Successful electroconvulsive therapy for 22q11.2 deletion syndrome with Schizophrenia and Parkinson's disease

The effectiveness and tolerability of pharmacotherapy for psychosis in 22q11.2 Deletion Syndrome: A systematic review

“…Trialling lower doses, Woestelandt et al (2018) used risperidone 0.5 mg then switched to cyamemazine 20 mg, with both resulting in poor clinical response. There were 14 case reports that achieved good outcomes using doses that were significantly below the standard recommended dosage for schizophrenia (Aksuand Demirkaya, 2016; Angelopoulos et al, 2017; Butcher et al, 2015; Chow et al, 1999; Ciano-Petersen et al, 2021: 12; Kontoangelos et al, 2015, 2020; Molebatsi and Olashore, 2018; Müller and Fellgiebel, 2008; Sachdev, 2002; Tanifuji et al, 2022; Tastuzawa et al, 2015; Verhoeven and Egger, 2015b; Yacoub and Aybar, 2007). Across the cases, there was a wide range of antipsychotic doses prescribed with some individuals responding to lower doses and others requiring high-dose antipsychotic therapy.…”

“…For the case reports, akathisia was reported twice, including with haloperidol 3 mg (Molebatsi and Olashore, 2018) and with olanzapine 5 mg, with the latter prompting a decrease in dose (Tanifuji et al, 2022). Ciano-Petersen et al (2021) reported dyskinetic movement and oculogyric crisis with haloperidol and risperidone (doses not reported) and therefore switched to a ‘ low dose ’ (Ciano-Petersen et al, 2021) of olanzapine.…”

“…In schizophrenia, treatment resistance is defined as ongoing positive symptoms after a trial of at least two antipsychotics, each for a satisfactory period of time (minimum 6 weeks), at a reasonable dose (Galletly et al, 2016). Using this definition, it has been reported that 22q11.2DS psychosis is treatment resistant (Aksu and Demirkaya, 2016; Garg and Pai, 2011; Tanifuji et al, 2022; Tastuzawa et al, 2015; Verhoeven and Egger, 2015a), although others suggest there is insufficient evidence to draw this conclusion (Boot et al, 2015b; Mosheva et al, 2020). Those with 22q11.2DS can variably exhibit seizures, cytopenias and movement disorders (De Boer et al, 2019) which are also antipsychotic side effects, further complicating psychosis management in this complex population.…”