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Current Psychiatry Research and Reviews

Editor-in-Chief

ISSN (Print): 2666-0822
ISSN (Online): 2666-0830

Case Report

Psychiatric Manifestations of Ehlers-Danlos Syndrome in Adolescents: A Case Report and Literature Review

Author(s): Daisy Vyas Shirk* and Sarah D. Williams

Volume 16, Issue 4, 2020

Page: [288 - 291] Pages: 4

DOI: 10.2174/2666082216999201126165311

Price: $65

Abstract

Background: Ehlers-Danlos Syndromes (EDS) comprise a group of heterogeneous hereditary connective tissue disorders [1, 2]. Psychiatric disorders such as depression, anxiety, panic disorder, agoraphobia, schizophrenia, neurodevelopmental disorders, personality disorder, eating disorders, substance misuse and interpersonal issues have been reported in the literature to be associated with EDS [1-3].

Objectives: The case of a 15-year old male who was hospitalized after a suicide attempt by gunshot, who was discovered to have symptoms suggestive of EDS, is presented in this paper along with the results of a literature search of psychiatric manifestations of EDS in children and adolescents.

Methods: Literature review was conducted on the UpToDate website on March 11, 2020 to review symptoms of Ehlers-Danlos Syndrome for the purpose of preliminary diagnosis of this patient. Additional literature search was conducted on PubMed on 4/2/20 at 12:10 P.M. and on 4/9/20 at 10:51 P.M. and on the search engine Google on 4/2/20 at 12:25 P.M. On May 11, 2020 at 2 P.M., another web search was conducted with a review of 6 different websites pertaining to Ehlers-Danlos Syndrome.

Results: A systematic review of psychiatric manifestations of Ehlers-Danlos Syndromes revealed a strong incidence of psychiatric symptoms.

Conclusion: Our patient’s psychiatric symptoms of depression, suicidal ideations, anxiety and social and educational struggles may have been at least partially due to chronic pain- abdominal, headache and musculoskeletal, and social ostracization associated with Ehlers-Danlos Syndrome. Education regarding this illness helped our patient’s recovery as he came to understand why he was so “odd” and the cause of his multisystemic chronic pain.

Keywords: Depression, musculoskeletal pain, migraines, abdominal pain, anorexia, joint hypermobility, hereditary.

