Antipsychotic Treatment of Adolescent Dual Diagnosis Patients

BACKGROUND A diagnosis of schizophrenia requires development of a pharmacotherapy regimen that balances many factors in the therapeutic decision-making process. Patient age and the presence or absence of comorbid chemical dependency represent two factors. Comorbid chemical dependency can have a profound impact on the successful treatment of schizophrenia, making patients with dual diagnoses of schizophrenia and chemical dependence a uniquely challenging population. There is little information regarding treatment of schizophrenia and chemical dependence in the pediatric population. Existing data from pediatric and adult populations may facilitate a well-guided and knowledgeable approach to treating pediatric dual diagnosis patients. METHODS A review of the literature for medication trials evaluating antipsychotic medication used to treat schizophrenia in childhood and adolescence as well as antipsychotic use in the treatment of the dual diagnoses of schizophrenia and chemical dependence was done. Databases for Ovid MEDLINE, PubMed, and PsycInfo were searched using the terms “addiction,” “adolescence,” “childhood,” “dual diagnosis,” “schizophrenia,” and “substance abuse.” Results were limited to English-language articles. RESULTS Seven articles were identified related to psychotic disorders and substance abuse in pediatric populations. Psychosis measurement instruments included the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression. Mean improvements were insignificant in most cases. Medication trials included clozapine, olanzapine, risperidone, and molindone. Trial safety concerns included metabolic effects, increased prolactin levels, and akathisia. One study with random assignment to olanzapine was discontinued early because of substantial weight gain without evidence of superior efficacy. Clozapine treatment was associated with more adverse drug events. CONCLUSION There is a great need for more research and use of available data to develop safe and effective treatment guidelines for childhood and adolescent dual diagnosis patients. When appropriate decisions are made regarding treatment of patients with comorbid schizophrenia and chemical dependence, both conditions may benefit with increased remission.

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Discriminating between Substance Abusers with Single and Dual Diagnoses Using MMPI Profiles and the MAC Andrews Alcoholism Scale: Axis I and Axis II Subtypes

Psychological Reports ◽

10.2466/pr0.1988.63.3.985 ◽

1988 ◽

Vol 63 (3) ◽

pp. 985-986 ◽

Cited By ~ 3

Author(s):

Ronald H. Rozensky ◽

Barbara Neirick ◽

Gary M. Slotnick ◽

Debra Morse

Keyword(s):

Substance Abuse ◽

Dual Diagnosis ◽

Substance Abusers ◽

Substance Abusing ◽

Psychiatric Diagnoses ◽

Axis Ii ◽

Heterogeneous Nature ◽

Dual Diagnoses ◽

Axis I

The MacAndrews Scale of the MMPI differentiated 21 dual-diagnosis substance abusers with a DSM-III—R, Axis I diagnosis from a group of 21 single-diagnosis substance abusers and 18 dual-diagnosis substance abusers with an Axis II diagnosis. Subjects were 50 substance-abuse only and 39 dual-diagnosis, hospitalized men. Research must take into account the heterogeneous nature of psychiatric diagnoses within the substance-abusing population.

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Use of atypical antipsychotics in early onset schizophrenia

European Psychiatry ◽

10.1016/s0924-9338(11)72033-8 ◽

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.

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Barriers to Cooperation between Domestic-Violence and Substance-Abuse Programs

Families in Society The Journal of Contemporary Social Services ◽

10.1177/104438949407500503 ◽

1994 ◽

Vol 75 (5) ◽

pp. 277-286 ◽

Cited By ~ 72

Author(s):

Larry Bennett ◽

Marie Lawson

Keyword(s):

Substance Abuse ◽

Domestic Violence ◽

Random Sample ◽

Substance Abusers ◽

Chemical Dependency ◽

Chemical Dependence ◽

Interagency Cooperation ◽

Substance Abuse Programs

Staff and administrators drawn from a statewide random sample of 74 chemical-dependency and domestic-violence programs completed a questionnaire on linkage, referral, impairments to interagency cooperation, and beliefs about cross-problem incidence. Survey participants estimated that 46% of the male substance abusers currently in their care were batterers, 60% of the female substance abusers were victims, and 42% of the women now in domestic violence programs were substance abusers. Four of five survey participants believed that these clients would benefit from increased cooperation between chemical-dependence and domestic-violence programs. Implications of these findings are discussed.

