不应忽视未诊断的自闭症作为TRD的可能原因，尤其是没有身份证的女性，较高的低诊断率可能部分与他们更多地使用伪装有关。它还表明，ASD诊断不足和由此产生的未满足的需求可能与压力经历的脆弱性有关，抑郁症,和自杀。此外，它显示了为自闭症青年TRD提供护理的复杂性，表明锂的增强疗法，在典型的发展样本中，一种通常推荐的难治性抑郁症的治疗策略，在这个人群中也可能是有效的。
