Pharmacotherapy effectiveness for clinical subgroups among children and adolescents with early onset schizophrenia

2017 ◽  
Vol 32 (2) ◽  
pp. e2585 ◽  
Author(s):  
Jeanette M. Jerrell ◽  
Roger S. McIntyre ◽  
Chelsea B. Deroche
Keyword(s):  
Children And Adolescents ◽  
Early Onset ◽  
Early Onset Schizophrenia

scholarly journals Neurodevelopmental Trajectories and Clinical Profiles in a Sample of Children and Adolescents With Early- and Very-Early-Onset Schizophrenia

2021 ◽  
Vol 12 ◽  
Author(s):  
Maria Pontillo ◽  
Roberto Averna ◽  
Maria Cristina Tata ◽  
Fabrizia Chieppa ◽  
Maria Laura Pucciarini ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Neurodevelopmental Disorders ◽  
Early Onset ◽  
Social Role ◽  
Treatment Plan ◽  
Neurodevelopmental Disorder ◽  
Communication Disorders ◽  
Autism Spectrum ◽  
Early Onset Schizophrenia ◽  
Assessment And Treatment

Schizophrenia before the age of 18 years is usually divided into two categories. Early-onset schizophrenia (EOS) presents between the ages of 13 and 17 years, whereas very-early-onset schizophrenia (VEOS) presents at or before the age of 12 years. Previous studies have found that neurodevelopmental difficulties in social, motor, and linguistic domains are commonly observed in VEOS/EOS patients. Recent research has also shown a high prevalence of neurodevelopmental disorders (e.g., intellectual disability, communication disorders, autism spectrum disorder, neurodevelopmental motor disorders) in VEOS/EOS patients, indicating genetic overlap between these conditions. These findings lend support to the neurodevelopmental continuum model, which holds that childhood neurodevelopmental disorders and difficulties and psychiatric disorders (e.g., schizophrenia) fall on an etiological and neurodevelopmental continuum, and should not be considered discrete entities. Based on this literature, in this study we focused on the overlap between neurodevelopmental disorders and schizophrenia investigating, in a large sample (N = 230) of VEOS/EOS children and adolescents, the clinical differences, at the onset of psychosis, between VEOS/EOS with neurodevelopmental disorder or neurodevelopmental difficulties and VEOS/EOS with no diagnosed neurodevelopmental disorder or neurodevelopmental difficulties. The findings showed that, in children and adolescents with a neurodevelopmental disorder or neurodevelopmental difficulties, psychosis onset occurred at an earlier age, was associated with more severe functional impairment (e.g., global, social, role), and was characterized by positive symptoms (e.g., grandiose ideas, perceptual abnormalities, disorganized communication) and disorganized symptoms (e.g., odd behavior or appearance, bizarre thinking). Instead, in children and adolescents without a neurodevelopmental disorder or neurodevelopmental difficulties, psychosis onset was mainly characterized by negative symptomatology (e.g., social anhedonia, avolition, expression of emotion, experience of emotions and self, ideational richness). Given these differences, the presence of a neurodevelopmental disorder or neurodevelopmental difficulties should be carefully investigated and integrated early into the assessment and treatment plan for VEOS/EOS patients.

Use of atypical antipsychotics in early onset schizophrenia

2011 ◽  
Vol 26 (S2) ◽  
pp. 324-324
Author(s):  
M. Marin Mayor ◽  
N. Martinez Martin ◽  
E. Verdura Vizcaino ◽  
R.A. Codesal Julian
Keyword(s):  
Side Effects ◽  
Children And Adolescents ◽  
Early Onset ◽  
Atypical Antipsychotics ◽  
Metabolic Effects ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Childhood And Adolescence ◽  
Early Onset Schizophrenia ◽  
Children And Adolescent

