EPV385 - Atypical and Severe Psychotic Presentations in Adults with Autism Spectrum Disorder: Clinical Insights from Three Cases
EPV385
Atypical and Severe Psychotic Presentations in Adults with Autism Spectrum Disorder: Clinical Insights from Three Cases
A. K. Rios-Landeo 1,*, S. Albarzani 1, E. Ros-Cucurull 2, F. Palma-Alvarez 2, O. Akpubi 1
1Psychiatry , University Hospital Waterford - HSE, Waterford , Ireland, 2Psiquiatria, Hospital Universitari Vall d’Hebron, Barcelona, Spain
Introduction: Autism Spectrum Disorder (ASD) is recognised as a significant vulnerability factor for the development of psychotic disorders in adulthood. Presentations are frequently atypical and variable trajectories that challenge timely recognition and management. Overlapping features can obscure emerging psychosis. Pharmacological treatment is often constrained by poor tolerability, inconsistent efficacy, and higher rates of treatment resistance compared with non-ASD populations. Despite these clinical challenges, systematic case-based data in adults remain limited, hindering the development of tailored therapeutic approaches.
Objectives: To present three adult cases with ASD exhibiting atypical or severe psychotic symptoms, highlighting diagnostic complexity, functional impact, and treatment challenges.
Methods: Three adults with ASD were systematically evaluated through comprehensive clinical histories, structured psychiatric assessments, detailed mental state examinations, and longitudinal treatment records. Emphasis was placed on atypical psychotic features, functional impairment, and individualized pharmacological and psychosocial management strategies.
Results:
Case |
Age |
Sex |
Primary Diagnosis |
ASD Features |
Psychotic/Affective Symptoms |
Triggers |
Treatment |
Outcome |
|
1 |
25 |
M |
Schizoaffective |
Social withdrawal, rigid behaviours |
Severe negative symptoms, self-harm, minimal insight |
Psychosocial stressors |
Clozapine + Aripiprazole + Valproate |
Partial remission, ongoing support (residential care) |
|
2 |
30 |
F |
Schizoaffective |
Social naivety, sensory sensitivity |
Polymorphic delusions, affective dysregulation |
Psychosocial stressors, sleep loss |
Lithium + Quetiapine + Paliperidone + Psychotherapy + psychosocial support |
Full remission |
|
3 |
32 |
F |
Delusional Disorder |
High-functioning ASD, social naivety, rigid behaviours |
Persecutory delusions, severe self-harm, minimal insight |
Psychosocial stressors, sleep loss |
Olanzapine + Aripiprazol + psychosocial support |
Full remission |
Conclusions: Psychosis in ASD is not only more frequent than previously recognised but also clinically distinct, often presenting with polymorphic, severe, and treatment-resistant profiles. The three cases illustrate key clinical scenarios: (1) profound negative symptoms hindering recovery, (2) polymorphic psychosis complicated by pharmacological intolerance, and (3) severe persecutory delusions masked by high cognitive functioning and minimal insight. These insights stress the need for early recognition, tailored pharmacological strategies, structured psychosocial interventions, and sustained multidisciplinary care. Broader clinical awareness and targeted research are essential to improve outcomes in this highly vulnerable subgroup.
(Beebani et al., 2022; Deste et al., 2020; Strålin & Hetta, 2019; Yalcin et al., 2016; Bargiela et al., 2016; Downs et al., 2017; Chisholm et al., 2015; Sporn et al., 2004)
Disclosure of Interest: None Declared