Graphical Abstract

[1]
Hershenfeld SA, Wasim S, McNiven V, et al. Psychiatric disorders in Ehlers-Danlos syndrome are frequent, diverse and strongly associated with pain. Rheumatol Int 2016; 36(3): 341-8.https://link.springer.com/article/10.1007/s00296-015-3375-1
[http://dx.doi.org/10.1007/s00296-015-3375-1]
[2]
Hakim AJ, Sahota A. Joint hypermobility and skin elasticity: the hereditary disorders of connective tissue. Clin Dermatol 2006; 24(6): 521-33.
[http://dx.doi.org/10.1016/j.clindermatol.2006.07.013] [PMID: 17113970]
[3]
Wasim S, Suddaby JS, Parikh M, et al. Pain and gastrointestinal dysfunction are significant associations with psychiatric disorders in patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders: a retrospective study. Rheumatol Int 2019; 39(7): 1241-8.https://link.springer.com/article/10.1007/s00296-019-04293-w
[http://dx.doi.org/10.1007/s00296-019-04293-w]
[4]
Adib N, Davies K, Grahame R, Woo P, Murray KJ. Rheumatology 2005; 44(6): 744-50.https://pubmed.ncbi.nlm.nih.gov/15728418/
[5]
Forghani I. Updates in Clinical and Genetics Aspects of Hypermobile Ehlers Danlos Syndrome 2019; 36(1): 12-6.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335943/?tool=pubmed
[http://dx.doi.org/10.4274/balkanmedj.2018.1113]
[6]
Miklovic T, Sieg VC. Ehlers Danlos SyndromeStatPearls [Internet] Available at: 2019.https://www.ncbi.nlm.nih.gov/books/NBK549814/
[7]
Kalisch L, Hamonet C, Bourdon C, Montalescot L, de Cazotte C, Baeza-Velasco C. Predictors of pain and mobility disability in the hypermobile Ehlers-Danlos syndromeDisabil Rehabil 2019; 42(25): 3679-86.https://www.tandfonline.com/doi/full/10.1080/09638288.2019.1608595?scroll=top&needAccess=true
[http://dx.doi.org/10.1080/09638288.2019.1608595]
[8]
The Ehlers-Danlos Society What are the Ehlers-Danlos Syndromes? Available at: . https://www.ehlers-danlos.com/what-is-eds/
[9]
NIH US National Library of Medicine Ehlers-Danlos syndrome Available at: . https://ghr.nlm.nih.gov/condition/ehlers-danlos-syndrome
[10]
Sinibaldi L, Ursini G, Castori M. Am J Med Genet C Semin Med Genet 2015; 169(1): 97-106.https://pubmed.ncbi.nlm.nih.gov/25821094/
[11]
Baeza-Velasco C, Pailhez G, Bulbena A, Baghdadli A. Joint hypermobility and the heritable disorders of connective tissue: clinical and empirical evidence of links with psychiatry. Gen Hosp Psychiatry 2015; 37(1): 24-30.https://www.sciencedirect.com/science/article/pii/S0163834314002643
[http://dx.doi.org/10.1016/j.genhosppsych.2014.10.002]
[12]
Espiridion ED, Daniel A, Van Allen JR. Recurrent depression and borderline personality disorder in a patient with Ehlers-Danlos syndrome. Cureus 2018; 10(12)e3760https://www.ncbi.nlm.nih. gov/pmc/articles/PMC6389018/
[http://dx.doi.org/10.7759/cureus.3760]
[13]
Bregant T, Klopcic Spevak M. Ehlers-Danlos syndrome: not just joint hypermobility. Case Rep Med 2018; 2018Article ID 5053825https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136482/
[14]
Gazit Y, Jacob G, Grahame R. Ehlers-Danlos Syndrome-Hypermobility Type: A Much Neglected Multisystemic Disorder. Rambam Maimonides Med J 2016; 7(4)e0034https://www. ncbi.nlm.nih.gov/pmc/articles/PMC5101008/
[15]
Eccles J, Harrison N, Critchley H. Joint hypermobility syndrome. Psychiatric manifestations. Rambam Maimonides Med J 2016; 7(4)e0034https://www.bmj.com/content/342/bmj.d998.long
[16]
Lumley MA, Jordan M, Rubenstein R, Tsipouras P, Evans MI. Psychosocial functioning in the Ehlers‐Danlos syndrome. Am J Med Genet 1994; 53(2): 149-52.https://www.ncbi.nlm.nih.gov/pubmed/7856639
[http://dx.doi.org/10.1002/ajmg.1320530206]
[17]
Walter SM. Case Report: Ehlers-Danlos Syndrome in an adolescent presenting with Chronic Daily Headache. Surg Neurol Int 2014; 5: S475-8.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253035/? report=classic
[19]
Cederlöf M, Larsson H, Lichtenstein P, Almqvist C, Ludvigsson JF, Serlachius E. Nationwide population-based cohort study of psychiatric disorders in individuals with Ehlers-Danlos syndrome or hypermobility syndrome and their siblings. BMC Psychiatry 2016; 16: 207.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932739/
[http://dx.doi.org/10.1186/s12888-016-0922-6]
[20]
Tinkle BT. Symptomatic joint hypermobility. Best Pract Res Clin Rheumatol 2020; 34(3)101508https://www.sciencedirect.com/science/article/abs/pii/S0025712519300781?via%3Dihub
[21]
Mu W, Muriello M, Clemens JL, et al. Factors affecting quality of life in children and adolescents with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders. Am J Med Genet A 2019; 179(4): 561-9.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029373/
[22]
Pacey V, Tofts L, Adams RD, Munns CF, Nicholson LL. Quality of life prediction in children with joint hypermobility syndrome. J Paediatr Child Health 2015; 51(7): 689-95.https://onlinelibrary. wiley.com/doi/abs/10.1111/jpc.12826
[http://dx.doi.org/10.1111/jpc.12826]
