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Karpov B, Muhonen M, Kieseppä T. Psychotic Symptoms and Malignant Neuroleptic Syndrome in Williams Syndrome: A Case Report. Front Psychiatry 2022; 13:891757. [PMID: 35711606 PMCID: PMC9193575 DOI: 10.3389/fpsyt.2022.891757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Somatic and mental comorbidities are characteristic of individuals with Williams syndrome. The psychiatric profile of these patients mainly comprises affective disorders, while psychotic symptoms are rare. METHODS We present a case report of psychosis and malignant neuroleptic syndrome in a patient with Williams syndrome. We also conduct a review of recent works on the topic. CASE PRESENTATION A 38-year-old Caucasian male with Williams syndrome presented with somatic delusions, previously experiencing severe anxiety and concerns about a headache. The patient was prescribed olanzapine, which did not, however, have any effect on the delusions. After switching to lurasidone, the patient presented with malignant neuroleptic syndrome (muscle rigidity, tremor, urinary retention, fluctuating level of consciousness). He was hospitalized and the antipsychotic medication was discontinued. After somatic recovery, the patient did not experience severe anxiety and the somatic delusions diminished notably. The patient was discharged from the hospital in a stable physical condition, albeit still with transient worries about his health condition. CONCLUSIONS We present a case of the coincidence of Williams syndrome and psychosis. We hypothesize on the possible pathological relationships between the onset of the psychosis and severe anxiety in an individual with Williams syndrome. This case report duly contributes to the limited literature on psychiatric comorbidity in Williams syndrome.
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Affiliation(s)
- Boris Karpov
- Department of Psychiatry, HUS Helsinki University Hospital, Helsinki, Finland
| | - Maria Muhonen
- Department of Psychiatry, HUS Helsinki University Hospital, Helsinki, Finland
| | - Tuula Kieseppä
- Ministry of Social Affairs and Health, Helsinki, Finland
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Thom RP, Pober BR, McDougle CJ. Psychopharmacology of Williams syndrome: safety, tolerability, and effectiveness. Expert Opin Drug Saf 2021; 20:293-306. [PMID: 33369485 DOI: 10.1080/14740338.2021.1867535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Williams syndrome (WS) is a neurogenetic disorder characterized by a hyper-social personality, intellectual disability, and multiple medical co-morbidities. Psychiatric co-morbidities are also common. Since medical co-morbidities are common in this population, the risk-benefit of the use of psychiatric medications must be carefully considered and monitoring for safety and tolerability is needed.Areas covered: We review the cognitive profile and common medical co-morbidities in WS. We then discuss the common presentations of psychiatric disorders and review the available evidence on the use of psychiatric medications in WS. No prospective psychiatric medication trials have been conducted. We highlight the side effect profile of common psychiatric medications as they pertain to WS.Expert opinion: Psychiatric disorders can have a major effect on the quality of life of individuals with WS. The lack of long-term safety data and high likelihood of medical co-morbidities in WS make the judicious use of psychiatric medications more challenging; however, they can play an important role in decreasing distress and improving functioning. We provide recommendations for first- and second-line classes of medications based on our clinical experience and consideration of adverse effect profiles, as well as safety monitoring parameters at baseline and periodically.
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Affiliation(s)
- Robyn P Thom
- Lurie Center for Autism, Lexington, MA, USA.,Massachusetts General Hospital, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Barbara R Pober
- Massachusetts General Hospital, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Christopher J McDougle
- Lurie Center for Autism, Lexington, MA, USA.,Massachusetts General Hospital, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Iasevoli F, Barone A, Buonaguro EF, Vellucci L, de Bartolomeis A. Safety and tolerability of antipsychotic agents in neurodevelopmental disorders: a systematic review. Expert Opin Drug Saf 2020; 19:1419-1444. [DOI: 10.1080/14740338.2020.1820985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Felice Iasevoli
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Elisabetta Filomena Buonaguro
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Licia Vellucci
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
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Valdes F, Keary CJ, Mullett JE, Palumbo ML, Waxler JL, Pober BR, McDougle CJ. Brief Report: Major Depressive Disorder with Psychotic Features in Williams Syndrome: A Case Series. J Autism Dev Disord 2019; 48:947-952. [PMID: 29164439 DOI: 10.1007/s10803-017-3384-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Descriptions of individuals with Williams syndrome (WS) and co-morbid major depressive disorder (MDD) with psychotic features have not appeared in the literature. In addition to reviewing previous reports of psychotic symptoms in persons with WS, this paper introduces clinical histories and therapeutic management strategies for three previously unreported adults with WS diagnosed with co-morbid MDD with psychotic features. Co-morbid medical disorders common in WS are highlighted with regard to safe and appropriate pharmacological treatment. The importance of assessment for co-morbid MDD with psychotic features in individuals with WS is emphasized.
