Autism Spectrum Disorder, Temporal Lobe Epilepsy, and Treatment-Resistant Schizophrenia With Media-Themed Delusions and Impaired Insight: A Case Report.

Abstract

This case report describes a male patient in his 30s diagnosed with autism spectrum disorder (ASD), childhood-onset temporal lobe epilepsy paired with nonepileptic seizures (NES), and treatment-resistant schizophrenia (TRS). The patient was diagnosed with temporal lobe epilepsy in childhood and demonstrated features of ASD during adolescence. His psychiatric symptoms emerged during adolescence, including paranoid delusions, auditory and visual hallucinations, and pseudo-seizures precipitated by psychosocial stressors. He has remained institutionalized in psychiatric care for over two decades due to severe impairments in reality testing and persistent, complex delusions, which are strongly influenced by ASD-related hyperfixations on fictional characters. His symptoms include attributing personal experiences to fictional characters and engaging in media-influenced spiritual battles. Treatment with clozapine has provided partial control of his psychotic symptoms, while sodium valproate has effectively managed his epilepsy. This case highlights the clinical intricacies associated with the coexistence of ASD, epilepsy, and TRS, underscoring the need for patient-specific, multidisciplinary approaches to diagnosis and long-term management.