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Cognitive impairments in clients with dual diagnosis (chronic psychotic disorders and substance abuse): considerations for treatment

Occupational Therapy International ◽

10.1002/oti.32 ◽

1996 ◽

Vol 3 (2) ◽

pp. 122-141 ◽

Cited By ~ 2

Author(s):

Terri S. Harrison ◽

Pat Precin

Keyword(s):

Substance Abuse ◽

Dual Diagnosis ◽

Psychotic Disorders ◽

Cognitive Impairments

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Dual diagnosis: Clinical issues in the treatment of substance abuse, and affective, personality, and psychotic disorders

Journal of Contemporary Psychotherapy ◽

10.1007/bf02307707 ◽

1996 ◽

Vol 26 (1) ◽

pp. 73-82 ◽

Cited By ~ 2

Author(s):

Thomas W. Miller ◽

Carl G. Leukefeld ◽

Barbara Jefferson

Keyword(s):

Substance Abuse ◽

Dual Diagnosis ◽

Psychotic Disorders ◽

Clinical Issues

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Daily functioning and symptom factors contributing to attitudes toward antipsychotic treatment and treatment adherence in outpatients with schizophrenia spectrum disorders

BMC Psychiatry ◽

10.1186/s12888-021-03037-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

J. Leijala ◽

O. Kampman ◽

J. Suvisaari ◽

S. Eskelinen

Keyword(s):

Side Effects ◽

Activities Of Daily Living ◽

Treatment Adherence ◽

Daily Living ◽

Psychotic Disorders ◽

Rating Scale ◽

Systematic Evaluation ◽

Daily Functioning ◽

Antipsychotic Treatment ◽

Schizophrenia Spectrum

Abstract Background Poor adherence and negative attitudes to treatment are common clinical problems when treating psychotic disorders. This study investigated how schizophrenia core symptoms and daily functioning affect treatment adherence and attitudes toward antipsychotic medication and to compare patients using clozapine or other antipsychotics. Method A cross-sectional study with data from 275 patients diagnosed with schizophrenia spectrum disorder. Patients adherence, attitudes, insight and side-effects were evaluated using the Attitudes toward Neuroleptic Treatment scale. Overall symptomology was measured using the Brief Psychiatric Rating Scale (BPRS), the Health of the Nation Outcome Scale (HoNOS). The functioning was assessed using activities of daily living scale, instrumental activities of daily living scale and social functioning of daily living scale. Results Self-reported treatment adherence was high. Of the patients, 83% reported using at least 75% of the prescribed medication. Having more symptoms was related with more negative attitude towards treatment. There was a modest association with functioning and treatment adherence and attitude toward antipsychotic treatment. Attitudes affected on adherence in non-clozapine but not in clozapine groups. Conclusion Early detection of non-adherence is difficult. Systematic evaluation of attitudes toward the treatment could be one way to assess this problem, along with optimized medication, prompt evaluation of side effects and flexible use of psychosocial treatments.

