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New treatment option in resistant schizophrenia in adolescence – case study
IACAPAP 2012 – 20th World congress / Neuropsychiatrie de l’enfance et de l’adolescence 60S (2012) S197–S253 Methods.– Tests assessing memory, attention, thinking. Z-scales were used for estimation of cognitive deficit. Results.– Patients with F20.8 have strong deficit in all cognitive functions. F21 patients demonstrate a variety of cognitive deficit degrees including age norm outstrip. F2x.x patients keep intermediate position. Severe thinking deficit occurs in all patients, especially in F20.8 (85%). Attention deficit most often occurs in F20.8 patients (70%). F21 and F2x.x patients have close levels of attention deficit (50%). Memory deficit level is the lowest in F2x.x and the highest in F20.8 (60–70%). Conclusions.– Degree of cognitive deficit has peculiarity and depends on diagnosis. http://dx.doi.org/10.1016/j.neurenf.2012.04.581 Tu-P-2205
Predictors of suicide attempt in early-onset, first-episode psychoses V. Sanchez-Gistau a,∗ , I. Baeza a , C. Arango b , A. Gonzalez-pinto c , E. De la Serna d , M. Parellada b , M. Graell e , B. Paya f , C. Llorente b , J. Castro-Fornieles g a Department Of Child And Adolescent Psychiatry And Psychology, hospital clinic, Barcelona, Spain b Adolescent Unit, hospital Gregorio Mara˜ non, Madrid, Spain c Department Of Psychiatry, Hospital Santiago Apostol, Vitoria, Spain d CIBERSAM, Barcelona, Spain e Hospital Infantil Universitario Ni˜ no Jesús, Madrid, Spain f Child and Adolescent Mental Health Unit. Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain g Hospital Clínic de Barcelona, Fundació Clínic, CIBERSAM, Barcelona, Spain ∗ Corresponding author. Background.– Longitudinal First Episode Psychosis (FEP) adult studies have reported high rates of suicide attempts (SA) specially in the first years after psychosis onset; but no follow-up studies of early onset FEP samples have investigated that issue. Objectives.– To study the prevalence of suicide attempts (SA) and to identify and early predictors of SA over a 24-month follow-up period in an early-onset FEP cohort. Method.– One hundred and ten subjects in their FEP between the ages of 9 and 17 were assessed using the KD-SADS-Pl and a battery of clinical instruments at baseline and at 12 and 24 months. SA and level of suicidality were assessed using The Clinical Global Impression for Severity of Suicidality (CGI-SS) and item 3 of HDRS. Potential predictors of SA were investigated by logistic regression analyses. Results.– The 24-month prevalence of attempters was 12.4%. The categorization of high suicide risk at baseline (OR = 81.66, 95% CI = 11.61–574.35, P = 0.000) was the only significant predictor of SA during follow-up. http://dx.doi.org/10.1016/j.neurenf.2012.04.582 Tu-P-2206
New treatment option in resistant schizophrenia in adolescence – case study A. Wisniewski Child And Adolescenty Psychiatry, Medical University of Warsaw, Warsaw, Poland Early-onset schizophrenia has not only more severe course than in adults, it is also associated with poor response to antipsychotic treatment. There are only limited data about effectiveness, safety and tolerability of second-generation antipsychotics (SGA) in children, but current recommendations suggest using atypical antipsychotics as the first line treatment. Case study: 15-year-old schoolboy admitted to psychiatric hospital after acute psychotic episode. His symptoms started 2 years ago. After a few months he was diagnosed schizophrenia paranoid type. During 2 years he has been hospitalized many times because of persistent psychotic symptoms. He was treated using: risperidon, olanzapine, amisulpride, quetiapine, ziprasidone, perfenazin. All the drugs were ineffective, all were used
S239
in full doses, given no shorter than 8 weeks. Patient did not cooperate in treatment – he spits out or has hidden the tablets, has to be controlled during drug supplies. He did not responded to long-acting injections of risperidon. Finally, the treatment has been changed to new form of olanzapine in extended release injections started 210 mg i.m. every 14 days increased to 300 mg after 2 weeks. After 2 months of treatment (5 injections) reduction of positive and negative symptoms of schizophrenia was observed. Patients starts to socialize, attend school. He is on the drug now, the drug is well tolerated. http://dx.doi.org/10.1016/j.neurenf.2012.04.583 Tu-P-2207
