Psychiatry and Clinical Psychopharmacology

Asperger’s Syndrome and comorbid somatic type delusional disorder and epilepsy: a case report

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S165-S166
Read: 1133 Published: 18 February 2021

Asperger’s Syndrome is a form of pervasive developmental disorder, which can include poor social understanding, all-absorbing narrow interests, uncoordinated motor movements, speech and language idiosyncrasies and difficulties with non-verbal communication. Comorbid psychiatric conditions are frequent in patients with AS. We present a case with Asperger’s Syndrome, who has comorbid somatic type delusional disorder and epilepsy. A 35 year-old, single, male, epileptic patient was presented with feeling his lips stuck, inability to wiggle his mouth, feeling bone-like structure at the tips of his lips in last 2 years. He thought that, he could not read books because of these feelings. He was intolerant and irritable. His social relations were weak; eye contact was limited. He could memorize the books that he read before, about geography or religion. He knows all vehicle registration plates of Turkey and all districts of provinces of Turkey. His antiepileptics were 1600 mg/day gabapentin and 1600 mg/day carbamazepine. He graduated from primary school. There wasn’t any language, cognitive development and self-help skill delay. His first psychiatric examination showed that his mood and affect was anxious. His consciousness was clear. He was cooperative and well oriented towards people, places and time. He had inadequate insight and judgment. He had psychomotor agitation. When he was asked for subjects that he memorized, he took a ritualistic posture and started shaking and saying that he memorized with minimal eye contact. There wasn’t any hallucination. He had perseverations and somatic delusions that his lips were stuck and stiff like a bone. Alexander IQ: 65 (mild mental retardation) Neuropsychological test results were general cognitive disorder and frontal type memory disorder. We thought that epilepsy and delusional disorder had bad inşuence about tests. EEG result was diffuse, mild bioelectrical delay. We first continued his antiepileptic drugs, and started clomipramine 75 mg/day for perseverations and olanzapine 20 mg/day for delusional thoughts about his lips. Because of minimal eye contact, history of social isolation and ritualistic behaviors, we referred him to child and adolescent psychiatry for confirmation of Asperger’s Syndrome. They confirmed the diagnosis and suggested aripiprazole treatment. We started aripiprazole 10 mg/day, lorazepam 2,5 mg/day for akathisia. In follow-ups olanzapine, clomipramine and lorazepam were discontinued; aripiprazole dose was increased to 20 mg/day. He was discharged with improvement. The patient we presented—an adult male with a history of repetitive behavior, social dysfunctions, aggressions, and limited interests in a specific range—met virtually all DSM IV criteria for AS. PDD patients have a two-to-six times greater risk of experiencing comorbid psychiatric conditions than normal population. AS may display symptoms similar to those seen in psychotic or depressive disorders and some personality disorders. AS may be associated with psychotic episodes. Clinicians warn against overvaluing psychotic symptoms, when specific features of AS are present. With aripiprazole treatment, the patient experienced a range of positive clinical changes in social and psychological skills. We aimed to inform the clinicians about the comorbidities of AS.

EISSN 2475-0581