Positive Psychotic Symptoms after Escitalopram Treatment in a Female Adolescent with Peroxisome Spectrum Disorder Due to PEX-6 Gene Mutation

Introduction: In this case report, we present positive psychotic symptoms that developed after low-dose (5 mg/day) escitalopram treatment in a 16-year-old female adolescent with a peroxisome biogenesis disorder. Case presentation: Two weeks after starting escitalopram treatment for depression, the patient experienced vomiting attacks several times a day. About 2-3 days after the attacks began, the family stopped administering escitalopram. Five days after the onset of vomiting and 2-3 days after stopping escitalopram, the patient developed visual and auditory hallucinations and persecutory delusions. During the patient's follow-up period, the diversity of her hallucinations and delusions increased. When olanzapine treatment was gradually increased to 20 mg/day, the patient's psychotic symptoms disappeared. Conclusion: We discuss serotonin syndrome, drug-induced bipolar disorder, and psychotic disorder in the differential diagnosis. We believe that this case report is valuable as it is the first in the literature regarding the development of positive psychotic symptoms after SSRI use in a patient with a peroxisome biogenesis disorder.