Effectiveness of switching from oral ziprasidone to risperidone in a patient with comorbid autistic disorder, profound intellectual disability, Gilbert syndrome, and exacerbation of psychosis

Autism and intellectual disability may hinder any other coexisting psychiatric diagnosis. Diagnoses are often based on behavioral observations, directly ob- tained or reported by family members or operators in frequent contact with the patient, and non-verbal communications, as well as on the psychological and physical symptoms manifested by the patient. We describe the case of a 28-year-old Italian man, hospitalized in one of our long-term care wards for comorbid profound intellectual disability (IQ<25), autistic and psychotic disorders, and Gilbert syndrome, who manifested a severe exacerbation of psychosis, for which ziprasidone was prescribed. This condition para- doxically further deteriorated after the introduction of this drug. A subsequent switch to risperidone greatly and rapidly improved both psychosis-related and symp- toms emerging after the introduction of ziprasidone.