Pharmacological Treatment of 22q11.2 Deletion Syndrome-related Psychoses

E. Boot; N. J. Butcher; J. A. S. Vorstman; T. A. M. J. van Amelsvoort; W. L. A. Fung; A. S. Bassett

doi:10.1055/s-0035-1554645

Pharmacopsychiatry, Table of Contents

Pharmacopsychiatry 2015; 48(06): 219-220
DOI: 10.1055/s-0035-1554645

Letter

Pharmacological Treatment of 22q11.2 Deletion Syndrome-related Psychoses

Authors

E. Boot

¹The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto, Canada

²Department of Psychiatry, University Health Network, Toronto, Canada

³Department of Psychiatry, University of Toronto, Canada
N. J. Butcher

⁴Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto

⁵Institute of Medical Science, University of Toronto, Canada
J. A. S. Vorstman

⁶Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
T. A. M. J. van Amelsvoort

⁷Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
W. L. A. Fung

¹The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto, Canada

³Department of Psychiatry, University of Toronto, Canada

⁴Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto

⁵Institute of Medical Science, University of Toronto, Canada

⁸Toronto General Research Institute, University Health Network, Toronto, Canada
A. S. Bassett

¹The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto, Canada

²Department of Psychiatry, University Health Network, Toronto, Canada

³Department of Psychiatry, University of Toronto, Canada

⁴Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto

⁵Institute of Medical Science, University of Toronto, Canada

⁸Toronto General Research Institute, University Health Network, Toronto, Canada

⁹Division of Cardiology, Department of Medicine, University Health Network, Toronto, Canada

Abstract

In their recent article in Pharmacopsychiatry Verhoeven and Egger report a case series of 28 patients and state that “treatment of psychotic symptoms in patients with 22q11.2 deletion syndrome (22q11.2DS) with quetiapine or clozapine in combination with valproic acid appears likely to be more effective than with other psychotropic compounds”. In this letter, we discuss the limitations of their case series and the lack of evidence for such a sweeping conclusion. In lieu of strong evidence to the contrary, standard pharmacological treatments of psychotic illness in 22q11.2DS remains recommended, with attention to 22q11.2DS-related issues. The latter would include management strategies to help ameliorate the elevated risk of seizures (e. g. when using clozapine), and vigilance for Parkinson’s disease or other potential movement disorders.

Key words

22q11 deletion syndrome - antipsychotic agents - psychotic disorders

Full Text

References

References
1 Verhoeven WM, Egger JI. Atypical Antipsychotics and Relapsing Psychoses in 22q11.2 Deletion Syndrome: A Long-term Evaluation of 28 Patients. Pharmacopsychiatry 2015; Feb 5. [Epub ahead of print]
2 Fung WLA, Butcher NJ, Costain G et al. Practical guidelines for managing adults with 22q11.2 deletion syndrome. Genet Med 2015; Jan 8 [Epub ahead of print]
3 Butcher NJ, Fung WLA, Fitzpatrick L et al. Response to clozapine in a clinically identifiable subtype of schizophrenia: 22q11.2 deletions mediate side effect risk and dosage. Br J Psychiatry 2015; [Epub ahead of print]
4 Warnez S, Alessi-Severini S. Clozapine: a review of clinical practice guidelines and prescribing trends. BMC Psychiatry 2014; 14: 102
5 Bassett AS, Chow EW, Husted J et al. Clinical features of 78 adults with 22q11 Deletion Syndrome. Am J Med Genet A 2005; 138: 307-313
6 Cheung EN, George SR, Costain GA et al. Prevalence of hypocalcaemia and its associated features in 22q11.2 deletion syndrome. Clin Endocrinol (Oxf) 2014; 81: 190-196
7 Boot E, Butcher NJ, van Amelsvoort TA et al. Movement Disorders and Other Motor Abnormalities in Adults with 22q11.2 Deletion Syndrome. Am J Med Genet A 2015; Feb 13 [Epub ahead of print]