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

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.

Neuropsychological Deficits in the Prodromal Phase and Course of an Early-Onset Schizophrenia

2014 ◽  
Vol 42 (3) ◽  
pp. 167-176 ◽  
Author(s):  
Vanessa Puetz ◽  
Thomas Günther ◽  
Berrak Kahraman-Lanzerath ◽  
Beate Herpertz-Dahlmann ◽  
Kerstin Konrad
Keyword(s):  
Verbal Memory ◽  
Early Onset ◽  
Neuropsychological Functioning ◽  
Neuropsychological Testing ◽  
Clinical Situation ◽  
Adolescent Male ◽  
Antipsychotic Treatment ◽  
Early Onset Schizophrenia ◽  
Prodromal Phase ◽  
Illness Onset

Objectives: Although clear advances have been achieved in the study of early-onset schizophrenia (EOS), little is known to date about premorbid and prodromal neuropsychological functioning in EOS. Method: Here, we report on a case of an adolescent male with EOS who underwent neuropsychological testing before and after illness onset. Results: Marked cognitive deficits in the domains of attention, set-shifting, and verbal memory were present both pre-onset and during the course of schizophrenia, though only deficits in verbal memory persisted after illness-onset and antipsychotic treatment. Conclusion: The findings of this case study suggest that impairments in the verbal memory domain are particularly prominent symptoms of cognitive impairment in prodromal EOS and persist in the course of the disorder, which further demonstrates the difficult clinical situation of adequate schooling opportunities for adolescent patients with EOS.

scholarly journals Gender differences in the use of atypical antipsychotics in early-onset schizophrenia: a nationwide population-based study in Brazil

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Izabela Fulone ◽  
Marcus Tolentino Silva ◽  
Luciane Cruz Lopes
Keyword(s):  
Gender Differences ◽  
Early Onset ◽  
Atypical Antipsychotics ◽  
Population Based ◽  
Cross Sectional Study ◽  
Administrative Database ◽  
Age Group ◽  
Early Onset Schizophrenia ◽  
Cross Sectional ◽  
Assistance Programme

Abstract Background The use of atypical antipsychotics for the treatment of schizophrenia and other mental disorders in populations under 18 years of age is increasing worldwide. Little is known about treatment patterns and the influence of gender differences, which may be a predictor of clinical outcomes. The aim of this study was to investigate gender differences in the use of atypical antipsychotics in patients with early-onset schizophrenia (EOS) assisted by the public health system in Brazil. Methods We conducted a cross-sectional study of outpatients with EOS aged 10 to 17 years who received at least one provision of atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a large Brazilian pharmaceutical assistance programme. Data were retrieved from a nationwide administrative database from 2008 to 2017. Results Of the 49,943 patients with EOS, 63.5% were males, and the mean age was 13.6 years old. The patients were using risperidone (62.5%), olanzapine (19.6%), quetiapine (12.4%), ziprasidone (3.3%) and clozapine (2.2%). We found gender differences, especially in the 13–17 year age group (65.1% for males vs. 34.9% for females, p < 0.001), in the use of risperidone (72.1% for males vs. 27.9% for females, p < 0.001) and olanzapine (66.5% for males vs. 33.5% for females, p < 0.001). Only in the 13 to 17 years age group were the prescribed doses of olanzapine (p = 0.012) and quetiapine (p = 0.041) slightly higher for males than for females. Conclusions Our findings showed gender differences among patients diagnosed with EOS and who received atypical antipsychotics. More attention should be devoted to gender differences in research and clinical practice.

scholarly journals An Integrated Approach to Deal with Mental Health Issues of Children and Adolescent during COVID-19 Pandemic

2020 ◽  
Author(s):  
Mousumi Sethy ◽  
Reshmi Mishra
Keyword(s):  
Mental Health ◽  
Children And Adolescents ◽  
Adult Life ◽  
Holistic Approach ◽  
Integrated Approach ◽  
Well Being ◽  
Childhood And Adolescence ◽  
Health Issues ◽  
Children And Adolescent ◽  
Mental Health Issues

