An open trial of clozapine in neuroleptic-resistant childhood-onset schizophrenia

Turetz, Meredith L.; Mozes, Tamar; Toren, Paz; Chernauzan, Nadejda; Yoran-Hegesh, Roni; Mester, Roberto; Wittenberg, Nathan; Tyano, Sam; Weizman, Abraham

doi:10.1192/bjp.170.6.507

Cited by 62 publications

(29 citation statements)

References 15 publications

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“…Extrapyramidal symptoms were more frequent with haloperidol and risperidone, but weight increase was greater with olanzapine. Open studies with clozapine in children and adolescents with psychotic disorder resistant to other antipsychotics (Siefen and Remschmidt, 1986;Blanz and Schmidt 1993;Frazier et al 1994;Turetz et al 1997) have reported good response. In a double-blind, controlled study comparing clozapine with haloperidol in psychotic children and adolescents, Kumra et al (2006) found a somewhat better response to clozapine, but also more severe side effects.…”

Section: Introductionmentioning

confidence: 95%

Antipsychotic Treatment in Child and Adolescent First-Episode Psychosis: A Longitudinal Naturalistic Approach

Castro‐Fornieles

Parellada

Soutullo

et al. 2008

Journal of Child and Adolescent Psychopharmacology

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This meta-analysis assessed aggression and/or hostility-related events in children and adolescents treated with fluoxetine (n = 376) compared with placebo (n = 255). Aggression and/or hostility-related events were identified in 2.1% of fluoxetine versus 3.1% of placebo-treated patients (p = 0.588). This analysis fails to support an association between fluoxetine treatment and increased risk of aggression and/or hostility-related events in children and adolescents compared with placebo.

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Section: Introductionmentioning

confidence: 95%

Antipsychotic Treatment in Child and Adolescent First-Episode Psychosis: A Longitudinal Naturalistic Approach

Castro‐Fornieles

Parellada

Soutullo

et al. 2008

Journal of Child and Adolescent Psychopharmacology

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“…An open trial with clozapine (mean dose 227.3 6 34 mg/day) in 11 children (<13 years) with neuroleptic-resistant schizophrenia showed a clear improvement in both positive and negative symptoms, mostly occurring in the first 6 to 8 weeks. Major side effects were somnolence and drooling but not agranulocytosis (Turetz et al 1997).…”

Section: Introductionmentioning

confidence: 99%

Clozapine in Adolescent Inpatients with Acute Mania

Masi

Mucci

Millepiedi

2002

Journal of Child and Adolescent Psychopharmacology

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Some bipolar patients with acute manic episodes can be refractory to conventional treatment with mood stabilizers. Clozapine, an atypical antipsychotic, has been reported to be effective in adults with treatment-resistant bipolar disorder. We describe the therapeutic effect of clozapine in 10 adolescent inpatients (12- to 17-year-olds) with severe acute manic or mixed episodes who did not improve after treatment with conventional drugs (mood stabilizers, antipsychotics). At hospital discharge, 15 to 28 days after clozapine treatment, all patients had responded positively according to the Clinical Global Impression-Improvement Scale scores. The mean changes in Mania Rating Scale, Brief Psychiatric Rating Scale, Children's Global Assessment Scale, and Clinical Global Impression-Severity Scale were significant (p < 0.001). Clozapine dosage was 142.5 +/- 73.6 mg/day (range 75-300 mg/day). Side effects (increased appetite, sedation, enuresis, sialorrhea) were frequent but not severe enough to require reduction of dosage. Mean weight gain after 6 months was 6.96 +/- 3.08 kg (10.7%). Neither decrease of white cells nor epileptic seizures were reported during follow-up (12-24 months). These preliminary findings suggest that clozapine may improve the clinical picture in adolescents with treatment-refractory manic or mixed episodes. Controlled studies on larger samples are warranted.

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“…This would not only contravene the National Institute for Clinical Excellence guidance on atypical antipsychotics, which states that 'in individuals with evidence of treatment resistant schizophrenia clozapine should be introduced at the earliest opportunity' (National Institute for Clinical Excellence, 2002), but it would also deprive patients of a potentially unique and effective treatment. Some studies in fact suggest that its use might be worthwhile and beneficial in children and young people (Kumra et al, 1996;MacEwan & Morton, 1996;Turetz et al, 1997).…”

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confidence: 99%

Clozapine prescribing in adolescent psychiatry: survey of prescribing practice in in-patient units

Cirulli¹

2005

Psychiatr. bull.

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Aims and MethodClozapine is an effective drug in treatment-resistant schizophrenia, but it seems to be prescribed for few patients under the age of 18 years. This study reports a survey of consultant psychiatrists working in adolescent units in the UK, looking at their use of clozapine and experience with it.ResultsOut of 83 clinicians, 59 responded (71%). More than 40% of respondents do not use clozapine, and those who do may not always be following best practice recommendations. Reasons for not using clozapine, beliefs about its effectiveness and problems encountered in its use are described.Clinical ImplicationsClozapine may not always be made available to young people with treatment-resistant schizophrenia. There is a need for more education, guidance and debate on clozapine use in child and adolescent psychiatry.

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An open trial of clozapine in neuroleptic-resistant childhood-onset schizophrenia

Abstract: Clozapine may be a promising drug for the treatment of resistant childhood-onset schizophrenia.

Cited by 62 publications

References 15 publications

Antipsychotic Treatment in Child and Adolescent First-Episode Psychosis: A Longitudinal Naturalistic Approach

Antipsychotic Treatment in Child and Adolescent First-Episode Psychosis: A Longitudinal Naturalistic Approach

Clozapine in Adolescent Inpatients with Acute Mania

Clozapine prescribing in adolescent psychiatry: survey of prescribing practice in in-patient units

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