Case report: Evolution of catatonic mutism and psychotic symptoms in an adolescent with Down syndrome: transition from Down syndrome disintegrative disorder to anti-N-methyl-D-aspartate receptor encephalitis

Suicidal behavior among individuals with trisomy 21: an integrative review

Trisomy 21 (T21) is a genetically determined human condition that occurs in one in every 800 births worldwide. Improvements in lifelong care have generated discussion about the mental health of people with T21. However, suicidal behavior in this population has still received little attention. This integrative review aimed to understand and synthesize scientific production on the topic of 'suicide in people with T21'. We conducted the review in the Virtual Health Library, PubMed, and PsycInfo databases using the descriptors 'Down syndrome', 'Down's syndrome', and 'trisomy 21' in combination with 'suicide', 'suicide attempted', and 'suicidal ideation'. We analyzed articles published until 10th October 2023. The selected articles were evaluated for their level of evidence and categorized thematically. Eight articles from three countries met the eligibility criteria: three case reports, three narrative literature reviews, one observational cross-sectional study, and one cohort study. The articles were organized and discussed in four categories: (1) scientific literature impressions about suicide in individuals with T21; (2) T21 life course issues and forms of expression of suicidal behavior; (3) suicide frequency in individuals with T21; and (4) possible implications for caring for individuals with T21 who exhibit suicidal behavior. The results revealed a lack of literature on the subject, which indicates the need for additional research. Based on the evidence available, suicidal behavior among people with T21, while a possible phenomenon, seems uncommon. Health professionals should investigate T21 individuals' mental health, searching for depression and self-injury symptoms.

Neuroimaging abnormalities associated with immunotherapy responsiveness in Down syndrome regression disorder

OBJECTIVE

To determine the prevalence of neuroimaging abnormalities in individuals with Down syndrome regression disorder (DSRD) and evaluate if neuroimaging abnormalities were predictive of therapeutic responses.

METHODS

A multicenter, retrospective, case-control study which reviewed neuroimaging studies of individuals with DSRD and compared them to a control cohort of individuals with Down syndrome (DS) alone was performed. Individuals aged 10-30 years and meeting international consensus criteria for DSRD were included. The presence of T1, T2/FLAIR, and SWI signal abnormalities was reviewed. Response rates to various therapies, including immunotherapy, were evaluated in the presence of neuroimaging abnormalities.

RESULTS

In total, 74 individuals (35%) had either T2/FLAIR and/or SWI signal abnormality compared to 14 individuals (12%) without DSRD (p < 0.001, 95%CI: 2.18-7.63). T2/FLAIR signal abnormalities were not appreciated more frequently in individuals with DSRD (14%, 30/210) than in the control cohort (9%, 11/119) (p = 0.18, OR: 1.63, 95%CI: 0.79-3.40). SWI signal abnormalities were appreciated at a higher frequency in individuals with DSRD (24%, 51/210) compared to the control cohort (4%, 5/119) (p < 0.001, OR: 7.31, 95%CI: 2.83-18.90). T2/FLAIR signal abnormalities were localized to the frontal (40%, 12/30) and parietal lobes (37%, 11/30). SWI signal abnormalities were predominantly in the bilateral basal ganglia (94%, 49/52). Individuals with DSRD and the presence of T2/FLAIR and/or SWI signal abnormalities were much more likely to respond to immunotherapy (p < 0.001, OR: 8.42. 95%CI: 3.78-18.76) and less likely to respond to benzodiazepines (p = 0.01, OR: 0.45, 95%CI: 0.25-0.83), antipsychotics (p < 0.001, OR: 0.28, 95%CI: 0.11-0.55), or electroconvulsive therapy (p < 0.001, OR: 0.12; 95%CI: 0.02-0.78) compared to individuals without these neuroimaging abnormalities.

INTERPRETATION

This study indicates that in individuals diagnosed with DSRD, T2/FLAIR, and SWI signal abnormalities are more common than previously thought and predict response to immunotherapy.