Quasipsychotic phenomena in autism spectrum disorders

This article presents a diagnostically ambiguous clinical case of a patient, Yakov, who had been classified as disabled since childhood due to a diagnosis of childhood-onset schizophrenia with an oligophrenic-like defect. Since the age of 3 years, he has been repeatedly hospitalized in psychiatric facilities and received antipsychotic therapy. However, during a specialized psychiatric assessment at the age of 23 years, the diagnosis of schizophrenia was not confirmed, as the observed psychopathological symptoms did not align with the diagnostic criteria. The initial diagnosis of childhood schizophrenia had been based on a misinterpretation of behavioral disturbances and symptoms of emotional-volitional deficit: from early childhood, the patient exhibited low sociability, social withdrawal, lack of initiative, emotional flatness, and a tendency toward unusual behaviors, along with developmental delays in cognition and speech. Later, his intellectual and speech delays eventually resolved, but behavioral peculiarities, communication difficulties, infantilism, and a tendency to fantasize and live in an imagined reality persisted. No clear signs of positive psychotic symptoms were observed. At the time of assessment at the age of 23 years, communicative difficulties, autistic traits, and speech disorders characteristic of autism spectrum disorder remained predominant, which led to a revised diagnosis of autism spectrum disorder instead of schizophrenia. Attention is drawn to the fact that the symptoms observed in the patient—previously regarded as delusional, hallucinatory, or indicative of disorganized and incoherent thinking—could be interpreted as quasipsychotic, associated with impaired cognitive information processing rather than true psychosis. The published data were analyzed, and the attention of colleagues was drawn to the issue of overdiagnosis of schizophrenia and disregarding the possibility of similar symptoms related to autism spectrum disorders.