A 1p31.3 deletion encompassing the nuclear factor 1A gene presenting as possible temporal lobe epilepsy in association with schizoaffective disorder

Clozapine Use Among Individuals With Schizophrenia Occurring on the Background of Intellectual Disability and Rare Genetic Variation: A Retrospective Chart Review

BACKGROUND

Treatment resistance in schizophrenia is associated with both intellectual disability and rare genetic variation. Information pertaining to the use of clozapine in this context has primarily come from case reports and small case series. Given the frequent occurrence of comorbid medical issues in various genetic disorders and the heightened sensitivity to antipsychotic medications among intellectually disabled individuals, additional information regarding the effectiveness and tolerability of clozapine in this population is needed, particularly in light of its unique side effect profile.

METHODS

This retrospective review of 1200 charts, which took place at a subspecialty psychiatry clinic, sought to characterize the use of clozapine in individuals with schizophrenia (or psychotic symptoms, generally speaking) and intellectual disability occurring on the background of rare genetic variation, a difficult to study and underserved patient population.

RESULTS

Twelve hundred charts were reviewed and 10 eligible individuals were identified, all of whom had been prescribed clozapine and carried a diagnosis of schizophrenia on the background of intellectual disability and rare genetic variation. Six of these 10 individuals harbored presumed pathogenic variants.

IMPLICATIONS

This study affirms what is known about clozapine treatment in 22q11.2 deletion syndrome, adds to the scarce literature on Usher syndrome in this context, and provides the first accounts of clozapine use in 22q11.2 microduplication syndrome and DCX variant-related heterotopia.

Therapeutic applicability of cannabidiol and other phytocannabinoids in epilepsy, multiple sclerosis and Parkinson's disease and in comorbidity with psychiatric disorders

Studies have demonstrated the neuroprotective effect of cannabidiol (CBD) and other Cannabis sativa L. derivatives on diseases of the central nervous system caused by their direct or indirect interaction with endocannabinoid system-related receptors and other molecular targets, such as the 5-HT1A receptor, which is a potential pharmacological target of CBD. Interestingly, CBD binding with the 5-HT1A receptor may be suitable for the treatment of epilepsies, parkinsonian syndromes and amyotrophic lateral sclerosis, in which the 5-HT1A serotonergic receptor plays a key role. The aim of this review was to provide an overview of cannabinoid effects on neurological disorders, such as epilepsy, multiple sclerosis and Parkinson's diseases, and discuss their possible mechanism of action, highlighting interactions with molecular targets and the potential neuroprotective effects of phytocannabinoids. CBD has been shown to have significant therapeutic effects on epilepsy and Parkinson's disease, while nabiximols contribute to a reduction in spasticity and are a frequent option for the treatment of multiple sclerosis. Although there are multiple theories on the therapeutic potential of cannabinoids for neurological disorders, substantially greater progress in the search for strong scientific evidence of their pharmacological effectiveness is needed.