Investigating Predictors of Clozapine Response in Adolescents with Schizophrenia and Schizoaffective Disorder

Illness-related outcomes of illicit substance use disorder in adolescents with early onset schizophrenia: a multicenter study

OBJECTIVES

Lifetime co-occurring substance use disorders are common at the time of presentation for the treatment of primary psychosis. Our aim was to investigate the clinical characteristics of adolescents with early-onset schizophrenia/schizoaffective disorder (EOS), categorized as either with (EOS + SUD) or without SUD (non-SUD/EOS), in a multi-center sample.

METHODS

Between 2016 and 2022, 255 patients were evaluated across three tertiary-care inpatient units. Diagnoses were confirmed by the treating physician according to the DSM-5 during the hospital stay. The severity of symptoms was measured using the Positive and Negative Syndrome Scale (PANSS).

RESULTS

The EOS + SUD group exhibited a higher illness onset, fewer years of education, longer duration of untreated psychosis (DUP), a higher frequency of male gender, more frequent hospitalizations, increased use of clozapine and zuclopenthixol LAI, along with higher rates of post-traumatic stress disorder and conduct disorder. Notably, differences in DUP, clozapine use, and the number of hospitalizations did not persist in the multivariate logistic regression model.

CONCLUSIONS

Our findings support the notion of SUD playing a role in modifying the course of illness in EOS. Future studies should emphasize exploring treatment responses to medications and interventions among youth with dual diagnoses.

Clozapine Use in Early-Onset Schizophrenia

Schizophrenia in the pediatric population poses unique challenges and has been associated with poorer prognosis. Early intervention and symptom stability are paramount. There are several antipsychotic medications with U.S. Food and Drug Administration approval, but when treatment resistance occurs, clozapine is an option that has demonstrated superiority in effectiveness. Due to side effect burden and monitoring requirements, clozapine remains an alternative to other pharmacotherapy options that have failed rather than a mainstay of treatment. Clinicians, nurses, family members, and others involved in pediatric mental health care must be knowledgeable about this option and how to maintain safety with its use. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 6-8.].