Psychosis treatment using Clozapine in velocardiofacial syndrome

Abstract

ABSTRACT Introduction: Velocardiovacial syndrome (VCFS) is a heterogeneous clinical entity caused, most of the times, by a microdeletion on chromosome 22. The main clinical features of this syndrome are: changes in facial and palate morphology, congenital heart abnormalities, hypoplasia of the thymus, immunodeficiencies with increased risk of infection, hypoparathyroidism, intellectual disability and psychiatric disorders. In most cases, the comorbid mental pathology falls into the psychotic disorder category. Methods: In this study, we present the clinical case of a 34-year-old patient diagnosed with VCFS, with past history of ventricular septal defect with spontaneous closure in childhood and refractory psychosis. Due to the patient’s treatment-resistant psychosis, treatment with clozapine has been put to practice. However, when taking into account the possible adverse effects of the drug in patients with VCFS, the authors conducted a non-systematic literature review on the treatment of psychosis in VCFS with clozapine in Pubmed, using the following keywords: velocardiofacial syndrome; clozapine. Results: There are not many medical studies on the use of psychiatric drugs concerning the treatment of psychiatric disorders in patients with VCFS. Treatment with clozapine in these populations should be considered, always taking into account the particularities and vulnerabilities of these patients, especially in cases of refractory psychosis. Risks and benefits of different treatments should be considered, bearing in mind this population’s great vulnerability to adverse effects of drugs. Discussion: In this case study, we concluded that treatment of psychosis in patients with VCFS remains a major challenge, given clinical vulnerabilities of this specific population, thus further studies being needed.

Keywords

• Velocardiofacial syndrome
• Clozapine