Case report of schizophrenia in adolescent with Russell–Silver syndrome

RUSSELL-SILVER SYNDROME (RSS) is a clinically and genetically heterogeneous syndrome characterized by craniofacial symptoms with triangular face and short stature. Very few comorbid psychiatric disorder cases with RSS have been reported. We report an adolescent case of schizophrenia (SZ) with RSS. A 14-year-old boy was referred to our hospital for medical examination from the Department of Psychiatry at X Child General Medical Center. His short height and characteristic appearance were pointed out at a health examination for 18-month-old children. He was diagnosed as having RSS by a pediatrician, and growth hormone therapy was started at 3 years of age. There was no obvious psychiatric family history. The patient began to show unmotivated laughter at 14 years of age. His parents took him to the X Center and SZ was suspected. He was referred to our hospital for medical examination. He was 143.0 cm tall and weighed 34.7 kg. Along with Eggerman’s form, his physical states were as follows: postnatal growth retardation (+), relative macrocephaly (+), asymmetry (–), developmental delay (+), triangular face (+), prominent forehead (+), ear or teeth anomalies (–), and micrognathia (+). No abnormal findings were observed on brain magnetic resonance imaging, electroencephalography, and in biochemical examination of the blood. Other psychiatric symptoms, including hallucination of bodily sensation, loosening of association, and delusion of reference, suddenly appeared 6 months after he was referred to us. He was diagnosed as having SZ definitively and hospitalized for treatment. Risperidone (2 mg/day) was moderately effective in reducing the hallucinations and delusions. After receiving treatment in our hospital for about 2 months, he was referred to the X Center for care of his negative schizophrenic symptoms with occupational therapy. Genetic examination was not completed due to a lack of participation by his parent. Vardi et al. reported a 4.5-year-old boy with RSS who showed autistic regression. An RSS case with a familial history of SZ has also been reported (the mother of a Nigerian RSS infant had been diagnosed with schizophrenia and used haloperidol). PubMed searches revealed no case similar to ours. Therefore, we believe that this is the first reported case of SZ with RSS. Further case accumulation is needed to reveal the correlation between RSS and psychiatric disorders. We are grateful to the parents of the patient for their cooperation and written consent regarding the current report.