Abstract
Selective mutism is rare with a prevalence below 1% in the general population, but
a higher prevalence in populations at risk (children with speech retardation, migration).
Evidence for treatment strategies is hardly available. This case report provides information
on the treatment of selective mutism in an 8-year-old girl with preexisting thalassaemia
major. As medications she received penicillin prophylaxis (500000 IE/d) and deferasirox
(Exjade; 20–25mg/kg/d), an iron chelator. The preexisting somatic disease and treatment
complicated the treatment, as there are no data about pharmacological combination
therapy. Psychotherapy in day treatment, supported by the use of the SSRI fluoxetine
(10 mg), led to a decrease in the selective mutism score from 33 to 12 points, GAF
improved by 21 points. Mean levels of fluoxetine plus norfluoxetine were 287.8 ng/ml
without significant level fluctuations.
Key words
mutism - SSRI - deferasirox - thalassaemia - fluoxetine
