Acute neuropsychiatric disorders in adolescents and young adults with Down syndrome: Japanese case reports

Figures & data

Table 1 A summary of the findings

Case number	Sex	Age at onset (years)	Complications	Premorbid characters	Signs	Diagnosis (DSM-IV)	Effective drugs (daily dose)	Response
1	F	10		Active, mild, tidy, precise, obstinate, hardworking	Abulia, insomnia, mutism, withdrawal, OC, stereotypic behavior, self-laughing	Major Depressive Disorder Not Otherwise Specified (311)	Vegetamin A (phenobarbital 30 mg, chlorpromazine hydrochloride 25 mg, promethazine hydrochloride12.5 mg)	Improved
2	F	29	Cataract	Cheerful, active, precise, hardworking	Slowness, abulia, withdrawal, OC, depressed mood, hypochondria	Major Depressive Disorder (296.2)	Fluvoxamine maleate 12.5–25 mg (selective serotonin reuptake inhibitor)	Improved
3	F	25	VSD, PDA, PH, Thyroid dysfunction	Cheerful, active, precise, hardworking	Slowness, insomnia, withdrawal, OC, depressed mood, agitation, mutism, self-talking	Obsessive–Compulsive Disorder (300.3)	Risperidone 2 mg, levomepromazine 10 mg, amantadine hydrochloride 100 mg	Partially improved
4	M	24		Cheerful, active, peaceful	Abulia, insomnia, withdrawal, delusions, anorexia, self-talking, tic, agitation, fatigue	Psychotic Disorder Not Otherwise Specified (298.9)	Haloperidol 1.5 mg, mexazolam 0.5 mg	Improved
5	M	18	Hirschsprung disease	Peaceful	Abulia, insomnia, withdrawal, mutism, self-laughing	Adjustment Disorder (309.28)	Remitted without drugs	ND
6	M	28	Cataract	Peaceful, precise	Abulia, slowness, withdrawal, self-talking, fatigue	Major Depressive Disorder (296.2)	Not treated	ND
7	F	20	Cataract	Mild	Abulia, stupor, insomnia, depressed mood, mutism, morning depression	Major Depressive Disorder Not Otherwise Specified (311)	Bromazepam 4 mg	Partially improved
8	M	18	ASD, VSD, Epilepsy	Mild	Abulia, insomnia, OC, depressed mood, morning depression	Major Depressive Disorder Not Otherwise Specified (311)	Carbamazepine 300 mg	Partially improved
9	F	28	Fallot’s tetralogy	Cheerful, active, precise, hardworking	Abulia, insomnia, withdrawal, OC, depressed mood	Major Depressive Disorder (296.2)	Clomipramine 30 mg, nitrazepam 5 mg	Partially improved
10	F	18	ASD	Cheerful, active	Abulia, OC, delusions, hallucination, self-laughing, self-talking, agitation	Psychotic Disorder Not Otherwise Specified (298.9)	Haloperidol 3 mg, levomepromazine 50 mg, romethazine hydrochloride 50 mg	Partially improved
11	F	21		Precise, sensitive	Abulia, hypochondria, withdrawal, anorexia	Anxiety Disorder Not Otherwise Specified (300.00)	Fluvoxamine maleate 25 mg	Non-effective
12	M	23	ASD, MI	Cheerful, mild, hardworking	Abulia, stupor, insomnia, withdrawal, tic	Major Depressive Disorder Not Otherwise Specified (311)	Amanthadine 150 mg, sulpiride 150 mg	Partially improved
13	M	14	ASD	Precise, peaceful, hardworking	Hypobulia, slowness, insomnia, OC, anorexia, tremor	Obsessive–Compulsive Disorder (300.3)	Clomipramine 30 mg	Partially improved

Note: Mean age: 21.2 years.

Abbreviations: VSD, ventricular septal defect; OC, obsessive-compulsive behavior; ASD, atrial septal defect; PDA, patent ductus arteriosus; PH, pulmonary hypertension; MI, mitral isufficiency; ND, ; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

Figure 1 (A) FLAIR sequence of brain MRI at the age of 10 years (Case 1). The patient showed marked areas of low signal intensity in the pallidum (arrowhead) and areas of slightly high signal intensity in the pyramidal tract (arrow). (B) FLAIR and T2-weighted sequences of MRI at the age of 30 years (Case 2). The patient showed hippocampal atrophy (arrow) and diffuse mild ischemic changes in the cerebral white matter (arrowhead). (C) CT scan at the age of 28 years (Case 3). The patient showed calcification of the pallidum (arrow), pineal body (arrowhead), and habenular commissure (open arrow). (D) FLAIR sequences of MRI at the age of 26 years (Case 4). The patient showed hippocampal atrophy (arrow), marked areas of low signal intensity in the pallidum (arrowhead), and areas of increased signal intensity in the decussation of the superior cerebellar peduncles (open arrow). (E) FLAIR sequences of MRI at the age of 18 years (Case 5). The patient showed hippocampal atrophy.

Abbreviations: FLAIR, fluid-attenuated inversion recovery; MRI, magnetic resonance imaging; CT, computed tomography.