Executive Dysfunction among Children with Antipsychotic Treated Schizophrenia

OBJECTIVE: To investigate the executive function among adolescents with antipsychotic-treated schizophrenia in Child and Adolescent Outpatient Clinic at Cipto Mangunkusumo General Hospital, Jakarta. METHODS: This was a cross sectional study with control group. Case was defined as adolescents with antipsychotic-treated schizophrenia without any mental retardation or other physical illnesses (n=45). The control group consisted of healthy and age-matched adolescents (n=135). Executive function is determined by using Indonesian version of Behavior Rating Inventory of Executive Function (BRIEF-Indonesian version). We used SPSS 16.0 program for windows to calculate the prevalence risk ratio (PRR) and set up the p value <0.05. RESULTS: Mean of age was 16.27 (standard deviation 1.86) year-old. Most of the case group (95%) has been treated with atypical antipsychotic such as risperidone, aripipripazole, olanzapine, and clozapine. Duration of having antipsychotic medication was ranged from one to 36 months. Adolescents with antipsychotic treated-schizophrenia had higher BRIEF T-score, except for inhibit scale, shift scale and behavior regulation index. The prevalence risk ratio on several clinical scales were higher in children with antipsychotic-treated schizophrenia compared to control group, such as on emotional state (PRR=7.43, 95% confidence interval [CI]=2.38-23.15), initiate scale (PRR=6.32, 95% CI=2.51-15.95), monitor scale (PRR=8.11, 95% CI=2.0-32.86), and behavior regulation index (PRR=4.09, 95% CI=1.05-15.98). CONCLUSION: In general, the results showed that adolescents with atypical antipsychotic treated-schizophrenia had higher BRIEF T-score compared, and comparable with their normal group control.

A case report on the relationship between treatment-resistant childhood-onset schizophrenia and an abnormally enlarged cavum septum pellucidum combined with cavum vergae / 中华医学杂志(英文版)

The treatment of refractory schizophrenia has been a clinical challenge for most psychiatrists; the possible reasons include diagnostic errors, medical conditions and brain dysgenesis. Here, we described a patient with childhood-onset schizophrenia who had severe psychiatric symptoms such as auditory hallucinations and persecutory delusions, and etc. We reexamined all his possible medical conditions and found that the patient had an abnormally enlarged cavus septum pellucidum (CSP) combined with cavum vergae (CV) (maximum length >30 mm). Some reports suggested that abnormal CSP (length >6 mm) has a significant association with schizophrenia. However, abnormally large CSP or CSP/CV and related prognosis were reported rarely. This case suggested that abnormally enlarged CSP or CSP/CV may worsen the prognosis.

Manejo del paciente autista en el consultorio odontológico / Management of the autistic patient during a dental care visit

La cavidad oral es la puerta de entrada tanto de nutrientes como de enfermedades e infecciones, en pacientes que tienen algún tipo de discapacidad es aun mßs importante mantener una buena salud oral que determine una mejor salud general. El Autismo es un Síndrome no una enfermedad, en la gran mayoría de los casos congénito, que afecta las relaciones sociales y afectivas así como la capacidad de comunicación de los individuos. Los profesionales que trabajemos alrededor de el tendremos la importante misión de darle una mejor calidad de vida. Para lograr esto es indispensable que el profesional se informe sobre el síndrome, sus características, sus antecedentes, etc. para así poder tratar a cada individuo como único, ya que en este tipo de pacientes descubriremos que no existe un caso igual a otro y deberemos adecuarnos a cada uno en particular, utilizando todos los recursos de los que podamos valernos para lograr resultados positivos. El manejo Psicológico debe realizarse desde la primera sesión y no dejar de hacerse hasta la última, debemos tener en consideración los datos consignados en la historia clinica, mantener contacto permanente con el o los médicos que tratan al paciente así como conel terapeuta físico, del lenguaje u ocupacional dependiendo de cada caso. El paciente autista debe familiarizarse con el profesional, el staff del consultorio, los colores, olores y ruidos propios del ambiente odontológico, debemos recordar que este tipo de pacientes son muy susceptibles a cambios de cualquier tipo a pesar de que en muchos casos pueden parecer abstraídos en su propio mundo 3. Es por esto que nuestro abordaje debe ser realizado de afuera hacia adentro, nunca acercarnos directamente a la cavidad oral e ir avanzando de acuerdo a como el paciente reaccione ante cada uno de nuestros movimientos.

