20.500.12556/RUL-180888 Kvalitativne razlike med motnjo avtističnega spektra in motnjo shizofrenskega spektra Qualitative differences between autism spectrum and schizophrenia spectrum disorder Uvod: Motnji avtističnega (MAS) in shizofrenskega spektra (MSS) imata skupno zgodovino. Besedo »avtizem«, ki v grobem pomeni umik iz socialne sfere, je prvi uporabil Eugen Bleuler za opis glavne značilnosti shizofrenije. Leo Kanner in Hans Asperger sta besedo avtizem prevzela in uporabila za opis otrok, ki so kazali primanjkljaje na področju socializacije. MAS in MSS sta nevrorazvojni motnji in opredeljeni s spektrom, skupne značilnosti pa so našli tudi na genetski ravni. Tako se motnji pričakovano prekrivata v znakih in simptomih, predvsem na socialnem področju, zato prihaja do napačnih diagnoz. V kliničnih praksah je uporabnost diagnostičnih kriterijev z namenom diferencialne diagnoze šibkejša, še posebej takrat, ko v ospredju ni tipičnih psihotičnih znakov. Pravilna diagnostika pa je izrednega pomena za ustrezno zdravljenje. Namen, cilj: Namen kvalitativne raziskave je proučevanje MAS in MSS s prvoosebne perspektive prek fenomenološkega kliničnega raziskovanja subjektivnih izkušenj, z namenom iskanja prekrivanj in predvsem pomembnih razlik med motnjama, ki se jih da nasloviti med diagnostičnim intervjujem. Cilj raziskave je tudi opredeliti centralnost posamezne motnje kot osrednje značilnosti, po kateri se motnji med seboj ločujeta. Preiskovanci in metode: V raziskavo je bila vključena klinična populacija mladostnikov ter mladih odraslih, starih od 15 do 26 let, z diagnozami motnje avtističnega in shizofrenskega spektra. Skupno število udeležencev, vključenih v raziskavo, je 42, po 21 iz vsakega spektra. Posamezniki v raziskavi niso bili akutno psihotični, bili so brez pridruženih razpoloženjskih ali organskih motenj in motenj, vezanih na uporabo psihoaktivnih snovi. Bili so vsaj povprečno inteligentni in brez govornih motenj. Uporabljena je bila Ocenjevalna lestvica simptomov (SCL-R 90), Lestvica globalnega nivoja funkcioniranja (CGAF/GAF) ter 2 polstrukturirana fenomenološka intervjuja Examination of Anomalous Self Experience (EASE) ter 2 domeni iz Examination of Anomalous World Experience (EAWE), ob čemer smo udeležencem zastavili tudi nekaj komplementarnih vprašanj. Rezultati: Na Ocenjevalni lestvici simptomov v splošnem rezultati niso bili pomembno povišani pri obeh vzorcih, na podlestvici Paranoidne ideacije je bila razlika med vzorcema statistično pomembna (p<.05), v prid MSS. Na (C)GAF je bila razlika med vzorcema statistično pomembna in posamezniki iz vzorca MSS pomembneje slabše funkcionirajo kot iz vzorca MAS (p<.001). Razlika na EASE je bila statistično pomembna znotraj vseh 5. domen in na skupnem rezultatu (p<.001), saj je izrazito več posameznikov iz vzorca MSS poročalo o fenomenih motenj sebstva, zajetih v intervjuju, med tem, ko na EAWE razlika med vzorcema ni bila statistično pomembna na nobeni domeni. Iz kvalitativnega vidika se je pokazala pomembna razlika med vzorcema v motnji ipseitete oziroma motnji minimalnega sebe in doživljanja sebe s prvoosebne perspektive, v motnjah demarkacije (razmejevanja med seboj in zunanjim svetom), v paranoidni anksioznosti, motnjah delovnega spomina ter magičnem mišljenju. O tovrstnih fenomenih so poročali le posamezniki iz vzorca MSS. Prekrivanja so se pokazala v naslednjih lastnostih: obsesiven stil mišljenja, hiperreflektivnost, fokus na detajle in motnje pozornosti, senzorna občutljivost, sinestezije, pomanjkanje samoumevnosti v socialnih odnosih, občutki inferiornosti v socialnih odnosih, socialna anksioznost, težave z vzpostavljanjem očesnega stika ter avtističen umik. Kljub prekrivanju v vedenju (npr. pomanjkljiv očesni stik, avtističen umik) pa smo s poglobljeno analizo ozadja prišli tudi do pomembnih kvalitativnih razlik med motnjama, ki so vezane na samo centralnost motnje, kar pri MSS predstavlja motnjo ipseitete, pri MAS pa motnjo primarne intersubjektivnosti. Razprava: Vzporedna primerjava subjektivnih izkušenj in doživljanj posameznikov z MAS in MSS nam omogoča vpogled v notranji svet posameznikov iz obeh spektrov ter predvsem diferenciacijo med motnjama, ki se v vedenjih in posameznih simptomih lahko tudi močno prekrivata. Njihov »avtizem« se tako, glede na rezultate razsikave, prekriva v pomanjkljivi socialni samoumevnosti in občutkih inferiornosti, zato so posledično anksiozni in nagnjeni k umiku. Ob tem pa so tudi prisotne pomembne diferencialnodiagnostične lastnosti, ki so ekskluzivno značilne za MSS, in sicer motnja ispeitete ter motnje demarkacije, kar lahko predstavlja diferencialnodiagnostično lastnost, ki se jo lahko naslovi že med diagnostičnim intervjujem, kar nam lahko omogoča boljšo diagnostično oceno. Introduction: Autism Spectrum Disorder (ASD) and Schizophrenia Spectrum Disorder (SSD) share a common history. The term "autism," broadly meaning withdrawal from the social sphere, was first used by Eugen Bleuler to describe