Challenges and opportunities in the diagnosis and treatment of early-onset psychosis: a case series from the youth affective disorders clinic in Stockholm, Sweden

Abstract

Early-onset psychosis is linked to adverse long-term outcomes, recurrent disease course, and prolonged periods of untreated illness; thus highlighting the urgency of improving early identification and intervention. This paper discusses three cases where initial emphasis on psychosocial treatments led to diagnostic and therapeutic delays: (1) a 15-year-old misdiagnosed with emotionally unstable personality disorder and autism, who improved on bipolar medication and antipsychotics; (2) another 15-year-old misdiagnosed with autism, who stabilized on lithium and antipsychotics, subsequently allowing for gender dysphoria evaluation; (3) a 9-year-old autistic boy incorrectly treated for ADHD, who recovered with appropriate antipsychotic treatment. These cases illuminate the vital importance of adhering to a diagnostic hierarchy, prioritizing diagnostic utility, and conducting longitudinal evaluations to facilitate early targeted treatment of psychotic symptoms in early-onset psychosis. Adherence to such strategies can minimize delays in managing early-onset psychosis and improve long-term prognoses.

Adolescent and Adult Transitions From Major Depressive Disorder to Bipolar Disorder

“…3 Moreover, youths may present with atypical presentations of BD, which may contribute to increased latencies in these populations. [4][5][6] This delay is a concern as extended periods of untreated BD are associated with adverse long-term outcomes, a more recurrent disease course, a more difficult-to-treat illness, suicide attempts, and suicide deaths. 7,8 The transition from major depressive disorder (MDD) to BD in youths is an important area of study, 9 with independent research reporting conversion rates from 3.6% to 48%, with higher figures often associated with younger patients.…”