[23]
Schubert-Hjalmarsson E, Ohman A, Kyllerman M, Beckung E. Pain, balance, activity, and participation in children with hypermobility syndromePediatr Phys Ther Winter 2012; 24(4): 339-44.https://journals.lww.com/pedpt/Fulltext/2012/24040/Pain,_Balance,_Activity,_and_Participation_in.11.aspx
[http://dx.doi.org/10.1097/PEP.0b013e318268e0ef]
[24]
Muriello M, Clemens JL, Mu W, et al. Pain and sleep quality in children with non-vascular Ehlers-Danlos syndromes. Am J Med Genet A 2018; 176(9): 1858-64.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528463/
[http://dx.doi.org/10.1002/ajmg.a.40371]
[25]
Yen J-L, Lin S-P, Chen M-R, Niu D-M. Clinical Features of Ehlers-Danlos Syndrome. J Formos Med Assoc 2006; 105(6): 475-80.https://www.sciencedirect.com/science/article/pii/S092966460960187X?via%3Dihub
[http://dx.doi.org/10.1016/S0929-6646(09)60187-X]
[26]
Ross J, Grahame R. Joint hypermobility syndrome. BMJ 2011; 342: c7167.https://www.bmj.com/content/342/bmj.c7167.long
[http://dx.doi.org/10.1136/bmj.c7167]
[27]
Sieg KG. Autism and Ehlers-Danlos syndrome J Am Acad Child Psy 1992.https://jaacap.org/article/S0890-8567(09)64430-0/pdf
[http://dx.doi.org/10.1097/00004583-199201000-00034]
[28]
Baeza-Velasco C, Cohen D, Hamonet C, et al. Autism, joint hypermobility-related disorders and pain. Front Psychiatry 2018; 9: 656.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292952/?tool=pubmed
[http://dx.doi.org/10.3389/fpsyt.2018.00656]
[29]
Casanova EL, Casanova MF, Kelly DP, Sharp JL, Edelson SM. A cohort study comparing women with autism spectrum disorder with and without generalized joint hypermobility. Behav Sci 2018; 8(3): 35.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867488/
[http://dx.doi.org/10.3390/bs8030035]
[30]
Takei A, Mera K, Sato Y, Haraoka Y. High-functioning autistic disorder with Ehlers-Danlos syndrome. Psychiatry Clin Neurosci 2011; 65(6): 605-6.https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1819.2011.02262.x
[http://dx.doi.org/10.1111/j.1440-1819.2011.02262.x]
[31]
Fehlow P, Bernstein K, Tennstedt A, Walther F. Early infantile autism and excessive aerophagy with symptomatic megacolon and ileus in a case of Ehlers-Danlos syndrome. Padiatr Grenzgeb 1993; 31(4): 259-67.https://europepmc.org/article/med/8259320
[32]
Piedimonte C, Penge R, Terzani A, et al. Exploring relationships between joint hypermobility and neurodevelopment in children (4-13 years) with hereditary connective tissue disorders and developmental coordination disorder. Am J Med Genet B Neuropsychiatr Genet 2018; 177(6): 546-56.https://pubmed.ncbi. nlm.nih.gov/30070022/
[33]
Barnum R. Problems with diagnosing Conversion Disorder in response to variable and unusual symptoms. Adolesc Health Med Ther 2014; 5: 67-71.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000178/
[http://dx.doi.org/10.2147/AHMT.S57486]
[34]
Bulbena A, Baeza-Velasco C, Bulbena-Cabré A, et al. Psychiatric and psychological aspects in the Ehlers-Danlos syndromes. Am J Med Genet C Semin Med Genet 2017; 175(1): 237-45.https://onlinelibrary.wiley.com/doi/full/10.1002/ajmg.c.31544
[http://dx.doi.org/10.1002/ajmg.c.31544]
[35]
Ghali N, Sobey G, Burrows N. Ehlers-Danlos syndromes. BMJ 2019; 366: l4966.https://www.bmj.com/content/bmj/366/bmj.l4966full.pdf
[http://dx.doi.org/10.1136/bmj.l4966]
[36]
Bennett SE, Walsh N, Moss T, Palmer S. Understanding the psychosocial impact of joint hypermobility syndrome and Ehlers-Danlos syndrome hypermobility type: a qualitative interview study. Disabil Rehabil 2019; 1-10.https://www.tandfonline.com/doi/full/10.1080/09638288.2019.1641848?scroll=top&needAccess=true
[http://dx.doi.org/10.1080/09638288.2019.1641848]
[37]
Tran ST, Jagpal A, Koven ML, Turek CE, Golden JS, Tinkle BT. Symptom complaints and impact on functioning in youth with hypermobile Ehlers–Danlos syndrome. J Child Health Care 2020; 24(3): 444-57.https://pubmed.ncbi.nlm.nih.gov/31370685/
[http://dx.doi.org/10.1177/1367493519867174]
[38]
Castori M, Celletti C, Camerota F, Grammatico P. Chronic fatigue syndrome is commonly diagnosed in patients with Ehlers-Danlos syndrome hypermobility type/joint hypermobility syndrome. Clin Exp Rheumatol 2011; 29(3): 597-8.https://www.clinexprheumatol. org/article.asp?a=4635
[39]
Domany KA, Hantragool S, Smith DF, Xu Y, Hossain M, Simakajornboon N. Sleep Disorders and Their Management in Children With Ehlers-Danlos Syndrome Referred to Sleep Clinics. J Clin Sleep Med 2018; 14(4): 623-9.https://www.ncbi.nlm.nih. gov/pmc/articles/PMC5886440/
[http://dx.doi.org/10.5664/jcsm.7058]
[40]
Ghibellini G, Brancati F, Castori M. Neurodevelopmental attributes of joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type: Update and perspectives. Am J Med Genet C Semin Med Genet 2015; 169(1): 107-16.https://pubmed.ncbi. nlm.nih.gov/25654988/

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