Theory of mind in early onset schizophrenia S. Bourgou a , S. Halayem-Dhouib b,∗ , A. Bouden a , I. Amado c , M.B. Halayem a a Department Of Child And Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia b Child And Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia c Hôpital Saint Anne, Paris, France ∗ Corresponding author. Twelve adolescents aged from 13 to 17 years with early onset schizophrenia diagnosis were matched to healthy participants, without familial history of psychiatric disorders, according to age and educational level. Theory of Mind (ToM) was assessed with the Moving Shapes test. Scoring includes three different dimensions: intentionality, appropriateness and length of each answer. In the Random Movement sequences, there were no difference between patients and controls with regard to intentionality and length of answers. In the Goal-directed sequences, significant differences were found between patients and controls with regard to the three scoring dimensions. In the ToM sequences, a highly significant difference was found between patients and controls with regard to appropriateness of the answer, intentionality and length of each answer (respectively P < 0.001, P < 0.001, P = 0.006). In conclusion, Patients suffering from EOS show ToM deficits, which are a part of a global cognitive deficit in causality. http://dx.doi.org/10.1016/j.neurenf.2012.04.584 Tu-P-2208
Genetic findings in pediatric catatonia C. Laurent a,∗ , M. Gianitelli a , A. Consoli a , M. Raffin a , O. Bonnot a , D.F. Levinson b , D. Cohen a a GH Pitié-Salpétrière and UPMC, Paris, France b Department Of Psychiatry, Stanford University, Palo Alto, USA ∗ Corresponding author. Objective.– To assess the involvement of known genetic diseases and copy number variants (CNVs) in pediatric catatonia. Methods.– We assessed prospectively 58 children and adolescents (10-18 years) admitted for catatonia with a comprehensive and multidisciplinary assessment of medical and genetic disorders. CNVs were evaluated in 19 of these patients using the Illumina 610-Quad genotyping array. Results.– Thirteen (22.4%) patients had medical conditions including 6 (10.4%) with a genetic or metabolic disorder likely to be the cause of the catatonia (Chorea [N = 2], 5HT cerebrospinal fluid deficit [N = 1], storage disease [N = 1], fatal familial insomnia [N = 1], and PRODH mutations [N = 1]). Three CNVs (106 kb deletion of exon 6 of PARKIN2; 1.16Mb 16p13 duplication; 190 kb 8p23.3 deletion) were identified which might plausibly contribute to vulnerability to catatonia based on known gene functions. Finally, 2 CNVs (13q34 microdeletion; 2q36 deletion) requires further exploration to support contribution to catatonia. Conclusion.– Pediatric catatonia is associated with a high prevalence of medical conditions including genetic disorders. http://dx.doi.org/10.1016/j.neurenf.2012.04.585 Tu-P-2209
Analysis of socio-demographic data from a group of children and adolescents diagnosed with psychosis
Predictors of suicide attempt in early-onset, first-episode psychoses V. Sanchez-Gistau a,∗ , I. Baeza a , C. Arango b , A. Gonzalez-pinto c , E. De la Serna d , M. Parellada b , M. Graell e , B. Paya f , C. Llorente b , J. Castro-Fornieles g a Department Of Child And Adolescent Psychiatry And Psychology, hospital clinic, Barcelona, Spain b Adolescent Unit, hospital Gregorio Mara˜ non, Madrid, Spain c Department Of Psychiatry, Hospital Santiago Apostol, Vitoria, Spain d CIBERSAM, Barcelona, Spain e Hospital Infantil Universitario Ni˜ no Jesús, Madrid, Spain f Child and Adolescent Mental Health Unit. Department of Psychiatry and Psychology, Hospital Universitario Marqués de Valdecilla, Santander, Spain g Hospital Clínic de Barcelona, Fundació Clínic, CIBERSAM, Barcelona, Spain ∗ Corresponding author. Background.– Longitudinal First Episode Psychosis (FEP) adult studies have reported high rates of suicide attempts (SA) specially in the first years after psychosis onset; but no follow-up studies of early onset FEP samples have investigated that issue. Objectives.– To study the prevalence of suicide attempts (SA) and to identify and early predictors of SA over a 24-month follow-up period in an early-onset FEP cohort. Method.– One hundred and ten subjects in their FEP between the ages of 9 and 17 were assessed using the KD-SADS-Pl and a battery of clinical instruments at baseline and at 12 and 24 months. SA and level of suicidality were assessed using The Clinical Global Impression for Severity of Suicidality (CGI-SS) and item 3 of HDRS. Potential predictors of SA were investigated by logistic regression analyses. Results.– The 24-month prevalence of attempters was 12.4%. The categorization of high suicide risk at baseline (OR = 81.66, 95% CI = 11.61–574.35, P = 0.000) was the only significant predictor of SA during follow-up. http://dx.doi.org/10.1016/j.neurenf.2012.04.582 Tu-P-2206
