Innovations In Clinical Neuroscience

MAR-APR 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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33 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE March-April 2018 • Volume 15 • Number 3–4 C A S E R E P O R T S Since the concept of psychosis by Blueler 1 and Kraeplin 2 first emerged, autism spectrum disorder (ASD) was thought to be an early manifestation of psychosis or schizophrenia, and ASD in children was referred as "childhood psychosis" or "schizophrenic syndrome of childhood." 3 On the basis of similar findings in brain regions, neurotransmitter systems, genetic markers, linguistic traits, impaired attention, theory of mind, and neuropsychological dysfunction, ASD and schizophrenia/psychosis have been proposed to be on two ends of a spectrum related to the social brain. 4,5 The exact prevalence of psychosis in individuals with ASD is not known, though some studies have reported that individuals with ASD are at an increased risk of developing psychosis. 3,6,7 It often becomes a diagnostic dilemma when an individual with a previous diagnosis of ASD presents with psychotic experiences. The situation becomes more challenging if the individual is a child (i.e., <13 years of age). The existing literature in this area suggests that the deficit symptoms of schizophrenia and symptoms of ASD are very similar, causing a boundary overlap during diagnostic assessments. Patients with ASD often have intellectual disability and are unable to clearly express psychotic experiences. They might present with disruptive behavioral problems, which can be difficult to treat. Here, we present a case of a 12-year-old male child with atypical autism who developed psychotic symptoms. Challenges in diagnosis, including differentials, and treatment are discussed. CASE VIGNETTE Patient A, a 12-year-old boy, was second in birth order and was delivered full-term by normal vaginal birth with no prenatal, perinatal, and postnatal complications. He was in the fifth grade of school and was from middle socioeconomic status with no family history of mental illness. He was brought to our child and adolescent psychiatric outpatient services by his parents, who reported that he had been exhibiting abnormal behavior and fearfulness for the last year. Compared to his elder sister, he had a delay of 2 to 3 months in achieving speech and motor milestones of development, and 3-to-4-month delay in social smiling and recognition of his mother. There was no history of significant physical illness. The parents reported that since early childhood, Patient A was less communicative with his siblings and children his age and/ or with family members. He used only a few words and often did so in a hypernasal tone. He would not approach or make eye contact with any guests at home and would start crying if his mother ever forced him to interact with any person who was not familiar to him. Patient A was disinterested in attending social gatherings, would not initiate interaction or A B S T R A C T Recent studies have shown that individuals with an autism spectrum disorder (ASD) are at an increased risk of developing psychosis. Diagnosing psychosis in such individuals can be challenging when they present with symptoms at a young age. A careful history and thorough assessment are essential for proper diagnosis to avoid mislabeling certain behavioral problems encountered among children with ASD. We present the case of a 12-year-old child with atypical autism who developed psychotic symptoms that led to a diagnostic dilemma. Proper exploration of early childhood history, prompt treatment with an antipsychotic medication, and social skill training led to resolution of psychotic symptoms and improvement in disruptive symptoms of autism. Keywords: Autism, psychosis, association, autism spectrum disorder, ASD Psychosis in a Child with Atypical Autism: A Case Report and a Brief Review of the Association of Psychosis and Autism by SWAPNA JEET SAHOO, MD; SUSANTA KUMAR PADHY, MD; NEHA SINGLA, MD; and AAKANKSHA SINGH, MD Drs. Sahoo, Singla, and Singh are Senior Residents and Dr. Padhy is Associate Professor in the Department of Psychiatry at the Post Graduate Institute of Medical Education and Research in Chandigarh, India. Innov Clin Neurosci. 2018;15(3–4):33–36 FUNDING: The authors have received no funding in any kind for this manuscript. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. CORRESPONDENCE: Swapnajeet Sahoo; Email: swapnajit.same@gmail.com.

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