Childhood onset violence and early onset schizophrenia. A molecular diagnosis of 15q13.2-13.3 duplication syndrome and the effects on insight and engagement

Genetic investigations do not form part of the routine assessment of patients with psychosis in secure settings. The case of a man admitted to a low secure unit after initial civil detention is presented. He was arrested after violence at home and there followed persistent violence in adult general wards. Many risk factors for violence were present and would usually be considered sufficient explanations for the totality of his presentation and risk. The novel aspect was the results of genetic testing. This revealed associations with his physical appearance, development and neurodevelopment, early onset violence and aggression, psychosis, and possibly the excellent response to clozapine. Array Comparative Genomic Hybridisation (aCGH) revealed a 15q13.2-13.3 microduplication, with the genetic report suggesting that many of the clinical aspects were, at least in part, attributable to this finding. This provided a complimentary narrative explanation for a presentation which had been difficult to treat and understand by both the patient and treating team. This is the only case report to describe this specific diagnosis from the patient's perspective and the helpful impact of the genetic diagnosis, particularly for the patient himself. A brief overview of genetic findings relevant to forensic practice is described.