Diagnostic and therapeutic challenges in autism spectrum disorder with comorbid bipolar disorder

Abstract

Autism spectrum disorder (ASD) is frequently associated with a variety of psychiatric comorbidities. Bipolar disorder (BD) is a mood disorder associated with ASD. The diagnosis and treatment of BD in the background of ASD presents unique difficulties in management of the patient in both diagnosis and management. Overlapping symptoms, inadequate communication of patient history and pharmacological limitations compromises treatment success. The paper discusses an adolescent male with ASD and complexities faced in diagnosing and treating secondary BD It showcases a 16 year old male with ASD with acute aggression, suicidal ideation, and severe school refusal. He was initially given a diagnosis of DMDD and GAD. His symptoms proceeded to a manic episode and a revised diagnosis of bipolar I disorder. Backed by strict parental monitoring and multidisciplinary school tracking, the patient achieved complete mood stabilization and extreme treatment compliance. The diagnostic process in the ASD-BD population is hindered by the lack of communication in history taking, masking of symptoms. Pharmacological management is complicated due to sensitivity to adverse events and limited treatment options. The comorbid ASD and BD require a highly targeted, multidisciplinary approach. There is a need for ASD specific diagnostic tools and specialized guidelines to prevent misdiagnosis and polypharmacy. The stabilization is achievable and requires tracking and tailored pharmacological strategy for optimal treatment.