Treatment-refractory schizophrenia in children and adolescents: an update on clozapine and other pharmacologic interventions.
ABSTRACT Treatment-refractory early-onset schizophrenia is a rare but severe form of the disorder associated with poor premorbid function and long-term disability. The currently available evidence suggests that clozapine remains the most efficacious treatment for the amelioration of both positive and negative symptoms of the disorder and problematic aggressive behaviors. Clozapine use in children and adolescents, however, is limited by its association with hematologic adverse events and an increased frequency of seizure activity. Further studies are needed to examine the usefulness of antipsychotic combinations and of augmentation therapies to antipsychotic medications in order to treat persistent residual psychotic symptoms in children and adolescents who have schizophrenia and who have not responded to several sequential trials of antipsychotic monotherapy.
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ABSTRACT: Auditory-Verbal Hallucinations (AVH) constitute extremely frequent positive symptoms in early-onset schizophrenia. These symptoms are all the more invalidating as they are often drug-resistant. The procedure of repetitive transcranial magnetic stimulation (rTMS), used in such cases in adult subjects with schizophrenia, showed good efficiency and tolerability. We present here the case of an 11-year-old child with a diagnosis of very-early onset schizophrenia including florid AVH and a massive delusion of alien control. His hallucinatory syndrome resistant to the antipsychotic treatments was considerably reduced by rTMS. This treatment allowed this child to attend school and to follow regular psychotherapeutic sessions. The spectacular and rapid response to rTMS reported here indicates that rTMS should occupy in future years a key role in the treatment of AVH in very early onset schizophrenia.Neuropsychiatrie de l Enfance et de l Adolescence 02/2009; 57(1):38–43. DOI:10.1016/j.neurenf.2007.07.017
Article: Response to majeske and kellner.American Journal of Psychiatry 09/2014; 171(9):1000. DOI:10.1176/appi.ajp.2014.14050628r · 13.56 Impact Factor
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ABSTRACT: Treatment resistance in early onset schizophrenia (EOS) is one of the most challenging problems in child and adolescent psychiatry. We retrospectively examined the therapeutic dosage, clinical response, and side effect profiles of long-term clozapine treatment in Korean children and adolescents with refractory EOS or very early onset schizophrenia (VEOS). 26 refractory patients treated with clozapine for more than 1 year were analyzed. Efficacy was determined by comparing hospitalization rate and duration, before and after clozapine treatment. Tolerability was assessed through review of documented adverse events. A significant reduction in hospital days per year was observed in 25 (96.2%) patients after clozapine treatment compared to before clozapine. Long-term benefit of the treatment was supported by a further reduction of the hospitalization rate in 14 patients treated with clozapine for more than 3 years. Neutropenia developed in 26.9% patients at 1 year and there was no agranulocytosis. Overall, eight male patients (8/12, 66.7%) and one female patient (1/14, 7%) developed neutropenia and out of the nine patients, seven patients were maintained and two patients were successfully rechallenged on clozapine. These findings suggest that long-term clozapine treatment may effectively reduce the amount of time Asian patients with refractory EOS or VEOS spend in the hospital. However careful monitoring of adverse events is required.Human Psychopharmacology Clinical and Experimental 12/2008; 23(8):715-22. DOI:10.1002/hup.982 · 1.85 Impact Factor