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Common indicators are repetitive behaviors, temper tantrums, and self\u2010injurious behaviors such as skin\u2010 and\/or rectal picking. <jats:italic>N<\/jats:italic>\u2010Acetylcysteine (NAC) was previously described as a promising therapeutic option for skin picking in PWS. In this case series, we retrospectively investigated the effect of pharmacotherapy with NAC in 14 individuals with PWS suffering from skin\u2010 and\/or rectal picking. Treatment success was determined using the Clinical Global Impression\u2014Improvement scale (CGI\u2010I). The Clinical Global Impression\u2014Efficacy index (CGI\u2010EI) was used to put treatment success and side effects into perspective. Six of fourteen patients, all of which were female, showed improvement in symptoms (dosage 1800\u20132400\u2009mg\/day), whereas six patients did not show any change during treatment. Moreover, two male patients treated for solitary rectal picking showed new onset of skin picking. Across all cases, a CGI\u2010I of 3 (corresponding to minimal improvement) was seen after 3\u2009months of treatment, with a CGI\u2010EI of 1.6 (corresponding to moderate efficacy). NAC remains a reasonable therapeutic option in certain cases of skin picking in PWS but provides only limited efficacy compared to previous studies on the topic. There was a higher rate of adverse drug reactions than previously reported. The results particularly suggest caution in future treatment in individuals with solitary rectal picking and reduced efficacy when coadministered with neuroleptics.<\/jats:p>","DOI":"10.1002\/ajmg.a.62589","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T08:27:30Z","timestamp":1638433650000},"page":"828-835","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["<i>N<\/i>\u2010Acetylcysteine provides limited efficacy as treatment option for skin picking in <scp>Prader\u2013Willi<\/scp> syndrome"],"prefix":"10.1002","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8572-1365","authenticated-orcid":false,"given":"Jelte","family":"Wieting","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Social Psychiatry and Psychotherapy Medical School Hannover  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8759-8660","authenticated-orcid":false,"given":"Maximilian","family":"Deest","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Social Psychiatry and Psychotherapy Medical School Hannover  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Bleich","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Social Psychiatry and Psychotherapy Medical School Hannover  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helge","family":"Frieling","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Social Psychiatry and Psychotherapy Medical School Hannover  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Eberlein","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Social Psychiatry and Psychotherapy Medical School Hannover  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,12,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e318272677d"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/pcn.12362"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-015-0312-9"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.42.4.314"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.npp.1300733"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.NEUBIOREV.2015.04.015"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.62041"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.1996.tb01496.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNF.0000000000000001"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2788.1998.4260472.x"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-13-196"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/adb.12711"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2016.0060"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2006.11.021"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2009.60"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1521-0391.2009.00027.x"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","unstructured":"Guy W.(1976).Clinical Global Impressions (CGI). 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