Psychopharmacology of Williams syndrome: safety, tolerability, and effectiveness

ABSTRACT

Introduction: Williams syndrome (WS) is a neurogenetic disorder characterized by a hyper-social personality, intellectual disability, and multiple medical co-morbidities. Psychiatric co-morbidities are also common. Since medical co-morbidities are common in this population, the risk-benefit of the use of psychiatric medications must be carefully considered and monitoring for safety and tolerability is needed.

Areas covered: We review the cognitive profile and common medical co-morbidities in WS. We then discuss the common presentations of psychiatric disorders and review the available evidence on the use of psychiatric medications in WS. No prospective psychiatric medication trials have been conducted. We highlight the side effect profile of common psychiatric medications as they pertain to WS.

Expert opinion: Psychiatric disorders can have a major effect on the quality of life of individuals with WS. The lack of long-term safety data and high likelihood of medical co-morbidities in WS make the judicious use of psychiatric medications more challenging; however, they can play an important role in decreasing distress and improving functioning. We provide recommendations for first– and second-line classes of medications based on our clinical experience and consideration of adverse effect profiles, as well as safety monitoring parameters at baseline and periodically.

KEYWORDS:

• Williams syndrome
• psychopharmacology
• psychiatry
• anxiety

Article highlights

• Williams syndrome is a multi-system neurodevelopmental disorder, affecting the cardiovascular, metabolic, endocrine, neurologic, gastrointestinal, genitourinary, dental, and ocular/auditory systems

• Psychiatric co-morbidities including attention-deficit/hyperactivity disorder, anxiety disorders, and sleep disorders are common in Williams syndrome

• Prospective psychopharmacologic studies are lacking

• The judicious use of psychiatric medications should take into account the individual’s medical co-morbidities and risk of developing additional medical co-morbidities associated with Williams syndrome

• Baseline and periodic laboratory monitoring is required for certain psychiatric medications.

Declaration of interest

BR Pober has received research funding from the Williams Syndrome Association. CJ McDougle has received royalties from Oxford University Press and has completed editorial activities for Springer Publishing. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.