Studies on structural brain abnormalities in individuals with autism spectrum disorders (ASD) have been of limited size and many findings have not been replicated. In the largest ASD brain morphology study to date, we compared subcortical, total brain (TBV), and intracranial (ICV) volumes between 472 subjects with DSM-IV ASD diagnoses and 538 healthy volunteers (age range: 6 to 64 years), obtained from high-resolution structural brain scans provided by the Autism Brain Imaging Data Exchange (ABIDE). Compared to healthy volunteers, we found significantly larger pallidum (Cohen’s d = 0.15) and lateral ventricle volumes (Cohen’s d = 0.18) in ASD. These enlargements were independent of total brain volume and IQ, passed FDR correction for multiple comparisons, and were observed in overall, male-only, and medication-free subjects. In addition, intracranial, hippocampal, and caudate volumes were enlarged in ASD at a nominal statistical threshold of p<0.05. This study provides the first robust evidence for pallidum enlargement in ASD independent from TBV and encourages further study of the functional role of the pallidum in individuals with autism spectrum disorder.

Delirious mania is an understudied psychiatric disorder with a mortality rate as high as 75%. Previous case studies suggest that electroconvulsive therapy (ECT) may be an effective treatment for delirious mania, though this procedure may not always be a viable option. We describe the case of a 20-year old patient, with no previous psychiatric history, who developed delirious mania over the course of four months. ECT was not a viable option for this patient due to his religious beliefs, so alternative treatment modalities were explored. After failing trials of risperidone and olanzapine, significant improvements in symptoms were exhibited with a trial of clozapine. We propose that clozapine may be an effective option in cases of delirious mania, when ECT is not a viable option. Additional research is still necessary to understand the pathology of this condition and potential treatment modalities.

Delirious mania is an understudied psychiatric disorder with a mortality rate as high as 75%. Previous case studies suggest that electroconvulsive therapy (ECT) may be an effective treatment for delirious mania, though this procedure may not always be a viable option. We describe the case of a 20-year old patient, with no previous psychiatric history, who developed delirious mania over the course of four months. ECT was not a viable option for this patient due to his religious beliefs, so alternative treatment modalities were explored. After failing trials of risperidone and olanzapine, significant improvements in symptoms were exhibited with a trial of clozapine. We propose that clozapine may be an effective option in cases of delirious mania, when ECT is not a viable option. Additional research is still necessary to understand the pathology of this condition and potential treatment modalities.