Psychotic Episode and autism?

My boyfriend has aspergers, which has suddenly become worse in the last 2 years (he is 31), probably due to an extremely high level of stress he has faced in this time which is making it harder for him to cope and keep masking so well.

He has been experiencing regular 'shutdowns' which usually last between 3 and 6 days. He has also had extended periods where he seems depressed or anxious, which we have put down to his aspergers. 

The last 2 months he has been really struggling with stress and multiple shutdowns, having just been gone for two whole weeks. He has been in a manic phase for about 5 days following his return and then yesterday became completely psychotic. E.g believed he had won the lottery and was throwing chairs, thinking he was the President of America, running in front of cars, thinking his mum was a doctor who found a coronavirus cure. He was finally sectioned early hours this morning

My question is, has any one else experienced a complete psychotic break down like this simply down to their autism. And it being a build up of all the recent stress which has just reached a point he cant handle. Or does this sound like he could also have bipolar and this is his first proper manic phase? 

I know autism is often linked with other illnesses. He also has anxiety disorder. But now reading the NHS description of bipolar it sounds just like him. It's like a cycle of a depressive state which slowly worsens until he has a shutdown. And after a shutdown he is then always at his best for a few days, but to the point of being almost manic. E.g doesnt stop talking, very excited by everything, very sociable and positive, impulsive buying, sudden future plans and big decisions. 

And for any one who may have experienced similar, will he ever be ok again? I appreciate recovery will be long but I'm so scared he wont come back from this. He has been like it 48 hours, didnt even recognise who his own family were. The worst part is I've been told he just kept asking for me and shouted that I'm "his answer to everything", but his family wouldnt let me near him 

  • That all sounds very hard for you. Obviously I'm not a psychiatrist, but I'd say this sounds like bipolar mood disorder, possibly of the 'rapid cycling' kind, or maybe schizoaffective disorder (which is somewhere between depression and psychosis). I've known people with each of those. Most autistic people are probably more vulnerable to stress because of experiencing things more intensely, but 'delusions of grandeur' are not particularly common for autistic people, and being autistic doesn't automatically make you depressed. 'Hypomanic' means all the impulsive buying and making plans and so on without delusions, 'manic' when there are also delusions. And (NT, not autistic) friends with a bipolar diagnosis have said the depression is actually the worst bit, even though you're not spiralling our of control and concerning other people as much as when you're on a high.

    I think psychosis can be a response to stress. I've one friend who was in hospital after delusions because of work stress, but never had another episode before or since. And know several other people who have a diagnosis of bipolar but use medication to keep the mood swings under control.

    I hope you get to see him soon. It can take a few days, and then some weeks to get back to normal.

    (BTW you probably haven't time for things like this now, but at least part of the series Stephen Fry made in 2006 about his bipolar. 'Secret Life Of The Manic Depressive' is on YouTube, as is a more recent follow-up.)

  • I'd also look into possibility of borderline personality/c-ptsd. Repeated low level trauma's thoughout life are quite common for us and they often manifest in much the same way, making it easy even for professionals to confuse them with bipolar.

  • Hi.  Sorry you are going through this - it sounds really tough.   My colleague, also with an ASD diagnosis like me, had a psychotic episode and was sectioned after a prolonged period of stress in his life.  He recovered with quick intervention and has not had an episode (2 yrs ago) since.  He is medicated and under the care of the MH team to avoid relapse.  I think it’s fair to say that people on the spectrum disproportionately experience stress from navigating a nuerotypical word and therefore are more likely to experience mental health issues. There is increasing evidence of psychosis being more common in the autistic population https://www.spectrumnews.org/opinion/viewpoint/signs-psychosis-people-autism-warrant-serious-concern/

  • You are both having a very difficult time. My heart goes out to you and I hope you can now support him. There is so much shame attached to behaviours which seem 'mad' and families can implode in such a situation. My 33 year old son (diagnosed age 29 with ASD) has responded to stress in highly unusual ways. I am on a journey to find out more about psychosis and have enroled in a free online course with Future Learn run by the King's College called 'Caring for People with Psychosis'. It started today and I think people can still enrol in it. I expressed my interest in this course last May when my son spent five weeks in a supported 'open house' psychiatric setting. Always learning but also trusting my heart because too many people only see or seek diagnostic labels and do loose sight of the fact that we all have our strengths and our needs. For me that this the most meaningful starting point. 

  • Actually, the Future Learn course starts on 13 July. Once the learner is registered (it's free) there is a Welcome Forum where people can write a bit about themselves and what has motivated them to enrol in the course. At the moment there are 72 participants who have introduced themselves.The more participants the better I say; online courses can handle this number of participants. The course is only offered every two years or so https://www.futurelearn.com/courses/caring-psychosis-schizophrenia

  • To be ok he'll have to find a good mix of medication and a life with routine and low stress. 

    I had a nervous breakdown. I didn't work for a month. After that I had a period where I was considering suicide. My brain didn't work at normal speeds and that was very hard for me to deal with. I was helped for this. I also take escitalopram now, and that helps a lot. All in all it took about a year to go back to normal. But I feel ok now. My job is ok, I finished work on the garden, I'm teaching my daughter to drive a car, so lucky it's a thing of the past now.