Ulloa FRE, Sauer VTR, Apiquian GR

Language: Spanish
References: 52
Page: 429-433
PDF size: 75.74 Kb.

ABSTRACT

Schizophrenia is a severe and chronic disorder affecting children, adolescents and adults. The international recommendations for the treatment of pediatric patients with this disorder point to a comprehensive management which includes early detection programs, pharmacological and psychosocial treatment. A review of current information regarding the efficacy and safety of antipsychotics in children and adolescents, as well as the effect of psychosocial interventions on the academic and social functioning of patients with early onset schizophrenia is presented.
The pharmacological treatment’s goal is to achieve optimal outcome with the lowest effective dose and the fewest side effects. It should be started with an antipsychotic that has been evaluated on its efficacy and safety in this age group. Risperidone, olanzapine and aripiprazole have been approved for the treatment of schizophrenia in adolescents, clozapine has shown greater efficacy for the treatment resistant condition. The side effects of these drugs must be monitored during treatment.
The psychosocial treatment objectives are to provide information, to promote the patient´s adaptation, to reduce comorbidity and to prevent relapses through psychoeducation, psychotherapy and rehabilitation programs. The psychoeducation programs include information about the characteristics and causes of the illness, the available treatment choices and the factors associated to recovery or relapse. Psychotherapy in schizophrenia has been examined in individual, group and family modalities, the cognitive behavioral therapy has demonstrated efficacy on cognition, social adjustment and quality of life. The rehabilitation programs include the training on social skills, cognitive remediation therapy and exercise programs, which would increase the wellbeing of patients and reduce metabolic alterations associated to the use of antipsychotics.
In conclusion, the treatment of patients with early onset schizophrenia must be multimodal and directed to improve their long term outcome.

REFERENCES

1. Organización Mundial de la Salud. Informe sobre la salud en el mundo 2001. Francia: OMS; 2001.

2. Organización Mundial de la Salud. Programa Mundial de Acción en Salud Mental. Ginebra: OMS; 2002.

3. Jablensky A. Epidemiology of schizophrenia: The global burden of disease and disability. Eur Arch Psychiatry Clin Neurosci 2000;250:274-285.

4. Kumra S, Oberstar J, Sikich L, Findling R et al. Efficacy and tolerability of second-generation antipsychotics in children and adolescents with schizophrenia. Schizophr Bull 2008;34:60-71.

5. Merry S, Werry J. Course and prognosis. En: Remschmidt H (ed). Schizophrenia in children and adolescents. Cambridge: Cambridge University Press; 2001; pp.268-297.

6. Werry J, McClellan J, Chard L. Childhood and adolescence schizophrenia, bipolar and schizoaffective disorders: A clinical and outcome study. J Am Acad Child Adolesc Psychiatry 1991;30:457-465.

7. Hooper S, Giuliano A, Youngstrom E, Breiger D et al. Neurocognition in early-onset schizophrenia and schizoaffective disorders. J Am Acad Child Adolesc Psychiatry 2010;49:52-60.

8. Volkmar F. Childhood schizophrenia:developmental aspects. En: Remschmidt H (ed). Schizophrenia in children and adolescents. Cambridge: Cambridge University Press; 2001; pp.60-81.

9. Fleischhaker C, Schulz E, Tepper K, Martin M et al. Long-term course of adolescent schizophrenia. Schizophr Bull 2005;31:769-780.

10. Rabinowitz J, Napryeyenko O, Burba B, Martinez G et al. Premorbid functioning and treatment response in recent-onset schizophrenia: Prospective study with risperidone long-acting injectable. J Clin Psychopharmacol 2011;31:75-81.

11. Marshall M, Lewis S, Lockwood A, Drake R et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005;62:975-983.

12. Ulloa R, Ortiz S, Higuera F, Fresán A et al. Estudio de fiabilidad interevaluador de la versión en español de la entrevista Schedule for Affective Disordes and Schizophrenia for School- Age children- Present and Lifetime versión (K-SADS-PL). Actas Esp Psiquiatr 2006;34:36-40.

13. Sheehan D, Lecrubier Y, Colón-Soto M. MINI KID. Mini International Neuropsychiatric Interview para niños y adolescentes. Versión en español. Madrid; 2000. Consultado en www.medical-outcomes.com el 15 enero 2011.

