The role of PRKRA mutation in antipsychotic-induced extrapyramidal symptoms: a case report and implications for precision psychiatry.
Mude Jeevan Naik, Simran Arora, Likhita Thippeswamy et al.
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Case in brief
A 43-year-old woman with atypical psychosis developed severe extrapyramidal symptoms after treatment with olanzapine, an antipsychotic described as having a lower propensity for these effects. Genetic testing identified a heterozygous duplication in PRKRA, a gene involved in stress-response pathways and movement control. Allopurinol was added, which the report presents as a possible approach to neuroleptic sensitivity. The abstract does not specify the clinical outcome after augmentation.
What made this case unusual
Severe extrapyramidal symptoms occurred with olanzapine, alongside identification of a heterozygous PRKRA duplication; the report also describes allopurinol augmentation in this context.
Diagnostic / clinical pearl
Consider genetic susceptibility when severe extrapyramidal symptoms arise during antipsychotic treatment, including with an agent described as having lower propensity for these effects.
Why it matters
The case highlights the potential relevance of pharmacogenomic findings to individualized care, while a single report cannot establish the clinical significance of this PRKRA variant or the benefit of allopurinol.