The oral cavity is the main entrance for nutrients as well as for illness and infections, in patients who have any type of disability it is extremely important to maintain a good oral health which will determine a good general health. Autism is a syndrome, not an illness, most of the times congenital and which interferes with social and affective relations as well as the person communication. As Dental Care providers we all have the responsibility to improve their life condition into a better one. It is very important for Dental Care Providers to be appropriate informed about this syndrome, it will be the only way to treat each patient as a unique person because we will learn and notice that every case is different and each patient will need to be treated with all the medical resources as possible to obtain a positive result. The patient psychological management needs to be treated since the first visit, all the patient medical history and information is essential and will be considered for the treatment. Keep in touch with the patient's general care provider as well as the physical or the speech therapist depending on each case. It will help for a better understanding of the patient needs. The autistic patient needs to be involved and comfortable with the medical provider and office staff, the space, colours and noises to be found the dental office. Remember that, this type of patient is extremely sensitive to any changes surrounding, although they may look totally inside of their own world. This is why we will need to approach to the patient from the outside to the inside, never go directly to their oral cavity; all movements and actions will need to be done depending on the patient's reaction.

Total agenesis of the corpus callosum in a patient with childhood-onset schizophrenia

The hypothesis that schizophrenia involves aberrant inter-hemispheric communication has a long pedigree, however its precise role remains unclear. We therefore report the case of a total agenesis of the corpus callosum in a 21-year-old man with childhood-onset schizophrenia. The presence of schizophrenia with very early onset on absence of corpus callosum offers an opportunity to examine neurodevelopmental model and theories regarding to interhemispheric communication in the pathogenesis of psychosis.

A hipótese que a esquizofrenia envolve comunicação inter-hemisférica aberrante possui longa tradição, entretanto seu papel permanece incerto. Nós relatamos um caso de agenesia total do corpo caloso em um homem de 21 anos portador de esquizofrenia de início na infância. A associação de esquizofrenia de início precoce na ausência de corpo caloso oferece uma oportunidade para exame do modelo neurodesenvolvimental e de teorias que envolvem a comunicação interemisférica na patogênese da psicose.

Esquizofrenia de inicio en la niñez, revisión de conceptos actuales y dificultades en el diagnóstico / Child schizophrenia: A Review of Current Concepts and Diagnostic Difficulties

La esquizofrenia en niños es una patología cuyodiagnóstico es difícil. La mayoría de los estudioshablan de síntomas en niños escolares yadolescentes y la continuidad en la que se presentaen los adultos. Sin embargo, siguen existiendovacíos diagnósticos en los niños menoresy se busca encontrar mejores marcadores clínicospara detener o retrasar el deterioro propiode esta patología.

A esquizofrenia ao longo da infância / Schizophrenia during childhood

As pesquisas sobre os grupos de alto risco (filhos de pais esquizofrênicos), assim como os estudos prospectivos na população geral, mostram que os futuros esquizofrênicos apresentam, comparativamente aos sujeitos-controle, atrasos do desenvolvimento psicomotor, déficits cognitivos e algumas particularidades comportamentais. Tais dados parecem confirmar a idéia segundo a qual a esqizofrenia corresponderia a um distúrbio neuro-desenvolvimental cuja expressão varia ao longo da vida. As especificidades clínicas e evolutivas dos raros casos de esquizofrenia iniciando-se na infância levam alguns autores a pensar que se trataria de um entidade específica e cujo pertencimento ao "espectro autista" necessita ainda ser estudado.

