Asperger syndrome in adult patients: a case report

Asperger syndrome is a generalized developmental disorder characterized by qualitative impairment in social interaction and restricted and stereotyped patterns of behaviour, interests, and activities. The principal dimensions (psychopathological, neuropsychological and neurobiological) subtending the most frequent symptoms of Asperger syndrome can be traced back to a deviation in the cognitive processes which govern social reciprocity and to a peculiar style of information processing, usually associated with good cognitive and linguistic abilities. In adults, Asperger syndrome is an extremely variable disorder, from the clinical point of view, due to the heterogeneity of the nuclear symptoms and of the adaptations developed by the patients. Moreover, the evolution of Asperger syndrome, in adolescent and adult ages, is characterized by the appearance of clinical manifestations which tend to "mask" autistic symptoms, making them difficult to recognize by psychiatrists that have this type of patient in their care. The most frequent associated manifestations belong to obsessive-compulsive, anxiety and depressive spectrums. Moreover, obsessive-compulsive symptoms can often be assigned to a full-blown axis I obsessive-compulsive disorder. Consequently, adult psychiatrists can often recognize and treat the Axis I disorder in co-morbidity, but ignore the subtending autistic symptomatology. The fact that a psychiatric disorder, in an adult patient, could have links, in clinical and psychopathological terms, with pervasive development disorders, has notable repercussions in diagnostic and, above all, therapeutic clues. In fact, a patient with Asperger syndrome that presents, at clinical observation, obsessive-compulsive symptoms could receive the single diagnosis in axis I obsessive-compulsive disorder, with the consequent therapeutic plan of pharmacological and psychotherapeutic intervention. However, a deeper analysis of social and relational functioning of the patient could allow for the creation of an integrated diagnostic and therapeutic framework, both pharmacological and cognitive-behavioural, which would take into account the fact that one who presents the axis I disorder is a subject with the specific social and neuropsychological disabilities of Asperger syndrome. For these reasons, clinical management of this type of patient should be performed in strict association between child neuropsychiatry and adult psychiatry in order not to under-diagnose the Asperger syndrome in adult patients and to manage the passage from childhood to adult age and the relative modifications in psychopathological manifestations.