New treatment option in resistant schizophrenia in adolescence – case study A. Wisniewski Child And Adolescenty Psychiatry, Medical University of Warsaw, Warsaw, Poland Early-onset schizophrenia has not only more severe course than in adults, it is also associated with poor response to antipsychotic treatment. There are only limited data about effectiveness, safety and tolerability of second-generation antipsychotics (SGA) in children, but current recommendations suggest using atypical antipsychotics as the first line treatment. Case study: 15-year-old schoolboy admitted to psychiatric hospital after acute psychotic episode. His symptoms started 2 years ago. After a few months he was diagnosed schizophrenia paranoid type. During 2 years he has been hospitalized many times because of persistent psychotic symptoms. He was treated using: risperidon, olanzapine, amisulpride, quetiapine, ziprasidone, perfenazin. All the drugs were ineffective, all were used
S239
in full doses, given no shorter than 8 weeks. Patient did not cooperate in treatment – he spits out or has hidden the tablets, has to be controlled during drug supplies. He did not responded to long-acting injections of risperidon. Finally, the treatment has been changed to new form of olanzapine in extended release injections started 210 mg i.m. every 14 days increased to 300 mg after 2 weeks. After 2 months of treatment (5 injections) reduction of positive and negative symptoms of schizophrenia was observed. Patients starts to socialize, attend school. He is on the drug now, the drug is well tolerated. http://dx.doi.org/10.1016/j.neurenf.2012.04.583 Tu-P-2207
Theory of mind in early onset schizophrenia S. Bourgou a , S. Halayem-Dhouib b,∗ , A. Bouden a , I. Amado c , M.B. Halayem a a Department Of Child And Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia b Child And Adolescent Psychiatry, Razi Hospital, Manouba, Tunisia c Hôpital Saint Anne, Paris, France ∗ Corresponding author. Twelve adolescents aged from 13 to 17 years with early onset schizophrenia diagnosis were matched to healthy participants, without familial history of psychiatric disorders, according to age and educational level. Theory of Mind (ToM) was assessed with the Moving Shapes test. Scoring includes three different dimensions: intentionality, appropriateness and length of each answer. In the Random Movement sequences, there were no difference between patients and controls with regard to intentionality and length of answers. In the Goal-directed sequences, significant differences were found between patients and controls with regard to the three scoring dimensions. In the ToM sequences, a highly significant difference was found between patients and controls with regard to appropriateness of the answer, intentionality and length of each answer (respectively P < 0.001, P < 0.001, P = 0.006). In conclusion, Patients suffering from EOS show ToM deficits, which are a part of a global cognitive deficit in causality. http://dx.doi.org/10.1016/j.neurenf.2012.04.584 Tu-P-2208
Genetic findings in pediatric catatonia C. Laurent a,∗ , M. Gianitelli a , A. Consoli a , M. Raffin a , O. Bonnot a , D.F. Levinson b , D. Cohen a a GH Pitié-Salpétrière and UPMC, Paris, France b Department Of Psychiatry, Stanford University, Palo Alto, USA ∗ Corresponding author. Objective.– To assess the involvement of known genetic diseases and copy number variants (CNVs) in pediatric catatonia. Methods.– We assessed prospectively 58 children and adolescents (10-18 years) admitted for catatonia with a comprehensive and multidisciplinary assessment of medical and genetic disorders. CNVs were evaluated in 19 of these patients using the Illumina 610-Quad genotyping array. Results.– Thirteen (22.4%) patients had medical conditions including 6 (10.4%) with a genetic or metabolic disorder likely to be the cause of the catatonia (Chorea [N = 2], 5HT cerebrospinal fluid deficit [N = 1], storage disease [N = 1], fatal familial insomnia [N = 1], and PRODH mutations [N = 1]). Three CNVs (106 kb deletion of exon 6 of PARKIN2; 1.16Mb 16p13 duplication; 190 kb 8p23.3 deletion) were identified which might plausibly contribute to vulnerability to catatonia based on known gene functions. Finally, 2 CNVs (13q34 microdeletion; 2q36 deletion) requires further exploration to support contribution to catatonia. Conclusion.– Pediatric catatonia is associated with a high prevalence of medical conditions including genetic disorders. http://dx.doi.org/10.1016/j.neurenf.2012.04.585 Tu-P-2209
Analysis of socio-demographic data from a group of children and adolescents diagnosed with psychosis