14. Bech P, Kastrup M, Rafaelsen O. Mini-compendium of rating scales for states of anxiety, depression, mania, schizophrenia with corresponding DSM-III syndromes. Acta Psychiatr Scand 1986;73:1-37.

15. Kay S, Fiszbein A, Vital-Herne M, Fuentes L. The Positive and Negative Syndrome Scale-Spanish adaptation. J Nerv Ment Dis 1990;178:510-517.

16. De Jesus M, Razzouk D, Thara R, Eaton J et al. Packages of care for schizophrenia in low- and middle-income countries. PLoS Med 2009;6:e1000165. Consultado en: http://pubmedcentralcanada.ca/picrender.cgi?accid=PMC2758997&blobtype=pdf el 11 enero 2011.

17. Bird V, Premkumar P, Kendall T, Whittington C et al. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry 2010;197:350-356.

18. Fish B, Shapiro T, Campbell M. Long-term prognosis and the response of schizophrenic children to drug therapy: a controlled study of trifluoperazine. Am J Psychiatry 1966;123:32-39.

19. Lewis P, James N. Haloperidol and chlorpromazine: a double-blind cross-over trial and clinical study in children and adolescents. Aust N Z J Psychiatry 1973;7:59-65.

20. Sikich L, Hamer R, Bashford, Sheitman B et al. A pilot study of risperidone, olanzapine, and haloperidol in psychotic youth: a double-blind, randomized, 8-week trial. Neuropsychopharmacology 2004;29:133-145.

21. Zalsman G, Carmon E, Martin A, Bensason D et al. Effectiveness, safety, and tolerability of risperidone in adolescents with schizophrenia: an open-label study. J Child Adolesc Psychopharmacol 2003;13:319-327.

22. Bishop J, Pavuluri M. Review of risperidone for the treatment of pediatric and adolescent bipolar disorder and schizophrenia. Neuropsychiatr Dis Treat 2008;4:55-68.

23. Haas M, Unis A, Armenteros J, Copenhaver M et al. A 6-week, randomized, double-blind, placebo-controlled study of the efficacy and safety of risperidone in adolescents with schizophrenia. J Child Adolesc Psychopharmacol 2009;19:611-621.

24. Jensen J, Kumra S, Leitten W, Oberstar J et al. A comparative pilot study of second-generation antipsychotics in children and adolescents with schizophrenia-spectrum disorders. J Child Adolesc Psychopharmacol 2008;18:317-326.

25. Maloney A, Sikich L. Olanzapine approved for the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder in adolescent patients. Neuropsychiatr Dis Treat 2010;6:749-766.

26. Findling R, Robb A, Nyilas M, Forbes R et al. A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia. Am J Psychiatry 2008;165: 1432-1441.

27. Kumra S, Frazier J, Jacobsen L, McKenna K et al. Childhood- onset schizophrenia: A double-blind clozapine-haloperidol comparison. Arch Gen Psychiatry 1996;53:1090-1097.

28. Shaw P, Sporn A, Gogtay N, Overman G et al. Childhood-onset schizophrenia: A double-blind, randomized clozapine-olanzapine comparison. Arch Gen Psychiatry 2006;63:721-730.

29. Findling R, Frazier J, Gerbino-Rosen G, Kranzler H et al. Is there a role for clozapine in the treatment of children and adolescents? J Am Acad Child Adolesc Psychiatry 2007;46:423-428.

30. Sporn A, Vermani A, Greenstein D, Bobb A et al. Clozapine treatment of childhood-onset schizophrenia: Evaluation of effectiveness, adverse effects, and long-term outcome. J Am Acad Child Adolesc Psychiatry 2007;46:1349-1356.

31. Findling R, Johnson J, McClellan J, Frazier J et al. Double-blind maintenance safety and effectiveness findings from the Treatment of Early- Onset Schizophrenia Spectrum (TEOSS) study. J Am Acad Child Adolesc Psychiatry 2010;49:583-594.

32. Sikich L, Frazier J, McClellan J, Findling R et al. Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study. Am J Psychiatry 2008;165:1420-1431.

33. Ulloa R, Sauer T, Fernández C, Apiquian R. Esquizofrenia en niños y adolescentes. En: Ulloa R, Fernández C, Gómez H, Ramírez J, Reséndiz J (eds). Guías clínicas. México, DF: Hospital Psiquiátrico Infantil Dr. Juan N. Navarro; 2010; pp.267-291.