IntroductionChildhood or Early Onset Schizophrenia (EOS), defined as the onset of psychotic symptoms before the thirteenth birthday, represents a rare, clinically severe variant, associated with significant chronic functional impairment and poor response to antipsychotic treatment. Despite of that, in clinical practice, atypical agents have become the treatment of choice in patients with EOS.AimsTo review the different pharmacological strategies, in which an atypical antipsychotic was used in the management of EOS in childhood and adolescence.MethodsWe conducted a literature search of articles related to the use of atypical antipsychotics in children and adolescents with EOS in the last 20 years from the Medline database.ResultsSeveral atypical antipsychotics, such as Risperidone, Olanzapine, Quetiapine, Aripiprazol and Clozapine were consistently found to reduce the severity of psychotic symptoms in EOS when compared to placebo. Although Clozapine has demonstrated to be more efficacious than other atypical and typical antipsychotics, it remains the medication of last resort due to its profile of side effects. Finally, in general, children and adolescent have a higher risk of extrapyramidal symptoms, akathisia, prolactin elevation, sedation and metabolic effects of atypical antipsychotics than adults.ConclusionsAntipsychotics are the mainstay of treatment of EOS. Randomized controlled trials suggest a trend to superior efficacy for atypical antipsychotics over classic antipsychotic. Children and adolescents trend to be more sensible to antipsychotic side effects. Clinicians should be aware of this problem and be careful when monitoring this type of treatment.

scholarly journals Metabolic Side Effects of Risperidone in Children and Adolescents With Early-Onset Schizophrenia

2008 ◽  
Vol 10 (06) ◽  
pp. 486-487 ◽  
Author(s):  
Jean-Louis Goeb ◽  
Sophie Marco ◽  
Alain Duhmael ◽  
Renaud Jardri ◽  
Geraldine Kechid ◽  
...  
Keyword(s):  
Side Effects ◽  
Children And Adolescents ◽  
Early Onset ◽  
Early Onset Schizophrenia ◽  
Metabolic Side Effects

Comparative Neuropsychiatry: White Matter Abnormalities in Children and Adolescents with Schizophrenia, Bipolar Affective Disorder, and Obsessive-Compulsive Disorder

2015 ◽  
Vol 30 (2) ◽  
pp. 205-213 ◽  
Author(s):  
T. White ◽  
C. Langen ◽  
M. Schmidt ◽  
M. Hough ◽  
A. James
Keyword(s):  
White Matter ◽  
Children And Adolescents ◽  
Affective Disorder ◽  
Obsessive Compulsive Disorder ◽  
Early Onset ◽  
Bipolar Affective Disorder ◽  
Early Onset Schizophrenia ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
White Matter Abnormalities

AbstractBackground:There is considerable evidence that white matter abnormalities play a key role in the pathogenesis of a number of major psychiatric disorders, including schizophrenia, bipolar affective disorder, and obsessive-compulsive disorder. Few studies, however, have compared white matter abnormalities early in the course of the illness.Methods:A total of 102 children and adolescents participated in the study, including 43 with early-onset schizophrenia, 13 with early-onset bipolar affective disorder, 17 with obsessive-compulsive disorder, and 29 healthy controls. Diffusion tensor imaging scans were obtained on all children and the images were assessed for the presence of non-spatially overlapping regions of white matter differences, a novel algorithm known as the pothole approach.Results:Patients with early-onset schizophrenia and early-onset bipolar affective disorder had a significantly greater number of white matter potholes compared to controls, but the total number of potholes did not differ between the two groups. The volumes of the potholes were significantly larger in patients with early-onset bipolar affective disorder compared to the early-onset schizophrenia group. Children and adolescents with obsessive-compulsive disorder showed no differences in the total number of white matter potholes compared to controls.Conclusions:White matter abnormalities in early-onset schizophrenia and bipolar affective disorder are more global in nature, whereas children and adolescents with obsessive-compulsive disorder do not show widespread differences in FA.

scholarly journals Factors affecting improvement of children and adolescents who were treated in the child and adolescent psychiatry inpatient unit

