Gender Dysphoria Versus Acute Psychosis: Can One Properly Diagnose Gender Dysphoria Solely During Acute Psychosis?

Fisher, Kristy A.; Scemla, Samantha; Villalba, Clara L. Alvarez; Kroin, Jessica

doi:10.36518/2689-0216.1395

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Prior to treatment, the patient had been denied such assessments due to the severity of their symptoms. Up to 25% of individuals with schizophrenia may also experience gender dysphoria 24 , 25 . The case confirms both conditions can co-exist, and gender dysphoria may persist post-psychotic treatment.…”

Section: Discussionmentioning

confidence: 99%

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

Lundberg,

Andersson,

Lundberg

et al. 2024

Schizophr

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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.

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Section: Discussionmentioning

confidence: 99%

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

Lundberg,

Andersson,

Lundberg

et al. 2024

Schizophr

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“…Within psychiatry, gender identity disorder (prior to DSM‐5) was historically used to pathologize patients and discount other symptoms rooted in minority stress (Dhillon et al, 2011; Rodriguez et al, 2018), and desire to transition genders even considered a psychotic delusion through the 1960s (Meijer et al, 2017). There are case reports of gender dysphoria symptoms remitting following resolution of acute psychosis states (Campo et al, 2022; Fisher et al, 2022). However, literature suggests this presentation is uncommon, and gender dysphoria is typically not diagnosed when psychosis is comorbid.…”

Section: Introductionmentioning

confidence: 99%

Gender‐affirming care in the assessment and treatment of psychosis risk: Considering minority stress in current practice and future research

Ceccolini

Green

Friedman‐Yakoobian

2023

Early Intervention Psych

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IntroductionAlthough research has documented the marked disparities in rates of psychosis‐spectrum diagnoses in various socially marginalized populations, there is limited research addressing the needs of gender expansive individuals in the context of psychosis‐spectrum illnesses using a minority stress lens. As clinical high‐risk for psychosis (CHR‐p) assessment and treatment becomes accessible to increasingly diverse populations, there is a need for clinicians to demonstrate greater clinical competency working with individuals across diverse social backgrounds and identities.MethodsWe examined rates of gender expansive (GE) patients seeking evaluation at an urban‐based CHR‐p clinic and compared the diagnostic profile of GE individuals to cisgender patients. Post‐hoc analyses were conducted on clinical variables with significant differences between the cisgender and GE groups.ResultsThe proportion of GE patients seeking evaluation increased from 2017 (9.3%) to 2021 (16.7%). Compared to cisgender youth, GE patients had significantly higher depressive, social anxiety, borderline personality disorder symptoms, higher levels of suicidality and non‐suicidal self‐injurious behaviour, and lower role functioning. Gender identity was predictive of suicidality controlling for social anxiety, borderline symptoms, and role functioning.ConclusionsWe review implications for CHR‐p treatment and discuss ways to integrate minority stress theory and gender‐affirming practices into coordinated specialty care for CHR‐p patients.

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“…This fluidity in self-image can give rise to a desire to change aspects of oneself, including appearance, gender, or religion [ 6 ]. It is important not to diagnose gender dysphoria solely during a psychotic episode given the intrinsic lack of stable identity that often defines psychosis; re-evaluation of gender dysphoria is recommended after psychotic symptoms are stabilized [ 8 ]. Transgender people may also self-describe as psychotic due to a lack of their own understanding of their own identities and experiences [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Psychosis With Religious Delusions in a Reportedly Intersex Transgender Person

Kemp¹,

Zhang²,

Wang³

et al. 2023

Cureus

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There is limited research on mental illness in intersex and transgender individuals. This case report describes psychosis in a self-identified intersex transgender individual with a past psychiatric history of schizoaffective disorder. The patient and collateral information reported colpocleisis as a newborn, was assigned and raised as a male, then transitioned to a female. When the patient discussed her experiences as a transgender person, she would become significantly more psychotic with disorganized speech and grandiose Christian delusions. A psychological assessment including a projective test was completed to better understand the patient’s psychotic symptoms along with her views of self, others, and the world. This case explores how the psychotic process interacts with gender dysphoria in a predominantly cisnormative, Christian society, with discussions of psychological defenses and psychodynamic theory.

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Gender Dysphoria Versus Acute Psychosis: Can One Properly Diagnose Gender Dysphoria Solely During Acute Psychosis?

Cited by 3 publications

References 19 publications

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

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

Gender‐affirming care in the assessment and treatment of psychosis risk: Considering minority stress in current practice and future research

Psychosis With Religious Delusions in a Reportedly Intersex Transgender Person

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