https://doi.org/10.1177/0004867417744256 Australian & New Zealand Journal of Psychiatry, 00(0) Australian & New Zealand Journal of Psychiatry 1 © The Royal Australian and New Zealand College of Psychiatrists 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav journals.sagepub.com/home/anp Primary genetic dystonia and first episode of psychosis Tamoor Mirza 1 and Muhammad Hassan Majeed 2 1 headspace Youth Early Psychosis Program, headspace Darwin, Casuarina, NT, Australia 2 Natchaug Hospital, Mansfield Center, CT, USA Corresponding author: Tamoor Mirza, headspace Youth Early Psychosis Program, headspace Darwin, Casuarina, NT 0810, Australia. Email: tmirza@anglicare-nt.org.au DOI: 10.1177/0004867417744256 To the Editor The association of spontaneous dyski- netic movement disorders and psy- chosis in anti-psychotic naïve patients has been established (Pappa and Dazzan, 2009). In a high-risk popula- tion, baseline dyskinesia warrants thorough evaluation for psychosis (Callaway et al., 2014). We present a case of an adolescent with primary genetic dystonia (PGD) who devel- oped an early-onset first episode of psychosis (FEP). At 10 years of age, B was diagnosed with a PGD with superior intellect. She initially presented with facial dystonia, dysarthria, difficulty with handwriting, gait problems and bradykinesia. Genetic testing revealed 1.1 Mb duplication at chromosome 8p23.2 to 8p23.3. She was prescribed dopaminergic drugs for the movement disorder with no signifi- cant clinical improvement. At the age of 14 years, she exhibited negative symptoms of a prodromal psychotic ill- ness followed by distressing auditory hallucinations and persecutory delu- sions. Movement disorder was the only identifiable risk factor for psychosis. She was treated with low-dose olan- zapine and positive symptoms resolved in 4 weeks. The primary movement disorder symptoms were unaffected with olanzapine as evident by stable scores of 4 on Abnormal Involuntary Movement Scale. PGD, which presents with dyski- nesia, can be an independent risk fac- tor for the development of FEP. These dyskinetic movements are bio- logical predictor of pathogenesis intrinsic to psychosis. In the popula- tion with baseline movement disor- ders, the prevalence of psychosis is up to 20% (Callaway et al., 2014). Patients with PGD present with movement abnormalities hence are at high risk for the development of psychosis. It is clinically pertinent to fre- quently screen patients with PGD for prodrome and symptoms of psycho- sis. Close clinical observation and cog- nitive behavioral therapy in suspected cases are advised. Longer duration of untreated psychosis are associated with worse clinical, functional and cognitive outcomes in FEP (Díaz- Caneja et al., 2015). For the treatment of psychosis, it is prudent to consider lower doses of anti-psychotic medications with favorable extra pyramidal symptoms (EPS) side effects. The ratio of affin- ity for D 2 and 5-HT 2A receptors determines the EPS liability of these medications. EPS side effects could be hard to distinguish from primary dystonia itself. Clinicians should periodically screen PGD patients for prodromal symptoms and psychosis and if appro- priate refer to the specialized care. Larger scale studies controlling for confounding factors are necessary to establish a correlation of PGD and psychosis. Declaration of Conflicting Interests The author(s) declared no potential con- flicts of interest with respect to the research, authorship and/or publication of this article. Funding The author(s) received no financial sup- port for the research, authorship and/or publication of this article. References Callaway DA, Perkins DO, Woods SW, et al. (2014) Movement abnormalities predict tran- sitioning to psychosis in individuals at clinical high risk for psychosis. Schizophrenia Research 159: 263–266. Díaz-Caneja CM, Pina-Camacho L, Rodríguez- Quiroga A, et al. (2015) Predictors of out- come in early-onset psychosis: a systematic review. Npj Schizophrenia. Epub ahead of print 4 March. DOI: 10.1038/npjschz.2014.5. Pappa S and Dazzan P (2009) Spontaneous move- ment disorders in antipsychotic-naive patients with first-episode psychoses: A systematic review. Psychological Medicine 39: 1065–1076. Letter 744256ANP 0 0 10.1177/0004867417744256ANZJP CorrespondenceANZJP Correspondence research-article 2017 Letter