Cognitive behavioral therapy in adolescents with early-onset psychosis: a randomized controlled pilot study

Cognitive behavioral therapy for psychosis (CBT) is an effective treatment in adult patients with schizophrenia. However, no randomized controlled and blinded trial in adolescents with early-onset psychosis (EOP) has been conducted. Therefore, the present pilot study explores the acceptance, tolerability, feasibility, and safety of a modified CBT in adolescents with EOP. Twenty-five adolescents with EOP were randomized to either 9 months (20 sessions) of CBT + treatment as usual (TAU) or TAU alone. The primary endpoint was the PANSS-positive subscale (P1-7). Secondary endpoints included psychopathology, global functioning, and quality of life (QoL). Acceptance, tolerability, feasibility, and safety were assessed. Blinded assessments took place by the end of the treatment (9 months) and at 24-month follow-up. Despite improvements in both groups and lack of statistical significance between CBT + TAU and TAU regarding the primary endpoint, we observed between-group effect sizes of at least d = 0.39 in favor of CBT + TAU at post-treatment for delusions, negative symptoms, functioning and QoL after the intervention and effect sizes of at least d = 0.35 after 24 months. CBT in EOP was highly acceptable (73.5% agreed to randomization), well-tolerated (83.1% attendance rate, no drop-outs), and safe (one serious adverse event (SAE) in CBT + TAU in comparison with six SAEs in TAU). These findings suggest that CBT adapted to the needs of adolescents with EOP is a promising approach regarding negative symptoms, functioning, and QoL. CBT is a safe and tolerable treatment. However, due to the small sample size and the pilot character of the study, these conclusions are limited, and should be tested in a larger, adequately powered randomized controlled trial.

Cytochrome P450 2D6 deficiency and its clinical relevance in a patient treated with risperidone

In contrast to several authors who found hepatic cytochrome P 450 2D6 (CYP2D6) metabolising status to be clinically unimportant in treatment with the CYP2D6 substrate, risperidone, we report on a 17-year-old schizophrenic patient who suffered from severe extrapyramidal side effects (EPS) while being treated with risperidone at 4 mg per day. He was genotyped as a CYP2D6 poor metaboliser (PM). The active moiety of risperidone (sum of risperidone and 9-hydroxyrisperidone) was elevated and increased even further under co-medication with haloperidol and biperiden. We conclude that the PM phenotype for CYP2D6 of this patient had major clinical importance in treatment with risperidone. Most likely metabolic pathways other than CYP2D6 were also involved that are probably inhibited by haloperidol.

[Patient admission to a child and adolescent psychiatric polyclinic. Referral, patient information, preparation, concepts, expectations and fears of children, adolescents and their parents]

This study investigates 77 families i.e. their children, aged 7-17, and their parents, who attended the out-patient clinic of the child psychiatric department for the first time. It was intended to examine and outline the subjective situation on entering the clinic. A structured verbal interview was conducted with the children before the start of the actual examination procedure, while a written questionnaire was submitted to the parents. Among the questioned items were modes of referral, references, sources of information, knowledge and preparedness, ideas, expectations and apprehensions about the institution and its treatments. The answer that were obtained reflected a lack of self-determination on the part of the children and the strength of influence exerted by the parents along with other relevant authorities. The children were often taken to the clinic without any active consent on their part. When asked about hopes of improvement they did not often confirm. Similarly fears about the impending examination were at first denied by most children but subsequently conceded, when concrete suggestions were made. Strikingly the better informed and prepared, children were able to admit to their fears more often. The results of the parental questionnaire illustrate an extensive lack of information about the institution that the families were actually attending. It may be concluded that the parents had also been little assertive when preparing their children for the examination. When asked about their expectations the parents primarily quoted "help" and "advice". Scepticism about the examination came only at the bottom of the list.(ABSTRACT TRUNCATED AT 250 WORDS)