Electroconvulsive Therapy in One Female with Very Early Onset Schizophrenia: A Case Report / 대한정신약물학회지

Very early-onset schizophrenia (VEOS) has a very rare prevalence, below 2 in one million children. Electroconvulsive therapy (ECT) is a controversial treatment modality that is only rarely performed on children and adolescents. There is a marked paucity of published data relating to the indications, use, clinical outcome and complications of ECT in this age group. We reported a case of ECT in 11-year-old female patient with VEOS who displayed auditory and visual hallucinations, disorganized speech and behavior, and psychomotor agitation. The patient received 19 modified bilateral ECT through intravenous general anesthesia because of the unresponsiveness to risperidone, olanzapine, seroquel and amisulpride. During ECT, she remained on only risperdal 2 mg/day. After 15 treatments, there was significant improvement in her psychotic features. After 19 treatments, her psychotic features disappeared and her social activity was much improved. ECT in the management of childhood schizophrenia could be an effective treatment option, especially at the failure of pharmacologic and psychotherapeutic treatment modalities.

Esquizofrenia na infância e adolescência: um esboco histórico / Childhood and adolescence schizophrenia: historical outline

O presente artigo apresenta a evoluçäo do conceito da esquizofrenia na infância e adolescencia. Desde Moreau de Tours, 1888, quando publicou seu livro La folie chez les enfants, passando por Potter, 1933, que sistematizou um quadro clínico para esquizofrenia infantil, até as classificaçöes atuais, o DSM-III-R e DSM-IV, em que a esquizofrenia na infância a adolescencia nâo é considerada como um diagnóstico a parte, mas, sim, classificada junto a esquizofrenia que ocorre em pacientes

Psicoses desintegrativas / Desintegrative psychoses

As psicoses desintegrativas foram incluídas na CID-9, como sinônimo de síndrome de Hedler, e assim permaneceu na CID. Foram descritas como psicoses que apareceriam após cerca de 2 anos de desenvolvimento normal. Apresentariam uma regressäo em poucos meses, tornando-se, as crianças, retardadas, autistas, hiperativas, com padröes estereotipados de respiraçäo, estereotipias manuais e marcha atáxica. Essa síndrome, no entanto, pode ocorrer nas mais variadas condiçöes clínicas. Estudando atentamente as psicoses desintegrativas, iremos ver que elas se superpöem, perfeitamente, à síndrome psicorgânica de Eugen Bleutler, näo sendo clinicamente correto, pois, considerá-las apenas como psicoses infantis, pois podem ocorrer em indivíduos de qualquer faixa etária

Elective mutism of childhood: selective non-communication

This paper reviewed the current state of knowledge concerning elective mutism, a relatively uncommon, but most interesting and curious child psychiatric presentation. Clinical features, etiology, differential diagnosis and current treatment approaches were discussed. A case of genetically impaired siblings, both presenting this condition was presented

Autismo infantil: analise de uma populacao / Early infantile autism: a population analysis

Os autores analisam 28 casos de autismo diagnosticados atraves dos criterios do DSM-III-R quanto ao sexo, idade, hipoteses etiologicas e quadro clinico. As conexoes causais sao pequenas e os quadros clinicos parecem independer da etiologia em questao.

Esquizofrenia infantil: Análisis de una experiencia clínica / Childhood schizophrenia: Analysis of the clinical experience

El autor analiza 22 casos de niños diagnosticados con ezquizofrenia infantil en el Centro de Rehabilitación de la APAE-SP. De su muestra, 11 casos habían iniciado la enfermedad entre 1 y 3 años y 11 casos entre 3 a 12 años. Observamos una variación de la patoplastia del cuadro en función de la edad de inicio, indicando que la estructuración cognitiva y afectiva del individuo afectado es básica para la forma de presentación del cuadro