Treatment resistant psychosis in children and adolescents and clozapine: Nuances
With proliferation in research on high-risk psychosis spectrum diseases, it is crucial to distinguish a prodrome or psychosis-like episode in children and adolescents from true psychosis. The limited role of psychopharmacology in such circumstances is well-documented, underlining the difficulties in...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1014540/full |
| _version_ | 1797895493990219776 |
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| author | Jigyansa Ipsita Pattnaik Udit Kumar Panda Suhas Chandran Susanta Padhy Jayaprakash Russell Ravan |
| author_facet | Jigyansa Ipsita Pattnaik Udit Kumar Panda Suhas Chandran Susanta Padhy Jayaprakash Russell Ravan |
| author_sort | Jigyansa Ipsita Pattnaik |
| collection | DOAJ |
| description | With proliferation in research on high-risk psychosis spectrum diseases, it is crucial to distinguish a prodrome or psychosis-like episode in children and adolescents from true psychosis. The limited role of psychopharmacology in such circumstances is well-documented, underlining the difficulties in diagnosing treatment resistance. To add to the confusion is emerging data on the head-to-head comparison trials for treatment-resistant and treatment-refractory schizophrenia. Clozapine, the gold-standard drug for resistant schizophrenia and other psychotic psychopathology, lacks FDA or manufacturer guidelines for use in the pediatric population. Possibly due to developmental pharmacokinetic (PK) considerations, clozapine-related side effects are more commonly seen in children than adults. Despite evidence of an increased risk for seizures and hematological problems in children, clozapine is widely used off-label. Clozapine reduces the severity of resistant childhood schizophrenia, aggression, suicidality, and severe non-psychotic illness. There is inconsistent prescribing, administration, and monitoring of clozapine, and limited database evidence-backed guidelines. Despite the overwhelming efficacy, problems remain regarding unambiguous indications of use and risk-benefits assessments. This article reviews the nuances in the diagnosis of treatment resistance psychosis in childhood and adolescents and its management, in particular highlighting the evidence base for clozapine in this population group. |
| first_indexed | 2024-04-10T07:27:43Z |
| format | Article |
| id | doaj.art-969f456e4e554809b378ad66a0080a51 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-04-10T07:27:43Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-969f456e4e554809b378ad66a0080a512023-02-24T05:12:00ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402023-02-011410.3389/fpsyt.2023.10145401014540Treatment resistant psychosis in children and adolescents and clozapine: NuancesJigyansa Ipsita Pattnaik0Udit Kumar Panda1Suhas Chandran2Susanta Padhy3Jayaprakash Russell Ravan4Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, IndiaDepartment of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, IndiaChild and Adolescent Psychiatry, St. Johns Medical College and Hospital, Bengaluru, IndiaDepartment of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, IndiaDepartment of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, IndiaWith proliferation in research on high-risk psychosis spectrum diseases, it is crucial to distinguish a prodrome or psychosis-like episode in children and adolescents from true psychosis. The limited role of psychopharmacology in such circumstances is well-documented, underlining the difficulties in diagnosing treatment resistance. To add to the confusion is emerging data on the head-to-head comparison trials for treatment-resistant and treatment-refractory schizophrenia. Clozapine, the gold-standard drug for resistant schizophrenia and other psychotic psychopathology, lacks FDA or manufacturer guidelines for use in the pediatric population. Possibly due to developmental pharmacokinetic (PK) considerations, clozapine-related side effects are more commonly seen in children than adults. Despite evidence of an increased risk for seizures and hematological problems in children, clozapine is widely used off-label. Clozapine reduces the severity of resistant childhood schizophrenia, aggression, suicidality, and severe non-psychotic illness. There is inconsistent prescribing, administration, and monitoring of clozapine, and limited database evidence-backed guidelines. Despite the overwhelming efficacy, problems remain regarding unambiguous indications of use and risk-benefits assessments. This article reviews the nuances in the diagnosis of treatment resistance psychosis in childhood and adolescents and its management, in particular highlighting the evidence base for clozapine in this population group.https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1014540/fullchildhood psychosistreatment resistancechildhood onset schizophreniaearly onset psychosisearly onset schizophrenia |
| spellingShingle | Jigyansa Ipsita Pattnaik Udit Kumar Panda Suhas Chandran Susanta Padhy Jayaprakash Russell Ravan Treatment resistant psychosis in children and adolescents and clozapine: Nuances Frontiers in Psychiatry childhood psychosis treatment resistance childhood onset schizophrenia early onset psychosis early onset schizophrenia |
| title | Treatment resistant psychosis in children and adolescents and clozapine: Nuances |
| title_full | Treatment resistant psychosis in children and adolescents and clozapine: Nuances |
| title_fullStr | Treatment resistant psychosis in children and adolescents and clozapine: Nuances |
| title_full_unstemmed | Treatment resistant psychosis in children and adolescents and clozapine: Nuances |
| title_short | Treatment resistant psychosis in children and adolescents and clozapine: Nuances |
| title_sort | treatment resistant psychosis in children and adolescents and clozapine nuances |
| topic | childhood psychosis treatment resistance childhood onset schizophrenia early onset psychosis early onset schizophrenia |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1014540/full |
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