Treatment of psychiatric comorbidities in a patient with becker muscular dystrophy

Received December 13, 2005; revised December 22, 2005; accepted January 13, 2006. From the Dept. of Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD. Send correspondence and reprint requests to Hochang B. Lee, M.D., Dept. of Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, MD. e-mail: hochang@jhmi.edu Copyright 2007 The Academy of Psychosomatic Medicine Although the association between Becker muscular dystrophy (BMD) and muscle deterioration is known, the connection between BMD and psychiatric disorders is less clear. BMD is caused by a mutation in the dystrophin gene, causing translation of abnormal but functional dystrophin, a major component of the muscle subsarcolemmal cytoskeleton. This mutation leads to progressive voluntary muscle wasting and weakness. However, the clinical significance of the fact that dystrophin is also expressed in the cerebral cortex as part of the neuronal postsynaptic apparatus is less clear. The literature is limited, but some studies have reported an association between cognitive impairment and dystrophin deficiencies. Also, one study has reported an increased prevalence of depression among patients with BMD, and other studies have described the co-segregation of BMD and schizophrenia. As a result of this association between BMD and psychiatric disorders, many patients with BMD will require a combination of medical, neurologic, and psychiatric management. The purpose of this report is to illustrate the usefulness of combined pharmacotherapy and behavioral therapy, guided by neuropsychological assessment, for treatment of a complicated patient with BMD and psychiatric comorbidities.