ABSTRACT

There are many different comorbidities that may be present in autism spectrum disorder (ASD) in children and adolescents. Studies show that the frequency of Bipolar disorder (BD) in children and adolescents with ASD varies between 0,7 % and 27 %. With this case report, we aimed to present the clinical process of a girl who had been followed up with autism spectrum disorder since the age of 3 years old, where a depressive episode that had emerged at adolescence shifted into a state of acute mania. She was started on aripiprazole due to irritability and rage when she was 12 years old, and when she manifested obsessions of cleanliness and signs of depression, she was also started on selective serotonine reuptake inhibitors (SSRIs), with no benefi cial results, latter was discontinued. Increase in her masturbatory behaviour was considered a manifestation of self-directedness as a result of an increase in social diffi culties. After long term depression, she was admitted to emergency service because of self injuries, behavior harming others and trying to run away from home. With her clinical picture manifesting increase in energy, irritability and agression for the past ten days, she met the criteria for a manic episode. Her pharmacotherapy regimen was readjusted and she was started on clonazepam and 20 mg/day oral aripiprazole. Upon full remission of the manic phase, a depressive mood followed, and 100 mg/day oral lamotrigine was started while 20 mg/day aripiprazole resumed, showing an alleviation on depressive state. We believe presenting the clinical course of the case might be a useful contribution to relevant literature and clinical perspective in terms of recognition of the diagnosis that may be developed in the autism spectrum, in terms of the fact that no sign of symptom relief with SSRIs, her history of refractory depressive episodes, and obsessive masturbation might be indicative of a possible prodromal phase for bipolar disorder.