Familial adenomatous polyposis in an adolescent with coexisting schizophrenia: treatment strategies and implications.

Luisa Gonzalez,Erica Weinstein,Jose Alvarez,Panagiota Korenis

doi:10.1002/mgg3.114

Abstract

Schizophrenia is associated with high mortality and morbidity. The etiology of schizophrenia remains unclear, studies implicate a multifactorial origin with genetic and environmental factors. The adenomatous polyposis coli (APC) gene has been associated with FAP (familial adenomatous polyposis), and studies have linked it to schizophrenia. However, there are few studies which examine the association between FAP and schizophrenia. Limited data exist regarding recommendations for genetic counseling of adolescents with comorbid psychiatric illness. A case of an adolescent with FAP who developed psychotic symptoms is presented. This case hopes to add to the literature about mental illness in those with FAP. A review of literature about the role of APC in schizophrenia as well as implications of genetic counseling on those who suffer with mental illness will be discussed.

Highlights

Schizophrenia, a chronic and severe mental illness has been associated with high rates of mortality and morbidity leading to recurrent hospitalizations and increased risk of medical comorbidities
While the etiology of schizophrenia remains unclear, twin and adoption studies implicate a multifactorial origin with genetic factors playing a more dominant role than environmental factors (Levitt and Rodin 1992)
One gene associated with schizophrenia has been the adenomatous polyposis coli (APC) gene; a tumor suppressor gene that increases one’s risk for cancer, colorectal cancer and familial adenomatous polyposis (FAP)

Summary

Introduction

Schizophrenia, a chronic and severe mental illness has been associated with high rates of mortality and morbidity leading to recurrent hospitalizations and increased risk of medical comorbidities. One gene associated with schizophrenia has been the adenomatous polyposis coli (APC) gene; a tumor suppressor gene that increases one’s risk for cancer, colorectal cancer and familial adenomatous polyposis (FAP). Studies have confirmed an association with FAP and numerous medical comorbidities including: thyroid cancer, gastrointestinal tumors, medulloblastomas, and adrenal masses (Tibben 2011). Genetic counseling is recommended for those who have the familial pattern of FAP and may be at risk to inherit the disease, few recommendations and resources exist regarding counseling adolescents, adolescents with comorbid psychiatric illness. We present a case of a young woman with FAP inherited from her mother who developed psychotic symptoms including paranoia, thought disorder and hallucinations

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