More on the nature of my delusions at 14

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It seems my delusions at 14 may have just been a manifestation of autism spectrum disorder. The doctor I went to for my third opinion, an adolescent and adult autism specialist, said that during times of stress, psychosis can be triggered in some autistic people.

I was thinking more on the time I developed the delusions, and the second and third opinion saying that was probably not bipolar disorder and certain things I remember, suggest that it probably wasn't mania. Though I did have grandiose delusions, they did not seem to emerge from increased confidence or an elated mood; neither did anybody see that I was more energetic or active at the time. Also, I did sleep fully, but my sleep schedule was inverted: Sleeping mostly during the day and staying awake during the night. Though my speech was disorganized at times, and that was noted, nothing about pressured speech was noted, and I don't remember my thoughts "speeding up" or anything at that time.

The grandiose delusions seemed to emerge from a larger delusional context, which content was highly reminiscent of the fantasies I often engaged in both before and after the psychotic episode. In fact, even though I was pretty mum about what my delusions were really about, my doctor and my parents, I think, could tell that it was in some way related to my tendency to fantasize; they made me feel like I had to step on my tippy-toes when I fantasized, or even read fantasy. For example, when I read The Lord of the Rings for the first time about a year or two after the psychotic episode, my dad warned me, "You know that's not real, right?"

Of course, with the delusions and the disorganization, and mania being ruled out, you'd look next at schizophrenia. Some things from my childhood did seem to match schizophrenia: Poor premorbid adjustment, low scores in the Digit Symbol-Coding subtest of the WISC-III, poor fine motor skills and not exactly great gross motor skills, a steady decline in functionig in the year or so leading up to the psychotic episode, low Processing Speed, tendency to social withdrawal, and preceding the onset of psychosis a state of Wahnstimmung (a sense that something in your environment has changed, but you don't know what).

Then again, despite developing psychosis at such a young age (14)--the younger you are, the worse outcomes tend to be,--afterward I made a big improvement, functioning better than I ever had, and have not relapsed. I have had attenuated psychotic symptoms, though, in times of stress, which seems to support what the doctor I saw for my third opinion said. He said the solution would be, If I have psychotic-like symptoms, then I would be put on a short round of antipsychotic medication to resolve them, but I would not be maintained on medication. This seemed to work well back in May, when it felt like everyone was looking at me--it was like I kept seeing people's eyes always staring specifically at me,--they went away after being on antipsychotics not for long.

This sort of thing makes sense, I think.

Sounds like you have things pretty well handled.

I never had a reoccurance after my episode at about the same age. What's odd for me is that it feels that part is walled off since. It bothers me a little, because I sense a tie in with creativity and spontaneity--those feel walled off too sometimes. I've read of links between those before, and it makes sense to me. I went from a great amount of creative output to a trickle though, which does make me sad.

Hate you had to experience that, but it's nice it's not just me I guess.

Yes it does and also the ICD-10 states that, that especially in the adulesences of ppl with Asperger's, a psychotic episode can occour. But in fact it's a matter of interpretation if you say it's still part of ASD or not. I once read that there is not much difference found in the brain of ppl with psychotic depression and schizophrenia, because there is a spectrum from one to the other, eventhough it's officially something different. Psychosis is psychosis.

So I personally think it doesn't make much sence to over-dx ppl, because he is actually right, but someone else who would dx it in addition wouldn't be wrong too. There are no real guidlines when it comes to comorbidities, what's a huge problem, because many disorders are highly overlapping and it's a matter of personal opinion when to start dx comorbidities. But in fact autism specialists tend to be more carefull dx comorbidities, because they have seen the different ways ASD can present itself.

MjrMajorMajor,

Thanks. Would you mind sharing your experience?

Raziel,

Ja. Since I may be getting SRS soon, that brings on a lot of anticipation, fighting getting my hopes up, and worry and anxiety, along with poor sleep. In some ways, it's like the time back in April before I had those attenuated psychotic symptoms in May, though there is a lot more reason for optimism now. Oh well, at least we have a plan this time.

When I was 14 I was put on a medicine to treat ADHD, I think it was Concerta, not long after taking the medications I developed at first grandious fantasies and then it morphed into paranoid delusions. That went away after I stopped taking the medication, but then came back years later. I was diagnosed first with Paranoid schizophrenia, and then Schizoaffective bipolar disorder, which is like bipolar with an affect of schizophrenic symptoms like delusions, disorganized thinking, paranoia, inability to plan, but there are times when I'm almost normal. It's not nearly as bad as schizophenia is, but is worse than just bipolar in terms of the prognosis.

Interesting. The research and reference texts I've seen say that schizoaffective disorder is closer to schizophrenia than mood disorder, though. This study reaches that conclusion:

http://www.ncbi.nlm.nih.gov/pubmed/23528024

I believe most clinicians and researchers consider it to be part of the schizophrenia spectrum.

Thanks for sharing your experience. I guess if I started having recurrent or difficult-to-treat severe psychotic symptoms, I could end up with a diagnosis like that too. Considering my age, though, it is probably less likely.