Polysubstance and Behavioral Addictions ina Patient with Bipolar Disorder: Role of LifetimeSubthreshold Autism Spectrum

This case report draws attention to the potential relevance of undetected autism spectrum symptoms in a bipolar patient with highwork functioning showing a peculiar addictive profile with impulsive and antisocial behaviors. A 23-year-old man with a diagnosisof Bipolar Disorder (BD) and Substance Use Disorder (SUD) was hospitalized at the Psychiatric Clinic of the University of Pisa fordiuretics and𝛽-2 adrenergic agonist abuse in a remission phase of benzodiazepines and substance abuse. He reported a history ofbehavioral addictions in the framework of a global high work functioning with particular skills in computer science. When assessedfor adult autism spectrum symptoms, despite not fulfilling a DSM-5 diagnosis of Autism Spectrum Disorder (ASD), he reporteda score of 93/240 at the Ritvo Autism and Asperger Diagnostic Scale (RAADS-r) and of 88/160 at the Adult Autism SubthresholdSpectrum (AdAS Spectrum), both indicative of ASD. We argue the possible role of adult subthreshold autism spectrum features,generally disregarded in adult psychiatry, in the peculiar addictive profile developed by this patient with BD that may deserveappropriate treatment.