title: Bipolar disorder in adults with Asperger׳s Syndrome: a systematic review.
abstract: BACKGROUND
  Asperger׳s Syndrome (AS) is a neurodevelopmental disorder included in the Autism Spectrum (ASD). The current literature shows growing evidence of a high rate of comorbidity between AS and other psychiatric disorders, particularly Bipolar Disorder (BD). We reviewed available epidemiological and clinical data on BD-AS comorbidity and its diagnostic and therapeutic implications
  
  
  METHODS
  A systematic review of the literature was conducted through PubMed, Scopus and Psych-Info using combinations of the following search terms: Asperger׳s Syndrome, Bipolar Disorder, depression, mood disorder, psychiatric comorbidity, treatment, mood stabilizers, anticonvulsants, antipsychotics, and antidepressants.
  
  
  RESULTS
  BD prevalence in adults with AS ranges from 6% to 21.4% of the cases. Relatives of patients with AS showed a doubled risk of being affected by BD and a BD prevalence near to 10%. When comorbid with AS, BD assumes peculiar features which might shape its under-recognition or misdiagnosis (especially schizophrenia when psychotic symptoms are prominent). Although controlled data on pharmacological treatments in BD-AS comorbidity are substantially lacking, information is derived by open observations, case series and chart reviews. Mood stabilizers should be considered the first choice, and antipsychotics, especially second generation drugs (SGA) with 5-HT2a antagonism, have been shown useful in controlling psychotic and behavioral symptoms and improving social withdrawal. Some evidence of efficacy for the treatment of anxiety, obsessive-compulsive symptoms and depression is reported for SSRI antidepressants. The use of these drugs should be carefully monitored, because activation with hypomanic or manic switches is reported up to 54% of the treated subjects.
  
  
  CONCLUSIONS
  BD in AS patients is frequent, usually it onsets during adolescence and is often characterized by atypical presentation, making its correct identification particularly difficult. A correct diagnosis of BD in AS individuals has relevant implications on the choice of adequate psychopharmacological, psycho-social and rehabilitative treatments.
authors.affiliation: Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Pisa, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Vannucchi
authors.affiliation: IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Via dei Giacinti 2, 56018 Calambrone (Pisa), Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Masi
authors.affiliation: Institute of Behavioural Sciences "G. De Lisio", Via di Pratale 3, 56100 Pisa, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Toni
authors.affiliation: Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Pisa, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Dell'Osso
authors.affiliation: Otto Wagner Psychiatric Hospital of Vienna, Head of Department VI, Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Erfurth
authors.affiliation: Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Pisa, Institute of Behavioral Sciences "G. De Lisio", Via Roma, 67, 56100 Pisa, Italy. Electronic address: giulio.perugi@med.unipi.it.
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001007:Anxiety; D020817:Asperger Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D001526:Behavioral Symptoms; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Asperger׳s Syndrome; Bipolar Disorder; Comorbidity; Depression; Mood stabilizers; Psychopharmacological treatment