Autistic symptoms in unaffected first-degree relatives of people with schizophrenia: results from the Italian Network for Research on Psychoses multicenter study

Abstract: Background: Autistic symptoms represent a frequent feature in people with schizophrenia spectrum disorders (SSD), with a significant impact on clinical, cognitive and functional outcomes. However, the prevalence and the cognitive and functional correlates of autistic symptoms in unaffected firstdegree relatives of people with SSD remain to be assessed. Methods: A total of 342 unaffected first-degree relatives related to 247 outpatients diagnosed with schizophrenia were recruited as part of the multicenter study of the Italian Network for Research on Psychoses (NIRP). Autistic features were measured with the PANSS Autism Severity Scale (PAUSS). Three groups of participants defined on presence and severity of autistic symptoms were compared on a wide array of cognitive and functional measures. Results: Of the total sample, 44.9% presented autistic symptoms; 22.8% showed moderate levels of autistic symptoms, which can be observed in the majority of people diagnosed with SSD. Participants with higher levels of autistic symptoms showed worse performance on Working Memory (p=0.014) and Social Cognition (p=0.025) domains and in the Global Cognition composite score (p=0.008), as well as worse functional capacity (p=0.001), global psychosocial functioning (p<0.001), real-world interpersonal relationships (p<0.001), participation in community activities (p=0.017) and work skills (p=0.006). Conclusions: A high prevalence of autistic symptoms was observed in first-degree relatives of people with SSD. Autistic symptoms severity showed a negative correlation with cognitive performance and functional outcomes also in this population and may represent a diagnostic and treatment target of considerable scientific and clinical interest in both patients and their first-degree relatives. Keywords: Autism spectrum disorder; cognition; endophenotype; psychosocial functioning; schizophrenia first-degree relatives; social cognition.