Late-onset MLD has been proposed as a naturally occurring model of schizophrenia.2,20 The psychotic and cognitive features of late-onset MLD are extremely similar to those of schizophrenia. Both disorders are characterized by widespread anatomic dysconnectivity and secondary functional disruption. The prominent executive dysfunction in both MLD and schizophrenia reflects extensive disruption of frontal-subcortical circuits, which subserve mood, motivation, behavioral regulation, planning, and judgment.21 Although abundant evidence suggests that schizophrenia is predominantly a disease of gray matter and MLD is a disease of white matter, there is evidence of neuronal dysfunction in MLD and white matter abnormalities in schizophrenia.

An 18-year-old girl was admitted to the Child and Adolescent Psychiatry Unit in the Department of Paediatrics, Maribor Teaching Hospital, Maribor, Slovenia, for suspected disorganized (formerly called hebephrenic) schizophrenia. A year before that, at the age of 17, she had begun to laugh without reason, and her behaviour had become silly and disorganized. Her emotional responses were inappropriate. She started grimacing and became paramimic and parathymic. She withdrew socially and began to shut herself in her room. She had auditory hallucinations, consisting of a running commentary on her behaviour. At that time, there were no changes in her school performance, which was already consistently below average; however, her school performance deteriorated 3 months before admission to hospital, when she became unable to do any schoolwork. She also became disoriented as to her whereabouts and got lost several times.