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A retrospective chart review of the clinical and psychosocial profile of psychotic adolescents with co-morbid substance use disorders presenting to acute adolescent psychiatric services at Tygerberg Hospital

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v18i2.351 ◽

2012 ◽

Vol 18 (2) ◽

pp. 8 ◽

Cited By ~ 4

Author(s):

Anusha Lachman ◽

Rene Nassen ◽

Sue Hawkridge ◽

Robin A Emsley

Keyword(s):

Substance Abuse ◽

Substance Use ◽

Dual Diagnosis ◽

Chart Review ◽

Psychotic Disorders ◽

Drugs Of Abuse ◽

Treatment Guidelines ◽

Psychiatric Treatment ◽

Retrospective Chart Review ◽

First Episode

Background. A large number of adolescents meet criteria for ‘dual diagnosis’ (a psychiatric disorder plus co-morbid substance use disorder (SUD), which prolongs treatment response and complicates intervention strategies. The current service model in Cape Town divides the care of such patients into psychiatric treatment and a separate substance use intervention. Child and adolescent mental health services face the challenge of high rates of readmission of adolescents into psychiatric facilities before utilisation of community-based substance abuse services.Objective. There is a scarcity of available treatment guidelines for dual-diagnosis adolescents, and a lack of systematically documented epidemiological and clinical data in South African adolescent populations.Method. A retrospective chart review of adolescent psychiatric admissions to the Tygerberg Adolescent Psychiatric Unit during 2010 was conducted. Relevant epidemiological, clinical and demographic data for those presenting with a dual diagnosis (specifically psychotic disorders and SUD) was recorded. Results. Results suggest a high prevalence of SUD among adolescents presenting with a first-episode psychosis. Statistically significant correlations with lower levels of education were found in those with ongoing substance abuse (specifically cannabis and methamphetamine), and a significant relationship between choice of debut drug and ongoing drug use was also demonstrated. Risk factors for SUD (psychosocial adversities, childhood trauma, family and community exposure to substances, early debut drug ages), risky sexual behaviours, and clinical psychiatric profiles of adolescents with dual diagnosis are described.Conclusions. This cohort had an enhanced risk as a result of genetic vulnerability and environmental availability of substances, and the findings emphasise the differences in presentation, choice of drugs of abuse and psychosocial difficulties of adolescents with a dual diagnosis presenting to a psychiatric facility. We aim to influence role-players to provide more integrated services, and highlight the need for future prospective studies in this adolescent group to assist in improving outcomes.

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Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-021-02083-z ◽

2021 ◽

Author(s):

Sophie Hirsch ◽

Nancy Thilo ◽

Tilman Steinert ◽

Erich Flammer

Keyword(s):

Psychotic Disorders ◽

Rating Scale ◽

Antipsychotic Treatment ◽

Coercive Measure ◽

Court Order ◽

Perceived Coercion ◽

Inpatient Settings ◽

Forensic Psychiatric ◽

Insight Into Illness ◽

Insight Into

Abstract Purpose The present study investigates perceived coercion in psychiatric inpatients under prescribed antipsychotic medication without a court order. The objective of this study was to investigate whether and to what extent involuntary and voluntary inpatients feel coerced to take their medication and which factors affect perceived coercion. Methods Voluntarily and involuntarily admitted patients (55 and 36, respectively) were interviewed about the extent of perceived coercion. In addition, socio-demographic and clinical data were collected. The Admission Experience Scale (aAES) was used to assess perceived coercion concerning medication. To measure insight into illness, attitude towards medication, and symptom severity, we used a questionnaire on insight into illness (FKE-10), the Drug Attitude Inventory (DAI-10), and the Brief Psychiatric Rating Scale (BPRS-24), respectively. Results Voluntarily treated patients experienced significantly less coercion when taking prescribed medication in inpatient settings than involuntarily treated patients. The experience of coercion was not related to socio-demographic or clinical variables nor to the BPRS-24 score, but to insight into illness and attitude towards medication. Patients who had experienced at least one coercive measure during the index hospital stay showed a higher level of perceived coercion. Conclusion Perceived coercion related to medication is dependent on insight into illness and experience of previous coercive interventions rather than on the severity of psychopathological symptoms. These findings are very similar to a previous study in a forensic psychiatric sample. Having experience of at least one coercive measure seems to be a decisive aspect of the extent of the patients’ perceived coercion.

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