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Minerva Psychiatry 2021 June;62(2):107-11

DOI: 10.23736/S2724-6612.20.02142-1


language: English

Onset of treatment-resistant schizophrenia in an adolescent with undiagnosed autism

Roberto KELLER 1 , Diana CARLI 2, Stefania BRIGHENTI 1, Luana SALERNO 3, Elisa BIAMINO 2, Elena RAINÒ 4, Benedetto VITIELLO 4, Giovanni B. FERRERO 2

1 Unit of Local Health ASL of Turin, Department of Mental Health, Autism Center, Turin, Italy; 2 Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy; 3 Institute of Neuroscience (INS), Florence, Italy; 4
Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy

A psychotic onset in an adolescent patient may hide an undiagnosed autism; this is particularly possible in a person with autism with high intellectual functioning and good academic performance, who may also have been bullied. In this case, the psychotic clinical picture was a treatment-resistant schizophrenia that required clozapine treatment since adolescence. Here we report a patient with an unrecognized high-functioning autism spectrum disorder who presented a psychotic onset at the age of 12 years after school bullying episodes. He did not have other relevant medical comorbidities nor diagnosed neuroradiological, metabolic and genetic anomalies. The patient presented a rapid regression characterized by loss of school competencies, disorganized behavior, paranoid delusional ideation, and infantilism. He did not respond to treatment with chlorpromazine, haloperidol, risperidone, paliperidone and aripiprazole. He stabilized without recovering the previous level of functioning with the introduction of clozapine at the age of 16 years. This case indicated the importance of early diagnosis of autism spectrum disorder even in children with high intellectual functioning, to activate habilitative services and protective interventions regarding bullying. Moreover, it also shows the need of training programs for clinicians and teachers to detect undiagnosed persons even in adolescence.

KEY WORDS: Autism spectrum disorder; Schizophrenia; Bullying

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