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Affiliation(s)
| | - Christopher J Keary
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421-3114, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer E Mullett
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421-3114, USA
| | - Michelle L Palumbo
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421-3114, USA
- Harvard Medical School, Boston, MA, USA
| | - Jessica L Waxler
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Barbara R Pober
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher J McDougle
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421-3114, USA.
- Harvard Medical School, Boston, MA, USA.
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Walton JR, Martens MA, Pober BR. The proceedings of the 15th professional conference on Williams Syndrome. Am J Med Genet A 2017; 173:1159-1171. [DOI: 10.1002/ajmg.a.38156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/29/2016] [Accepted: 01/08/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Jennifer R. Walton
- Department of Pediatrics, Nationwide Children's Hospital; The Ohio State University; Columbus Ohio
| | | | - Barbara R. Pober
- Department of Pediatrics, Massachusetts General Hospital; Harvard Medical School; Boston
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Pineiro ML, Roberts AM, Waxler JL, Mullett JE, Pober BR, McDougle CJ. N-acetylcysteine for neuropsychiatric symptoms in a woman with Williams syndrome. J Child Neurol 2014; 29:NP135-8. [PMID: 24396132 DOI: 10.1177/0883073813512025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Williams syndrome is a relatively rare genetic disorder caused by the hemizygous microdeletion of a region in chromosome 7q11.23. Individuals with Williams syndrome typically present with a highly social, overfriendly, and empathic personality. Comorbid medical and neuropsychiatric disorders are common. Reports of effective pharmacological treatment of associated neuropsychiatric disorders are limited. The authors describe the successful treatment of interfering anger, aggression, and hair-pulling with N-acetylcysteine in a 19-year-old woman with Williams syndrome. The neuropsychiatric symptoms emerged 1 week following an upper gastrointestinal endoscopy, for which fentanyl, midazolam, and propofol were used as anesthetics. The patient's treatment course and hypothesized mechanisms underlying the clinical presentation and symptom resolution are described.
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Affiliation(s)
| | | | - Jessica L Waxler
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer E Mullett
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - Barbara R Pober
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Department of Medical Sciences, Netter School of Medicine, Quinnipiac University, Middletown, CT, USA
| | - Christopher J McDougle
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA Harvard Medical School, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Martens MA, Seyfer DL, Andridge RR, Foster JEA, Chowdhury M, McClure KE, Coury DL. Parent report of antidepressant, anxiolytic, and antipsychotic medication use in individuals with Williams syndrome: effectiveness and adverse effects. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:2106-2121. [PMID: 22776821 DOI: 10.1016/j.ridd.2012.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 06/11/2012] [Accepted: 06/11/2012] [Indexed: 06/01/2023]
Abstract
Williams syndrome (WS) is a neurodevelopmental genetic disorder characterized in part by anxiety and behavioral difficulties. We examine the effectiveness and adverse effects of antidepressant, anxiolytic, and antipsychotic medications in individuals with WS. A total of 513 parents/caregivers completed a survey of psychotropic medication usage regarding their child or adult with WS. Twenty-four percent (24%) of the individuals had been prescribed an SSRI medication, while 12% had been prescribed another type of antidepressant or anxiolytic. Overall, 81% of respondents indicated that SSRI medications were either "Helpful" or "Somewhat Helpful", with paroxetine reported to be the least helpful. Sixty-four percent (64%) of survey participants reported that non-SSRI antidepressants and anxiolytics were either "Helpful" or "Somewhat Helpful" in treating symptoms of anxiety. Side effects for the antidepressants and anxiolytics were typically neurological in nature. Ten percent (10%) of the survey participants reported taking an antipsychotic medication, with risperidone and quetiapine described as more helpful than aripiprazole. Medication effectiveness may be related to the impact on serotonin levels. These findings call for further studies of medication usage in WS in order to improve their quality of life.
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Affiliation(s)
- Marilee A Martens
- The Nisonger Center, The Ohio State University, Columbus, OH 43210, USA.
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