Sofia Morais

Innate vulnerabilities in autism spectrum disorder (ASD) could increase the risk of comorbid psychiatric conditions and judicial problems. Persistent deficits in social communication, narrow, repetitive interests, or sensory impairments could lead to deviant behaviors. This case study refers to a 22-year-old male who exhibited behavioral particularities in agreement with the presence of frotteurism and kleptomania. The impulsive nature of these behaviors was consistent with repetitive and stereotyped patterns. Premorbid social impairments, mainly in the communication domain, were also prominent, leading to the suspicion of ASD. This case report introduces two rare comorbid conditions in ASD, with forensic implications that can severely impact patients’ lives. The importance of this association especially applies to high-functioning ASD, given the propensity to an unknown diagnosis. A high-level awareness of ASD, especially in forensic psychiatry, is of paramount pertinence regarding the opportunity for early interventions addressing sexual education and social skills training. Autism, high-level, frotteurism, kleptomania, sexual, impulse, forensic, psychiatry, social skills As vulnerabilidades inatas nas perturbações do espectro do autismo (PEA) aumentam o risco de comorbilidades psiquiátricas e questões de enquadramento legal. Os défices persistentes na comunicação social, os interesses restritos e repetitivos, ou as particularidades sensoriais podem facilitar o aparecimento de comportamentos desviantes. Este caso clínico descreve a história de um jovem de 22 anos que exibia comportamentos particulares categorizados em frotteurismo e cleptomania. A natureza impulsiva destes comportamentos era também ela consistente com padrões repetitivos e estereotipados. A referência a prévias dificuldades a nível social, sobretudo na vertente da comunicação foi proeminente, tendo conduzido à suspeita do diagnóstico de PEA. Este caso apresenta duas condições raras, comórbidas com a PEA, cujas implicações a nível legal podem afetar severamente a vida dos indivíduos. A importância desta associação aplica-se sobretudo em PEA de alto funcionamento, devido à probabilidade destes indivíduos chegarem não diagnosticados à vida adulta. O diagnóstico de PEA mostra- -se pertinente sobretudo no campo da psiquiatria forense, pois a aferição diagnóstica permitirá o acesso a intervenções adequadas a nível da educação sexual e competências sociais.

Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback (NF), a training method for the self-regulation of brain activity, has shown promising results as a neurorehabilitation tool, depending on the ability of the patient to succeed in neuromodulation. This study explores connectivity-based structural and functional success predictors in an NF n-back working memory paradigm targeting the dorsolateral prefrontal cortex (DLPFC). We established as the NF success metric the linear trend on the ability to modulate the target region during NF runs and performed a linear regression model considering structural and functional connectivity (intrinsic and seed-based) metrics. We found a positive correlation between NF success and the default mode network (DMN) intrinsic functional connectivity and a negative correlation with the DLPFC-precuneus connectivity during the 2-back condition, indicating that success is associated with larger uncoupling between DMN and the executive network. Regarding structural connectivity, the salience network emerges as the main contributor to success. Both functional and structural classification models showed good performance with 77% and 86% accuracy, respectively. Dynamic switching between DMN, salience network and central executive network seems to be the key for neurofeedback success, independently indicated by functional connectivity on the localizer run and structural connectivity data.

Aim: Patients in early phases of schizophrenia or mood disorders with psychotic symptoms have a wide array of metabolic abnormalities. We analysed the potential predictive value of uric acid (UA) levels and other metabolic parameters in first‐episode psychosis patients to differentiate between non‐affective and affective psychosis.Methods: Retrospective chart review of all patients referenced to a first‐episode psychosis unit (n = 149), between 2012 and 2017, with available UA levels. Patients included (n = 37) were compared according to the follow‐up diagnosis of schizophrenia or mood disorder.Results: Mood disorder patients presented higher UA levels (p = .030) and lower fasting blood glucose levels (p = .020) compared with schizophrenia patients. The remaining variables did not show significant intergroup differences.Conclusions: Findings in this first‐episode psychosis cohort support previous evidence suggesting higher UA levels as a predictor of affective psychosis and glucose dysfunction as predictive of schizophrenia. Further studies are needed to explore metabolic parameters as possible diagnostic predictors in first‐episode psychosis.