Assessing Psychiatric Comorbidity and Pharmacologic Treatment Patterns Among Patients With Neurofibromatosis Type 1

Occurrence of Multiple Psychiatric Comorbidities in a Child with Neurofibromatosis Type 1 (NF1): A Case Report

Neurofibromatosis type 1 (NF1) is a complex genetic disorder often associated with neurocutaneous manifestations and cognitive impairments. This case report examines a nine-year-old child with NF1 who presented with multiple psychiatric comorbidities, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and developmental disorder of scholastic skills (DDSS). The child exhibited significant impairments in daily functioning and academic performance. Comprehensive assessments identified deficits in social communication and repetitive behaviors consistent with ASD, as well as symptoms of inattention and hyperactivity indicative of ADHD. Furthermore, the child struggled with reading, writing, and mathematics, consistent with DDSS. This report highlights the importance of diagnostic evaluations in children with NF1 to identify and address co-occurring psychiatric conditions. The association between NF1 and these comorbidities suggests a similar neurobiological basis, potentially involving disrupted neural pathways and altered brain development. Early intervention strategies, including behavioral therapies, educational support, and appropriate pharmacological treatments, were implemented to address the child's needs. This case emphasizes the importance of personalized approaches to improve developmental, cognitive, and psychological outcomes for children with NF1 and multiple psychiatric comorbidities. Further research is necessary to better understand the mechanisms driving these associations and to guide treatment strategies.

Pediatric Patient With Neurofibromatosis I Presenting With Perceptual Disturbances and a Suicide Attempt

This is a case of a pediatric patient with a history of neurofibromatosis I (NFI) presenting to the emergency department secondary to a suicide attempt via self-strangulation after being verbally and physically bullied at school. Upon hospital admission, the 10-year-old patient was found to have significant auditory and visual perceptual hallucinations in addition to suicidal ideations, for which psychiatry was consulted. The patient underwent magnetic resonance imaging (MRI) of the brain to evaluate for intracranial neurofibromas as a potential etiology of his behavior. There is evidence that the growth of neurofibromas in the brain can be associated with psychosis. His brain MRI was significant for multiple foci of non-enhancing lesions seen in the cerebellum, white matter, supratentorial white matter, and bilateral hippocampi that can be seen in NFI, highlighting a medical etiology for the patient's auditory and visual perceptual disturbances. The objective of this case report is to explore medical causes of psychosis including metabolic disorders, neurodegenerative diseases, metabolic disturbances, parathyroid diseases, genetic disorders (Fragile X, Prader-Willi, etc.), autoimmune disorders, multiple sclerosis, temporal lobe epilepsy, infections, and brain tumors.

Impact of neurofibromatosis type 1 on quality of life using the Skindex-29 questionnaire quality of life in NF1

BACKGROUND

Neurofibromatosis type 1 (NF1) is one of the most common RASopathies predisposing affected patients to melanic lesions and benign tumors. NF1 is associated with considerable esthetic and functional burden negatively affecting the patient's quality of life (QoL). This study aims to assess the clinical features of NF1 patients and evaluate their impact on QoL. We identified NF1 patients from a public health database of a region in Spain. All patients underwent clinical and ophthalmological evaluation for NF1 features. We measured QoL using the Spanish version of the Skindex-29.

RESULTS

Forty patients fulfilled the NF1 National Institute of Health criteria when we recruited patients. The median age was 42.00 years (IQR 26.5 -53.75). The median total Skindex-29 score was 12.3 (IQR 5.9-22.4); (emotion: 15.0, IQR 5.0-37.5; symptoms 8.9, IQR 0.0-17.9 and functioning 8.3; IQR 0.5-18.3). Women and NF1 patients with lower educational levels were associated with poorer QoL scores. We identified itching and sleep troubles to influence NF1 patients' QoL negatively.

CONCLUSION

NF1 considerably influences the psychological well-being of NF1 patients. We observed that female and low-educated patients scored higher on the emotional dimension of the Skindex-29 and could, therefore, be more at risk of depression. We also pointed out some "minor symptoms" that negatively impact NF1 patients' QoL such, as itching and sleep troubles which doctors could treat if sought by doctors.