The pandemic caused by COVID-19 has left few countries untouched. It is a far-reaching implication on humankind, with children and adolescents, being no exception. Although the prevalence and fatality are negligible among children, a possible impact on their psychological and mental health cannot be disregarded. The unprecedented change in the way of living is bound to be having some psychological consequences on children and adolescents. The experiences gathered in childhood and adolescence are known to contribute to shaping the physical, emotional, and social well-being in adult life. Children are highly susceptible to environmental stressors. The present situation has the potential of adversely affecting the physical and mental well-being of children. To save the children from the long term consequences of this pandemic, a holistic approach integrating biological, psychological, social and spiritual methods of enhancing mental health have become essential. A concerted effort of government, Non Government Organisations (NGOs), parents, teachers, schools, psychologists, counselors and physicians are required to deal with the mental health issues of children and adolescents. This paper discusses the possible role of these agencies in the holistic intervention of this crisis.

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.

Antipsychotic Effects of Cannabidiol

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1 ◽  
Author(s):  
F.M. Leweke ◽  
D. Koethe ◽  
F. Pahlisch ◽  
D. Schreiber ◽  
C.W. Gerth ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Paranoid Schizophrenia ◽  
Treatment Strategies ◽  
Endocannabinoid System ◽  
Psychotic Symptoms ◽  
Controlled Clinical Trial ◽  
Antipsychotic Treatment ◽  
Double Blind ◽  
Acute Schizophrenia

Background:In contrast to delta-9-tetrahydrocannabinol, the phytocannabinoid cannabidiol does not exert psychotomimetic effects. Cannabidiol was suggested a re-uptake inhibitor of anandamide and potential antipsychotic properties have been hypothesized for it. We therefore performed a clinical trial to investigate thesis hypothesis and to clarify the underlying link to the neurobiology of schizophrenia.Methods:We performed an explorative, 4-week, double-blind, controlled clinical trial on the effects of purified cannabidiol in acute schizophrenia compared to the antipsychotic amisulpride. The antipsychotic properties of both drugs were the primary target of the study. Furthermore, side-effects and anxiolytic capabilities of both treatments were investigated.Results:42 patients fulfilling DSM-IV criteria of acute paranoid schizophrenia participated in the study. Both treatments were associated with a significant decrease of psychotic symptoms after 2 and 4 weeks as assessed by BPRS and PANSS. However, there was no statistical difference between both treatment groups. In contrast, cannabidiol induced significantly less side effects (EPS, increase in prolactin, weight gain) when compared to amisulpride.Conclusions:Cannabidiol revealed substantial antipsychotic properties in acute schizophrenia. This is in line with our suggestion of an adaptive role of the endocannabinoid system in paranoid schizophrenia, and raises further evidence that this adaptive mechanism may represent a valuable target for antipsychotic treatment strategies.The Stanley Medical Research Institute (00-093 to FML) and the Koeln Fortune Program (107/2000 + 101/2001 to FML) funded this study.

Antipsychotics-induced leukopenia and neutropenia: A case report and review of literature

2016 ◽  
Vol 33 (S1) ◽  
pp. S546-S546 ◽  
Author(s):  
H. Maatallah ◽  
H. Ben Ammar ◽  
M. Said ◽  
A. Aissa
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Psychotic Symptoms ◽  
Review Of Literature ◽  
Blood Cell Count ◽  
Life Threatening ◽  
Dsm Iv ◽  
Competing Interest

IntroductionAntipsychotic drugs effectively control psychotic symptoms, but may cause important side effects, significantly increasing morbidity and mortality. Hematologic abnormalities are frequent and may be life-threatening in some patients. Many prospective investigations confirmed neutropenia as a frequent occurrence with virtually all atypical antipsychotics.Objective and methodsDefine epidemiological, clinical and therapeutic characteristics of antipsychotics – induced leukopenia and neutropenia through a case report and a review of literature.Case reportPatient 28 years old native of Tunis, with family history: brother who suffer of undifferentiated schizophrenia. Since the age of 16 years he has been followed for disorganized schizophrenia (DSM IV). He was initially put under Haldol Decanoate (2 months), fluphenazine (2 months), amisulpride (3 months), sulpride (2 months), olanzapine (3 months), Rispreridone (1 month), aripiprazole (5 months) leukopenia/neutropenia is occurring during treatment with each molecule and which promptly resolved after discontinuation. Reduced white blood cell count has also been reported after addition of lithium. Actually an ECT is proposed for this patient.ConclusionThis case report shows the importance of hematological monitoring during the course of typical or atypical treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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