The article titled “Challenges and opportunities in the diagnosis and treatment of early-onset psychosis: a case series from the youth affective disorders clinic in Stockholm, Sweden” by Mathias Lundberg et al., published in Schizophrenia (2024), 10:5, discusses three illustrative cases from the Child and Adolescent Affective Disorders Clinic in Stockholm to highlight the complexities and nuances in diagnosing and treating early-onset psychosis (EOP). The cases focus on individuals initially misdiagnosed with less severe conditions such as emotionally unstable personality disorder, autism, and ADHD, which led to delays in appropriate treatment. The article underscores the importance of a hierarchical diagnostic approach, prioritizing severe mental illnesses, and the need for continuous reassessment.

Case 1 details a 15-year-old with treatment-resistant depression and psychotic features, initially misdiagnosed with autism and emotionally unstable personality disorder. The case highlights the challenges in diagnosing complex cases where affective and psychotic symptoms overlap. The patient’s treatment journey illustrates the importance of diagnostic reassessment and the effectiveness of appropriate pharmacotherapy in improving symptoms and quality of life.

Case 2 describes a 15-year-old experiencing gender dysphoria, psychosis, and bipolar disorder. The case reveals the interplay of various neuropsychiatric conditions and the critical role of adhering to a hierarchical diagnostic approach. The patient’s improvement following appropriate treatment underscores the importance of recognizing and addressing underlying psychotic conditions to facilitate broader assessments and interventions, such as for gender dysphoria.

Case 3 focuses on a 9-year-old with disorganized psychosis, initially misdiagnosed with ADHD and autism. This case emphasizes the dangers of misdiagnosis and the need for thorough assessments, particularly when dealing with rapidly deteriorating behavioral and cognitive symptoms. The significant improvement following appropriate antipsychotic treatment highlights the importance of early and accurate diagnosis in altering the clinical trajectory.

The article argues for a nuanced diagnostic approach, considering the high stakes of early intervention in achieving favorable long-term outcomes. It emphasizes the need for a dynamic and continuous reassessment process, particularly in cases of treatment resistance or the emergence of new symptoms. The authors advocate for prioritizing diagnostic utility and a longitudinal perspective over strict diagnostic validity. They also stress the importance of rapid symptom remission through indicated medical interventions during acute disease states and the need for comprehensive treatment until remission to improve long-term outcomes.

In conclusion, the case series illustrates the critical need for a shift in diagnostic focus in adolescent mental healthcare, prioritizing a hierarchical perspective along with longitudinal course and clinical utility over strict diagnostic validity. This approach is pivotal in early recognition and effective treatment of severe illness states like EOP, which can significantly improve the prognosis and quality of life for affected individuals.


Lundberg, M., Andersson, P., Lundberg, J., & Desai Boström, A. E. (2024). Challenges and opportunities in the diagnosis and treatment of early-onset psychosis: a case series from the youth affective disorders clinic in Stockholm, Sweden. Schizophrenia, 10(5).