Context: Down syndrome may be associated with a number of medical problems (e.g. congenital heart disease) which are generally well recognised and managed. Co-existent mental health conditions associated with Down syndrome are less well recognised and understood. There are few case reports in the literature and longitudinal data is scarce.
Objectives: Retrospective review of medical records of patients with Down syndrome presenting to a joint medical/psychiatry clinic. Data was analysed and mental health conditions classified. Follow-up visit notes were analysed to document progress and outcomes.
Key messages: 12 patients with Down syndrome in the age group 16–25 years were identified and psychiatric diagnoses included: psychosis, obsessive compulsive disorder, bipolar disorder and depression. Medical conditions associated with psychiatric symptomatology included hyperthyroidism. Case studies will illustrate the presentation in a representative sample of the cohort and will focus on patients with psychotic episodes.
Conclusion: Psychotic episodes in young people with Down syndrome are not uncommon. Diagnosis may be difficult and delayed. Coexisting physical health problems must be excluded or treated. Psychosis in these patients appears to have a large affective component and antidepressants are often the first drugs prescribed. However, anti-depressants are often not particularly helpful, and anti psychotic medication is usually required, along with supportive strategies. Significant improvement is usually seen. However the majority of patients do not return entirely to their pre-morbid level of function. Ongoing monitoring is suggested to carefully document the progress and management of these patients. Longitudinal studies are required to determine whether psychotic episodes, such as reported here, may be the initial manifestation of dementia.
