Psychosis in a 47,XXX Adolescent: Clinical Management and Multidisciplinary Follow-up
Abstract
Triple X (47,XXX) syndrome is a sex chromosome aneuploidy associated with learning disabilities, attentional deficits, and social impairments. Its psychiatric manifestations, particularly psychosis, remain underrecognized. This case report describes a 13-year-old girl with 47,XXX syndrome who developed two recurrent psychotic episodes during adolescence and ultimately achieved sustained remission under clozapine, illustrating the need for individualized, genetically informed care. The patient initially presented with persecutory delusions, auditory hallucinations, behavioral changes, and functional decline. Comprehensive neurological, neuropsychological, and audiological assessments showed average overall cognitive functioning and no syndrome-specific sensory abnormalities. Psychotic symptoms emerged years after methylphenidate initiation and persisted during medication-free periods, arguing against stimulant-induced psychosis. Following partial response and poor tolerability to risperidone and aripiprazole, clozapine was introduced using a "start low, go slow" strategy. Low-dose clozapine (150 mg/day) produced complete remission within two months without hematological or cardiovascular adverse effects. Preventive metformin successfully mitigated antipsychotic-associated weight gain. A coordinated multidisciplinary follow-up integrating psychiatry, general medicine, neuropsychology, genetics, and school-based interventions proved essential to maintaining stability,…
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