Low dose clozapine controls adult-onset psychosis associated with the neurogenic ataxia-retinitis pigmentosa (NARP) mutation

Nosology and Phenomenology of Psychosis in Movement Disorders

“…Dementia or depression have been occasionally associated with psychosis. Treatment with atypical antipsychotics is usually effective in controlling psychotic symptoms …”

“…Treatment with atypical antipsychotics is usually effective in controlling psychotic symptoms. 125,137 Dystonia Psychosis was reported in some genetic dystonias, like myoclonus-dystonia attributed to heterozygous mutations or deletions in the epsilon-sarcoglycan gene (MYC/DYT-SGCE). In this condition, both hallucinations and paranoid delusions have been reported, usually associated with other psychiatric conditions, such as depression, panic disorder, social phobia, obsessive-compulsive disorder, and alcohol dependence or abuse, but not with cognitive decline.…”

Clozapine for mitochondrial psychosis

“…With interest we read the article by Demily et al about a 30 year old male with neuropathy, ataxia, and retinitis pigmentosa (NARP) syndrome due to the mutation m.8993T > C, clinically manifesting as cerebellar ataxia, pyramidal syndrome, and psychosis [1]. Upon antipsychotic medication the patient developed dystonia, akathisia, and extrapyramidal symptoms with falls [1].…”

“…Upon antipsychotic medication the patient developed dystonia, akathisia, and extrapyramidal symptoms with falls [1]. Switching to clozapine resolved psychosis but triggered fatigue, myoclonus, and falls.…”

Authors' reply — Clozapine for mitochondrial psychosis

“…We thank Drs J. Finsterer and S. Zarrouk-Mahjoub [1] for their comments regarding our report [2] on the beneficial effects of low dose clozapine for management of psychotic symptoms in a patient with neurogenic ataxia-retinitis pigmentosa (NARP mutation, m.8993T > C, maternally inherited from asymptomatic carrier mother). We agree that clozapine has many side effects, some of them being potentially lethal.…”