Clinical Case DiscussionsBosch-Boonstra-Schaaf Optic Atrophy Syndrome Presenting as New-Onset Psychosis in a 32-Year-Old Man: A Case Report and Literature ReviewHOBBS, MISTY M.; WOLTERS, WILLIAM C. DO; RAYAPATI, ABNER O. MD, MPH Author Information HOBBS: University of Kentucky College of Medicine, Lexington, KY WOLTERS and RAYAPATI: Department of Psychiatry, University of Kentucky College of Medicine, Lexington, KY M.M.H. and W.C.W. contributed equally. Informed consent was obtained from the patient and his mother for publication of this report and the photographs. The authors declare no conflicts of interest. Please send correspondence to: Misty M. Hobbs, 135 Regency Point Path, Lexington, KY 40503 (e-mail: [email protected]). Journal of Psychiatric Practice 26(1):p 58-62, January 2020. | DOI: 10.1097/PRA.0000000000000440 Buy Metrics Abstract Bosch-Boonstra-Schaaf optic atrophy syndrome (BBSOAS) is a recently described autosomal dominant disorder caused by mutations in the nuclear receptor subfamily 2 group F member 1 (NR2F1) gene. Its common features include optic atrophy and/or hypoplasia, developmental delay, intellectual disability, attention deficit disorder, autism spectrum disorder, seizures, hearing defects, spasticity, hypotonia, and thinning of the corpus callosum. Mitochondrial involvement has also been described with BBSOAS. Currently, 31 cases of BBSOAS have been described in the literature. Here we report a case of undiagnosed BBSOAS presenting as psychosis in a 32-year-old man with a history of bilateral optic nerve atrophy, intellectual disability, epilepsy, and mitochondrial complex I abnormality on muscle biopsy. Whole-genome sequencing identified a heterozygous de novo nonsense mutation in the NR2F1 gene [c.253 G>T (guanine to thymine mutation in coding position 253) in exon 1, p.E85X variant (GAG>TAG) (glutamic acid to stop codon mutation; protein truncated to 85 amino acids)]. A pathogenic nonsense mutation has not previously been reported in the literature in association with BBSOAS and represents an expansion of clinically relevant variants. Psychosis has also not been previously reported in this syndrome and may represent a phenotypic expansion of BBSOAS, a manifestation of prolonged disease, or a result of disease management. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.