Schizophrenia in children and adolescents

[Initial mental disorders in patients with psychotic of schizophrenia in adolescent]

OBJECTIVE

Clarification of the phenomenology and dynamics of initial mental disorders in patients with psychotic pubertal forms of schizophrenia, identification of the features of these disorders depending on sex.

MATERIAL AND METHODS

The study material was adolescent patients with psychotic forms of schizophrenia. Forty-three people were examined (women 44.2%, median age 14.3 [13.0; 16.8] years). Clinical-anamnestic, clinical-psychopathological, clinical-statistical methods were used.

RESULTS

The duration of the initial stage of the disease ranged from several hours to 5 years (median 0.8 [0.5; 1.7]. The structure of initial disorders was dominated by nonspecific mental disorders characterized by a combination of symptoms of non-psychotic and subpsychotic levels (20 patients - 43.5%; including 12 males - 26% and 8 females - 24.1% ). If behavioral disorders and episodes of psychoactive substance use were significantly more often detected in boys, then dysmorphic phenomena were detected in girls (p<0.05). In accordance with the dynamics of development, acute (n=14 - 32%), subacute (n=21 - 49%), fluctuating (n=8 - 19%) variants of initial disorders are distinguished. Young men turned to a psychiatrist in a more timely manner (already at the stage of prodrome), while girls sought psychiatric help only at the stage of development of psychotic disorders.

CONCLUSION

A psychotic episode in adolescents suffering from schizophrenia developed acutely in a third of cases. In the vast majority of cases, the initial mental disorders that appeared on the eve of acute psychosis was subacute, or differed in a fluctuating course, characterized by clinical polymorphism and multidirectionality. Differences were revealed in the preference for the occurrence of a number of initial disorders in boys and girls, as well as in the timeliness of seeking psychiatric help.

Psychotropic Drugs Prescription and Use among Children with Mental Disorders at a Tertiary Hospital in Vietnam

Background: Awareness of psychotropic medication and its adverse drug reactions (ADRs) can promote safe and rational use of medications, particularly in children and adolescents with mental problems. This study examined the prescription of psychotropic drugs and actual drug-drug interaction (DDI) and ADR for children with mental disorders under 18 years of age in a tertiary hospital in Vietnam. Methods: A cross-sectional descriptive study was performed on 257 psychiatric inpatients under 18 years of age at the National Mental Health Institute-Bach Mai Hospital in 2017. Information about the course of treatment included prescribed medications, drug interactions, side effects, drug combination, and modifications to the regimen was collected. Results: 14.8% and 59.5% of patients received a single-drug regimen and a 2-drug combination regimen upon admission, respectively. The most used regimen was antipsychotics + tranquilizers, accounting for 38.1%. Haloperidol was the most commonly prescribed drug (40.5%). Most patients were given the recommended dosage of the drug (>90%). There were 20.6% of patients having drug interactions with the largest proportion of the combination of diazepam and olanzapine (62.3%). ADRs of psychotropic drugs were detected in 46.3% of patients, with the highest rate of ADRs from antipsychotic drugs. Antipsychotics had the highest rate of replacement (91.3%), mostly replaced from a first-generation antipsychotic (FGA) to a second-generation antipsychotic (SGA). Conclusion: The appointment of psychotropic drugs to patients under 18 years of age has to comply with the recommendations, and carefully balance the benefits and risks of ADRs as well as the risk of DDI in case of the drug combination.

Validation study of the early onset schizophrenia diagnosis in the Danish Psychiatric Central Research Register

The objective of this study is to assess (1) the concordance and validity of schizophrenia register diagnoses among children and adolescents (early onset schizophrenia = EOS) in the Danish Psychiatric Central Research Register (DPCRR), and (2) the validity of clinical record schizophrenia diagnoses. Psychiatric records from 200 patients with a first-time diagnosis of schizophrenia (F20.x) at age < 18 years between 1994 and 2009 in the DPCRR were rated by experienced clinicians according to ICD-10 criteria, using a predefined checklist. We retrieved 178 records, representing 19.6% of all patients diagnosed with EOS from 1994 to 2009. Mean age was 15.2 years and 56.2% were males. The register-based and clinical diagnoses matched in 158 cases (88.8%). Raters' diagnoses confirmed the DPCRR schizophrenia diagnoses in 134 cases, rendering a diagnostic validity of 75.3% of DPCRR schizophrenia, while 149 cases were confirmed as being in the schizophrenia spectrum (83.7%). When removing records with registration errors, 83.5% of cases were confirmed as schizophrenia and 91.8% as being in the schizophrenia spectrum. Interrater reliability was substantial with Cohen's kappa > 0.78-0.83 depending on classification. Compared to diagnoses made in outpatient settings, EOS diagnoses during hospitalizations were more likely to be valid and had fewer registration errors. Diagnosed in inpatient settings, EOS diagnoses are reliable and valid for register-based research. Schizophrenia diagnosed in children and adolescents in outpatient settings were found to have a high number of false-positives, both due to registration errors and diagnostic practice. Utilizing this knowledge, it is possible to reduce the number of false-positives in register-based research of EOS.