Acute and Transient Psychosis Following Trauma, Particularly in Females With Autism

Autism has been associated with a higher incidence of PTSD and psychotic disorders [1, 2]. In clinical practice, transient psychosis is sometimes observed, only to later uncover an underlying diagnosis of autism. These transient psychotic symptoms are often triggered by sudden stressful or traumatic events. Additionally, female patients with autism are more likely to be undiagnosed due to less obvious externalizing symptoms, making it easier for clinicians to mistakenly diagnose primary psychosis [3]. The primary aim of this letter is to explore the potential risk of transient psychosis following trauma exposure, particularly in females with autism. There is a high comorbidity rate of up to 34% of autism and psychosis [4]. However, the relationship between the two disorders is complex. Autism spectrum disorder is typically found in childhood, whereas schizophrenia and related psychotic disorders often have an onset after adolescence. Positive symptoms are more commonly seen in schizophrenic patients. However, autism and psychosis sometimes share similar characteristics, including social communication deficits and negative symptoms [5]. Previous studies also indicate that individuals with autism are more prone to psychotic experience due to event-related stress compared to the control group [6]. The stress reactivity and vulnerability might play an essential role between autism and later psychotic symptoms. Due to the social communication deficits and restricted, repetitive behaviours or interests associated with autism, individuals with this disorder tend to have more rigid cognitive patterns. As a result, the same stressors may be harder to cope with, leaving autism patients more vulnerable to the impact of traumatic events and related fear responses. Additionally, their amygdala volume may undergo significant changes during the traumatization process [7]. Furthermore, traumatic childhood experiences may further hinder facial recognition and lower the fear threshold, making individuals with genetic predispositions more likely to develop psychotic symptoms [8]. Female autism is particularly more likely to develop post-traumatic stress symptoms. Conversely, individuals with autistic traits are more susceptible to trauma exposures [9]. Autism, due to social communication deficits, makes individuals more prone to interpersonal setbacks from childhood to adulthood. Reportedly, 80% of female autism remained undiagnosed before age 18 [3]. This may increase their likelihood of being exposed to trauma during development, thereby raising the risk of developing psychotic symptoms. In practice, we occasionally encounter adolescents or young adults with acute psychosis. Without a prior psychiatric diagnosis, assessing for autistic traits and past traumatic experience is a reasonable approach. This is particularly relevant for female individuals with autism, who are often diagnosed in their adolescence or early adulthood without previous medical records. If the psychotic symptoms resolve within days' observation, it is possible to avoid excessive medication, preventing exposure to the risks associated with using anti-psychotics. Accurate diagnosis is crucial as it pertains to the future course of treatment. Further research is needed to explore whether early intervention targeting autistic traits such as social skills training or behavioural therapy could benefit such cases. Additionally, if one continues to be profoundly affected by past traumatic experiences, psychotherapy will also be required. Of course, cases with transient psychosis have an increased probability of evolving into psychotic disorder, and regular follow-up over a period of time is still recommended. The author appreciates the treatment experiences provided by clinical patients and the guidance from past mentors. The author has nothing to report. The author has nothing to report. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.