34. Correll C. Antipsychotic use in children and adolescents: Minimizing adverse effects to maximize outcomes. J Am Acad Child Adolesc Psychiatry 2008;47:9-20.

35. Ernst M, Malone R, Rowan A, George R et al. Antipsychotics (neuroleptics). En: Werry J, Aman M (eds). Practitioner’s guide to psychoactive drugs for children and adolescents. Segunda edición. New York: Plenum; 1998; pp.297-328.

36. Weiss R, Diura J, Burget T, Tamborlane W et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362-2374.

37. Ross R, Heinlein S, Tregellas H. High rates of comorbidity are found in childhood-onset schizophrenia. Schizophr Res 2006;88:90-95.

38. Rubino I, Frank E, Croce Nanni R, Pozzi D et al. A comparative study of axis I antecedents before age 18 of unipolar depression, bipolar disorder and schizophrenia. Psychopathology 2009;42:325-332.

39. Hemmerle M, Röpcke B, Eggers C, Oades R. Evaluation of a two-year intensive outpatient care programme for adolescents with schizophrenia. Z Kinder Jugendpsychiatr Psychother 2010;38:361-369.

40. Valencia M, Rascon M, Juarez F, Escamilla R et al. Application in Mexico of psychosocial rehabilitation with schizophrenia patients. Psychiatry Res 2010;73:248-263.

41. Basan A, Pitschel-Walz G, Bäuml J. Psychoeducational intervention for schizophrenic patients and subsequent long-term ambulatory care. A four-year follow-up. Fortschr Neurol Psychiatr 2000;68:537-545.

42. Bechdolf A, Knost B, Nelson B, Schneider N et al. Randomized comparison of group cognitive behaviour therapy and group psychoeducation in acute patients with schizophrenia: effects on subjective quality of life. Aust N Z J Psychiatry 2010;44:144-150.

43. Pekkala E, Merinder L. Psychoeducation for schizophrenia. Cochrane Database Syst Rev 2002;2:CD002831. Consultado en: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD002831/frame.html el 11 enero 2011.

44. San Emeterio M, Aymerich M, Faus G, Guillamón I et al. Guía de práctica clínica para la atención al paciente con esquizofrenia. Versión breve para la aplicación en la práctica clínica. Barcelona: Agència d’Avaluació de Tecnologia i Recerca Mèdiques. CatSalut. Departament de Sanitat i Seguretat Social. Generalitat de Catalunya; 2003.

45. Bechdolf A, Knost B, Kuntermann C, Schiller S et al. A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in patients with schizophrenia. Acta Psychiatr Scand (Supl)2004; 110:21-28.

46. Bechdolf A, Köhn D, Knost B, Pukrop R et al. A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in acute patients with schizophrenia: outcome at 24 months. Acta Psychiatr Scand (Supl)2005;112:173-179.

47. Rector N. Cognitive behavioural therapy reduces short term rehospitalisation compared with psychoeducation in inpatients with schizophrenia. Evid Based Ment Health 2005;8:8.

48. Kurtz M, Mueser K. A meta-analysis of controlled research on social skills training for schizophrenia. J Consult Clin Psychol 2008;76:491-504.

49. Lindenmayer J, Khan A, Wance D, Maccabee N et al. Outcome evaluation of a structured educational wellness program in patients with severe mental illness. J Clin Psychiatry 2009;70:1385-1396.

50. Townsend L, Findling R. Modifying the risk of atypical antipsychotics in the treatment of juvenile-onset schizophrenia. Expert Opin Pharmacother 2010;11:195-205.

51. Wykes T, Newton E, Landau S, Rice C et al. Cognitive remediation therapy (CRT) for young early onset patients with schizophrenia: an exploratory randomized controlled trial. Schizophr Res 2007;94:221-230.

52. Olivera Reyna G. Alteraciones en los lípidos, glucosa y efectos extrapiramidales causados por haldol, risperidona y sus combinaciones con valproato en una muestra de adolescentes atendidos en el Hospital Psiquiátrico Infantil Juan N. Navarro (Estudio piloto). México, DF: Departamento de Psicología Médica, Psiquiatría y Salud Mental, Universidad Nacional Autónoma de México; 2006.