Herediter ataksiler arasında en sık gözlenen tip olan Friedreich's Ataksi (FA) otozomal çekinik geçişli nörodejeneratif bir hastalıktır. Bu hasta-lıkta depresyon, duygusal oynaklık ve psikotik belirtiler görülebilir. Ancak literatürde FA ve psikozun birlikte olduğu olgular sayıca azdır. Bu nedenle FA tanısı konmuş, psikozla giden ve ketiyapinden fayda gören olgu tartışıldı.

On yedi yaşında dengesiz yürüme yakınması başlayan hastaya, 20 yaşında FA tanısı konmuş. Yirmi beş yaşındaki kadın hasta, kliniğimize kontrolünde dengesiz yürüme, hayal görme yakınmalarıyla başvurdu. Depresif duygudurumu ve işitsel varsanıları vardı. Kendisine zarar verilebileceği şeklinde kötülük görme sanrıları vardı. FA tanılı, koenzim Q, B ve E vitamini tedavisi almakta olan hastaya, ciddi psikotik ve depresif bulgular nedeniyle essitalopram 10 mg/gün ve ketiyapin 400 mg/gün verildi. İki hafta sonra, psikotik ve depresif belirtileri kaybolmuştu.
FA hastalarındaki çalışmalarda, nöropsikiyatrik performansa bakılmıştır. Yürütücü işlev bozuk-lukları gibi bilişsel anormallikler tanımlanmıştır. Ancak FA, psikoz birlikteliği ve tedavisiyle ilgili az sayıda olgu bildirilmiştir. Bir çalışmada, FA hastasında gelişen psikotik belirtiler risperidonla başarıyla tedavi edilmiştir. Yiu-Chung Chan, FA'da gelişen psikozun risperidonla başarılı tedavisine karşın, hiperprolaktinemi gelişmesi nedeniyle aripiprazol başlamış, yanıt almıştır. Bu olguda, aripiprazolün psikozu tedavi etmesinin yanında bilişsel işlevlerde gelişme sağladığı da vurgulanmıştır. Literatürde, FA'da gelişen psikozda ketiyapinle ilgili bilgiye rastlanmadı. Biz bu hastada, psikotik bulgulara yönelik olarak ketiyapinle başarılı sonuç aldık. Ketiyapin, FA ve psikoz birlikteliğinde iyi tolere edilebilen, etkin alternatif bir farmakoterapötik ajan olabilir.

Friedreich's Ataxia (FA) is the most common form of progressive spinocerebellar ataxia with mixed sensory and cerebellar components, and inherits autosomal-recessive. Cognitive im-pairment, depression, emotional liability, and schizophrenia-like psychosis are the psychiatric manifestations of the disease. There are many studies, which focused on neuropsychological performances but there are only two reports of patients with FA with psychosis and their psychosis were treated with risperidone and aripiprazole successfully. We describe a patient with FA who developed psychosis and responded to quetiapine.
Ms. F. was a 25 [year]s old woman and diagnosed with FA while she was 17 [year]s old. She developed paranoia and was complaining of auditory and visual hallucinations. Her auditory hallucinations were including orders that control her behaviors and she believed that if she did not comply the orders she would be punished and she was continuously in fear. She was reluctant and had the somatic symptoms of insomnia and fatigue. In her past psychiatric history, there were depressive symptoms and since she could not tolerate she had discontinued paroxetine. Her family history was notable for an elder sister who also had FA and there were no alcohol and substance abuse history. The patient was referred to psychiatry clinic and started escitalopram 5 mg and quetiapine 300 mg and the dosages were increased 10 mg for escitalopram and 400 mg for quetiapine after one week. At the end of the first week, she did not believe her auditory and visual hallucinations and second week; her psychotic and depressive symptoms were signi-ficantly diminished. She experienced no extra-pyramidal symptoms or other side effects.

In the literature there are only two cases of FA with psychosis and their psychosis were treated with risperidone and aripiprazole successfully. One of them was first treated with quetiapine but due to the side effects of sedation, muscle stiffness, and vision impairment treatment was discontinued. In our patients, we started quetiapine and her complaints were significantly diminished. There were no complaints of cognitive function and sedation was improved in a period of one week. There were no complaints of extrapyramidal symptoms. Quetiapine was an effective and well-tolerated treatment for psychosis in our FA with psychosis patient.