# Alexander disease with an atypical psychiatric onset presenting as first-episode psychosis: a case report - URL: https://alisanburak.com/en/wcp-2026-posterler/ev0877 - Language: en - Last updated: not specified - Page title: Alexander disease with an atypical psychiatric onset presenting as first-episode psychosis: a case report | WCP 2026 Summary > Late-onset Alexander disease, a rare leukodystrophy, may present as first-episode psychosis with prominent psychotic symptoms and only subtle neurological sign… This page was translated automatically from Turkish. [Read the original](https://alisanburak.com/wcp-2026-posterler/ev0877) This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it. EV0877 E-PosterPsychosis and SchizophreniaCase Report # Alexander disease with an atypical psychiatric onset presenting as first-episode psychosis: a case report ATYPICAL PSYCHIATRIC-ONSET ALEXANDER DISEASE PRESENTING AS FIRST-EPISODE PSYCHOSIS: A CASE REPORT Presenter: YI Jie Yeo Country: Singapore Institution: Institute of Mental Health Late-onset Alexander disease, a rare leukodystrophy, may present as first-episode psychosis with prominent psychotic symptoms and only subtle neurological signs. The aim is to illustrate, through a case of late-onset Alexander disease, how organic etiologies may be overlooked in first-episode psychosis. Alexander disease is a progressive leukodystrophy and the only known primary genetic disorder of astrocytes; it is usually caused by de novo mutations in the glial fibrillary acidic protein (GFAP) gene on chromosome 17q21. More than 95% of cases carry a GFAP variant, and the estimated five-year prevalence is approximately 1 in 2.7 million. Mutant GFAP accumulates in the form of Rosenthal fibers, disrupting the astrocyte cytoskeleton and causing demyelination. In a classification based on 215 genetically confirmed patients, Type I has an earlier onset and a more severe course, whereas Type II can begin at any age and is characterized by bulbar, cerebellar, and oculomotor symptoms. The reported case concerns a 39-year-old man with no medical history other than a lumbar compression fracture. He presented with acute auditory hallucinations, paranoia, and disorganized behavior. A workup for organic causes, including blood tests and cerebrospinal fluid analysis, was largely unremarkable, while neurological examination revealed dysarthria and subtle asymmetric hypertonia, more pronounced on the left. Magnetic resonance imaging showed white matter changes consistent with a diffuse leukodystrophy pattern, peridentate involvement, thinning of the medulla oblongata, and signal abnormalities in the midbrain. Genetic testing identified a heterozygous pathogenic GFAP mutation, confirmed by Sanger sequencing. As there is no disease-specific treatment, management is symptomatic and supportive. Given the existing brainstem pathology and bulbar and pyramidal signs, low-dose second-generation antipsychotics were recommended to minimize extrapyramidal adverse effects and lowering of the seizure threshold. In this case, a good clinical response was achieved with amisulpride and olanzapine. [View the original poster](https://cslide.ctimeetingtech.com/wcp26/attendee/eposter/file/1082) How to cite this study APA 7: Yeo, Y. J., et al. (2026, September 23-26). Atypical psychiatric-onset alexander disease presenting as first-episode psychosis: a case report [E-poster]. 26th WPA World Congress of Psychiatry (WCP 2026), Stockholm, Sweden. https://cslide.ctimeetingtech.com/wcp26/attendee/eposter/file/1082 Vancouver: Yeo YJ, et al. Atypical psychiatric-onset alexander disease presenting as first-episode psychosis: a case report [e-poster]. 26th WPA World Congress of Psychiatry (WCP 2026); 2026 Sep 23-26; Stockholm, Sweden. Available from: https://cslide.ctimeetingtech.com/wcp26/attendee/eposter/file/1082 Author names and title formatting were generated automatically from the congress system; please check them against the original poster before use. ## On the same topic - [İlk atak psikoz ve esrar kullanım bozukluğu olan gençlerde yardım arama: Back to Reality video oyun serisinden çıkarımlar](https://alisanburak.com/en/wcp-2026-posterler/ev0002) - [Kimyasal bağımlılığın eşlik ettiği tedaviye dirençli şizofreni hastalarında modern antipsikotiklerin kombine kullanımının klinik sonuçları](https://alisanburak.com/en/wcp-2026-posterler/ev0014) - [Şizofrenide bilişsel gerileme: Sosyal işlevsellik üzerindeki etkisi ve bilişsel iyileştirme olanakları](https://alisanburak.com/en/wcp-2026-posterler/ev0018) - [Ağır kişilerarası şiddet öyküsü olan, şizofrenisi olan ve olmayan bireylerde temel benlik bozukluklarının karşılaştırılması](https://alisanburak.com/en/wcp-2026-posterler/ev0103) - [Yoğun çakra odaklı meditasyonla ilişkili bir ergende akut ve geçici psikotik bozukluk: olgu sunumu](https://alisanburak.com/en/wcp-2026-posterler/ev0231) [All WCP 2026 summaries](https://alisanburak.com/en/wcp-2026-posterler) --- Kaynak / Source: https://alisanburak.com/en/wcp-2026-posterler/ev0877 İletişim / Contact: Bağdat Caddesi, Veli Güneysu Apt. 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