Recognizing early-onset psychosis in a child misdiagnosed with autism

Abstract

Early-onset psychosis can manifest as a variety of presentations ranging from autism, depression, to autoimmune encephalitis. This case emphasizes the need for detailed evaluation to avoid misdiagnosis. Here is a 13-year-old boy who is a known case of seizure disorder, with a prior diagnosis of autism spectrum disorder, presented to the outpatient department with persisting symptoms despite treatment. Detailed evaluation suggested the onset of symptoms after age 8 years where there has been a gradual onset of symptoms with complaints of behavioral changes such as unprovoked anger outburst, physical aggression toward family members, decreased interaction with peers and family members, decline in eye contact, no emotional reciprocity, no sharing of interest, poor academic performance, and sleep disturbance for the last 5 years. Occasional muttering to himself and stereotypic hand movements were noted. There was further worsening of symptoms, and the patient required assistance in doing all activities of daily living for the last 2 years. Diagnosis of early-onset psychosis was made. Autoimmune encephalitis was ruled out as his blood workup was negative. Treatment with oral risperidone led to a significant improvement in his symptoms. The need for revaluation and comprehensive clinical assessment and periodic diagnostic reconsideration is required for implementing appropriate interventions and improving patient outcomes.