Hyperphagia and self-mutilation in Prader-Willi syndrome: psychopharmacological issues

Suicidality and Self-Harming Behaviors in Patients with Prader-Willi Syndrome (PWS): Case Report and Literature Review

Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder which is often associated with significant behavioral challenges and poor intellectual functioning. Research has shown that individuals with PWS are more likely to experience mental health problems, have higher relapse rates, and are at risk of self-harming behavior. Although PWS is associated with mild intellectual disability, which in itself confers a higher mortality rate, suicidality in this population is so far unreported in the literature. We present the case of an 18-year-old male patient who was admitted to our facility following exogenous insulin administration with suicidal intent. The main clinical characteristics, self-harming behaviors, and suicide risk factors of patients with PWS are discussed in this report. The article's objective is to redirect clinicians' attention to carefully screen and treat the underlying behavioral problems in PWS patients.

Topiramate in the treatment of Prader-Willi syndrome: A case report

Background

Prader-Willi syndrome (PWS), a neurologic disorder caused by a mutation of chromosome 15, is characterized by such symptoms as hypotonia, hypogonadism, hyperphagia, cognitive impairment, and difficult behaviors. One of the most concerning symptoms is hyperphagia, which can lead to uncontrolled obesity. Obesity is a major cause of increased morbidity and mortality in patients with PWS; however, diagnosing PWS early in life improves the prognosis.

Case Summary

An 11-year-old African American boy with a past medical history significant for PWS, attention deficit/hyperactivity disorder, oppositional defiant disorder, obesity, and asthma was admitted after he became violent and destructive at his foster home while trying to get food. The patient had a 28-day stay on the children's crisis intervention unit where quetiapine was discontinued and he was maintained on clonidine 0.1 mg 3 times daily, hydroxyzine 25 mg in the morning and 50 mg at bedtime, montelukast 5 mg daily and titrated on methylphenidate 10 mg in the morning and 5 mg in the afternoon, topiramate 100 mg twice daily, and aripiprazole 10 mg twice daily. The patient displayed improved behavior control and less food-related aggression; he denied any side effects of medications.

Discussion

This case demonstrates the positive effects of topiramate for reducing aggression and demand for food in a child with PWS most likely due to an increase in satiety. It is hard to definitively attribute the positive response directly to topiramate. Further research should be conducted to determine if topiramate is an effective treatment option in these individuals.