Schizophrenia with segawa syndrome: A therapeutic challenge

Abstract

Segawa syndrome is inherited dystonia characterized by gait disturbance and dystonia. The patients benefit from the treatment with levodopa. Although behavioral changes are known to be associated with this condition, there is limited literature on psychosis. Levodopa has been known to induce psychosis, while antipsychotics can exacerbate dystonia. Hence, a calculated approach is required for adequate management of both the conditions. This case report describes a 32-year-old male with dystonia for 20 years and psychotic symptoms for 16 years. He was on levodopa 250 mg BD for 5 years but was taking three times the prescribed dose for 3 years along with erratic antipsychotic treatment. He was successfully treated with levodopa 250 mg BD to control his dystonia symptoms and clozapine 200 mg for psychotic symptoms. Schizophrenia with Segawa syndrome is a rare presentation. The case was challenging owing to the complexity of presenting symptoms as well as the treatment.

Keywords

• clozapine
• levodopa
• schizophrenia
• segawa syndrome