2017 ◽  
Vol 45 (4) ◽  
pp. 1318-1323
Author(s):  
Burcu Serim Demirgoren ◽  
Aylin Ozbek ◽  
Ozlem Gencer
Keyword(s):  
Children And Adolescents ◽  
Adolescent Psychiatry ◽  
Early Onset ◽  
Familial Risk ◽  
Child And Adolescent Psychiatry ◽  
Inpatient Unit ◽  
Older Age ◽  
Risk Scores ◽  
Early Onset Schizophrenia ◽  
General Functioning

Objective This study aimed to assess the correlates and predictors of improvement in general functioning of children and adolescents who are treated in the child and adolescent psychiatry (CAMHS) inpatient unit. Methods Hospital records of 308 children and adolescents who were treated for at least 1 month in the CAMHS inpatient unit from 2005–2016 were included. Associations with individual, familial, and clinical variables and the difference in Children’s Global Assessment Scale (ΔCGAS) scores at admission and discharge were evaluated. Results Positive predictors of ΔCGAS were older age and lower CGAS scores at admission, whereas high familial risk scores at admission and diagnosis of early-onset schizophrenia negatively predicted ΔCGAS (B = 0.698, p = 0002; B = −0.620, p < 0.001; B = −0.842, p = 0.002; B =−9.184, p = 0.000, respectively). Familial risk scores were significantly and negatively correlated with ΔCGAS (p = 0.004, Spearman’s rho = −0.2). Conclusions This study indicates that improvement in general functioning during inpatient treatment in CAMHS is better at an older age and with lower general functioning at admission. However, high familial risks and diagnosis of early-onset schizophrenia weakens this improvement.

Time to Initiation of Clozapine Treatment in Children and Adolescents with Early-Onset Schizophrenia

2016 ◽  
Vol 49 (06) ◽  
pp. 254-259 ◽  
Author(s):  
E. Trinczek ◽  
M. Heinzel-Gutenbrunner ◽  
M. Haberhausen ◽  
C. Bachmann
Keyword(s):  
Children And Adolescents ◽  
Early Onset ◽  
Poor Prognosis ◽  
Psychiatric Hospitalization ◽  
Tertiary Care ◽  
Antipsychotic Treatment ◽  
Early Onset Schizophrenia ◽  
Clozapine Treatment ◽  
Time To Initiation ◽  
Clinical Records

Abstract Introduction: Early-onset schizophrenia (EOS) has a poor prognosis and is difficult to treat, which often leads to the initiation of clozapine treatment. Studies in adults have shown that the initiation of clozapine treatment is often delayed. There is a lack of studies concerning the initiation of clozapine in children and adolescents with EOS. The aim of this study was to investigate the time span from first EOS-related psychiatric hospitalization to clozapine initiation. Methods: We retrospectively studied a consecutive cohort of children and adolescents with EOS and first-time clozapine prescriptions from a tertiary care child and adolescent psychiatric center in Germany. Results: Clinical records with data on clozapine initiation were available for 112 patients (35.7% females, mean age: 15.2±1.6 years). The mean time from first EOS-related hospitalization to clozapine initiation was 1.1 (±1.0) years, with an average of 2.3 (±1.1) prior antipsychotic treatment episodes. Higher age and higher IQ predicted earlier clozapine initiation. At the time of clozapine initiation, 40.2% of patients received antipsychotic polypharmacy. Prior to clozapine, 33.9% of patients had received 3 or more antipsychotic treatment episodes. Discussion: In our study, clozapine treatment was initiated markedly earlier than in the few existing studies, which may partly be due to the expected poor prognosis of EOS. The significant portion of patients undergoing 3 or more antipsychotic trials or antipsychotic polypharmacy prior to clozapine may indicate a need for improved dissemination of knowledge on the effectiveness of clozapine in treatment-resistant schizophrenia in order to promote timely clozapine prescriptions in these cases.

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