a key feature of schizophrenia. Leo Kanner and Hans Asperger used the term "autistic" as an adjective to describe the condition of children they encountered professionally. Despite being categorically different disorders, ASD and SSD overlap in many aspects. Both are defined as spectra, are neurodevelopmental, and share common characteristics at the genetic level. Consequently, the disorders are expected to overlap in signs and symptoms, leading to misdiagnoses. In clinical practice, the utility of diagnostic criteria for differentiating these disorders is weaker, especially when typical psychotic symptoms are not prominent. Accurate diagnosis is crucial for appropriate treatment. Objective: The aim of this study is to qualitatively examine SSD and ASD from a first-person perspective through phenomenological clinical research of subjective experiences, to identify similarities and mostly differences between the spectra, and to define the centrality of each disorder as the core characteristic that distinguishes it from other disorders. The main differences could be addressed during the diagnostic interview. Participants and Methods: The study included a clinical population of adolescents and young adults aged 15 to 26 years, diagnosed with Autism Spectrum Disorder and Schizophrenia Spectrum Disorder. The total number of participants was 42, with 21 in each sample. Participants were not acutely psychotic, had no comorbid mood or organic disorders, and no substance use disorders. They were at least of average intelligence and had no speech disorders. The Symptom Checklist (SCL-R 90), Global Assessment of Functioning (CGAF/GAF), and two semi-structured phenomenological interviews, Examination of Anomalous Self Experience (EASE) and two domains from Examination of Anomalous World Experience (EAWE), were used, along with some complementary questions. Results: On the symptom checklist, the results on the subscales were not significantly elevated in either sample. On Paranoid Ideation subscale, the difference between the samples was statistically significant (p<.05), favouring SSD. On the (C) GAF, the difference between the samples was statistically significant, with individuals in the SSD sample functioning significantly worse than those in the ASD sample (p<.001). The difference on EASE was statistically significant across all five domains and the total score (p<.001), with significantly more individuals in the SSD sample reporting self disorder phenomena from the interview, while the difference on EAWE was not statistically significant in any domain. Qualitatively, significant differences were found between the samples in the disturbance of ipseity (self-experience from a first-person perspective), demarcation disturbances (boundaries between self and the external world), paranoid anxiety, short term memory disorder and magical thinking. Overlaps were found in the following characteristics: obsessive thinking style, hyperreflectivity, focus on details and attention disturbances, sensory sensitivity, synaesthesia, lack of social self-evidence, feelings of inferiority in social relationships, social anxiety, difficulty establishing eye contact, and autistic withdrawal. Despite behavioural overlaps (e.g., lack of eye contact, autistic withdrawal), detailed background analysis revealed qualitative differences between the disorders, related to the centrality of the disorder, with SSD characterized by disturbances of ipseity and ASD by disturbances of intersubjectivity. Discussion: A parallel comparison of subjective experiences of individuals with ASD and SSD provides insight into the inner world of individuals from both spectra and, above all, differentiation between the disorders, which can significantly overlap in behaviours and individual symptoms. Their "autism," according to the study results, overlaps in deficient social self-evidence and feelings of inferiority, leading to anxiety and withdrawal. However, there are also significant differential diagnostic features that are exclusively characteristic of SSD, namely disturbances of ipseity and demarcation, which can serve as differential diagnostic features that can be addressed during the diagnostic interview, allowing for a better differential diagnostic assessment. motnja avtističnega spektra motnja shizofrenskega spektra avtizem ipseiteta demarkacija intersubjektivnost fenomenologija Autism Spectrum Disorder Schizophrenia Spectrum Disorder autism ipseity demarcation intersubjectivity phenomenology true false false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2026-03-19 07:16:00 2026-03-19 07:16:25 2026-03-22 03:49:29 0000-00-00 00:00:00 2026 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1970-01-01 38966 8387.pdf 8387.pdf 1 668C3D8867E3ED1A463A4F808D9C0508 953e92b5e6da320117eca29cc76bf564b03fa40f1eff2f702f3f567ca722ea21 13d6a89b-235b-11f1-b0ab-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=230832 Medicinska fakulteta 0 0 0