First-Episode Psychosis in a Patient With Flaccid Paraplegia Following Childhood Poliomyelitis

First-episode psychosis in patients with pre-existing neurological disability presents important diagnostic and therapeutic challenges, particularly when the relationship between the two conditions is uncertain.This case report describes a 49-year-old man with flaccid paraplegia following childhood poliomyelitis who was involuntarily admitted for a first documented acute psychotic episode.His presentation included behavioural disorganisation, self-neglect, aggression, disorganised speech, and persecutory delusions.Initial laboratory investigations, including a complete blood count, inflammatory markers, electrolytes, glucose, and renal and hepatic function tests, were unremarkable.Urine toxicology screening was negative for the substances tested, while cranial computed tomography and neuropsychological assessment did not reveal acute structural abnormalities or major cognitive impairment that could explain the psychotic symptoms.However, more extensive neurological investigations were not performed.Clinical improvement was achieved with oral aripiprazole followed by long-acting injectable aripiprazole, alongside coordinated psychiatric and social support.This case highlights the importance of avoiding unsupported causal assumptions between remote neurological disease and new-onset psychosis, while recognising the diagnostic limitations of the available investigations.It also illustrates how chronic physical disability and psychosocial vulnerability can complicate psychiatric management, making multidisciplinary care essential for treatment continuity and functional stability.