Öz
ÖZET
Şizofreni toplumun %1'ini etkileyen ve işlevsellikte ciddi bozulmalara neden olan kronik bir hastalıktır. Şizofreni ile ilişkili belirtiler on sekiz yaşından önce başlıyorsa erken başlangıçlı şizofreni (EBŞ), on üç yaşından önce başlıyorsa çok erken başlangıçlı şizofreni (ÇEBŞ) olarak adlandırılmaktadır. Erişkin popülasyonda şizofreninin yaygınlığı ve risk faktörlerini araştıran pek çok çalışma olmasına rağmen ÇEBŞ ile ilgili henüz yeterli çalışma bulunmamaktadır. Bu konuyla ilgili çalışma sayısı sınırlı olsa da bu vakaların erişkin başlangıçlı şizofreniye göre daha ağır seyrettiği bilinmektedir. Çok erken başlangıçlı şizofrenide gri madde kaybının hastalığın başlangıcından itibaren devam ettiği, ergenlik döneminde ise hızlandığı tespit edilmiştir. Nörobilişsel bozulma daha hızlı ve şiddetli olduğundan, vakaların erken tanısı ve tedaviye erken başlanması kritik öneme sahiptir. Ayrıca tedavi direnci de nadir değildir. Yan etkileri de göz önünde bulundurulduğunda pediatrik popülasyonda kullanmayı sık tercih etmediğimiz klozapinin bu olgularda kullanımı düşünülmelidir. Bu yazıda 10 yaşındaki şizofreni hastasının klozapin ile başarılı tedavisini sunacağız. Hasta ailesi tarafından kliniğimize getirildi. Perseküsyon sanrıları, büyüklük sanrıları, kendi kendine konuşması, düzensiz davranışları, iletişimde azalması, negativizmi ve ajitasyonu mevcuttu. Ailesiyle neredeyse hiç konuşmuyordu, okula gidemiyordu. Bu hastada şizofreninin çok erken yaşta başlaması, nörobilişsel bozulmanın hızlı ve şiddetli olması; daha önce kullanılan üç antipsikotikle de remisyonun sağlanamaması sebebiyle klozapine geçtik. Klozapin tedavisinden sonra ciddi bir yan etki görülmedi ve hastanın psikotik semptomları önemli ölçüde geriledi. Hastanın günlük işlevselliğinde anlamlı bir düzelme oldu. Çok erken başlangıç şizofrenin prognozu daha kötüdür ve tedaviye direnç de sık görülür. Çocuk-ergen popülasyonunda kullanımı sık olmayan bir ajan olan klozapinin, tedaviye dirençli ÇEBŞ vakalarında bir tedavi seçeneği olarak klinisyenler tarafından akılda tutulması yararlı olacaktır.
Kaynakça
- 1. Andreasen NC. Schizophrenia: The fundamental questions. Brain Res Brain Res Rev. 2000;31(2-3):106–112.
- 2. McClellan J, Stock S. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013;52(9):976–990.
- 3. Röpcke B, Eggers C. Early-onset schizophrenia: A 15-year follow-up. Eur Child Adolesc Psychiatry. 2005;14(6):341–350.
- 4. Thompson PM, Vidal C, Giedd JN, Gochman P, Blumenthal J, Nicolson R, Toga AW, Rapoport JL. Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proc Natl Acad Sci U S A. 2001;98(20):11650-11655.
- 5. Malla AK, Bodnar M, Joober R, Lepage M. Duration of untreated psychosis is associated with orbital–frontal grey matter volume reductions in first episode psychosis. Schizophr Res. 2011;125(1):13-20.
- 6. Di Luzio M, Pontillo M, Villa M, Attardi AG, Bellantoni D, Di Vincenzo C, Vicari S. Clinical features and comorbidity in very early-onset schizophrenia: a systematic review. Front Psychiatry. 2023;14:1270799.
- 7. Pagsberg AK, Tarp S, Glintborg D, Stenstrøm AD, Fink-Jensen A, Correll CU, Christensen R. Acute antipsychotic treatment of children and adolescents with schizophrenia-spectrum disorders: a systematic review and network meta-analysis. J Am Acad Child Adolesc Psychiatry. 2017;56(3):191-202.
- 8. Sadock BJ, Sadock VA, Kaplan HI. Kaplan & Sadock’s comprehensive textbook of psychiatry. Philadelphia: Lippincott Williams & Wilkins, 2005.
- 9. Wimberley T, Støvring H, Sørensen, HJ, Horsdal HT, MacCabe JH, Gasse C. Predictors of treatment resistance in patients with schizophrenia: a population-based cohort study. The Lancet Psychiatry. 2016;3(4):358-366.
- 10. Meltzer, HY. Treatment-resistant schizophrenia - The role of clozapine. Curr Med Res Opin. 1997;14(1):1–20.
- 11. Siskind D, McCartney L, Goldschlager, R, Kisely S. Clozapine v. first- and second-generation antipsychotics in treatment-refractory schizophrenia: systematic review and meta-analysis. Br J Psychiatry. 2016;209(5):385–392.
- 12. Rachamallu V, Elberson BW, Vutam E, Aligeti M. Off-Label Use of Clozapine in Children and Adolescents—A Literature Review. Am J of Ther. 2019; 26(3):406-416.
- 13. Pimenta de Figueiredo T, de Almeida IR, de Freitas FAC, Kubrusly CHC, Alvim-Soares Júnior AM, de Miranda DM. Beyond the off-label: a systematic review of what we know about clozapine use for children. J Child Adolesc Psychopharmacol. 2024;34(9):e419-e426.
- 14. Aneja J, Singhai K, Paul K. Very early-onset psychosis/schizophrenia: case studies of spectrum of presentation and management issues. J Family Med Prim Care. 2018;7(6):1566-1570.
- 15. Schneider C, Corrigall R, Hayes D, Kyriakopoulos M, Frangou S. Systematic review of the efficacy and tolerability of clozapine in the treatment of youth with early onset schizophrenia. Eur Psychiatry. 2014;29(1):1-10.
- 16. Karal BN, Özdemir YE, Karayağmurlu A. The Management of Very Early-Onset Schizophrenia With an Olanzapine and Amisulpride Combination. J Clin Psychopharmacol. 2022;10-1097.
- 17. Bailly D, De Chouly De Lenclave, MB. A rare and not very studied disorder: childhood-onset schizophrenia. A case report. Encephale. 2004;30(6):540-547.
- 18. Mozes T, Toren P, Chernauzan N, Mester R, Yoran-Hegesh R, Blumensohn R, Weizman A. Clozapine treatment in very early onset schizophrenia. J Am Acad Child Adolesc Psychiatry. 1995;33(1):65-70.
- 19. Mortensen PB, Pedersen MG, Pedersen CB. Psychiatric family history and schizophrenia risk in Denmark: Which mental disorders are relevant? Psychol Med. 2010;40(2):201–210.
- 20. Williams R, Malla A, Roy MA, Joober R, Manchanda R, Tibbo P, Banks N, Agid O. What Is the Place of Clozapine in the Treatment of Early Psychosis in Canada? n. 2017;62(2):109–114.
- 21. Trinczek E, Heinzel-Gutenbrunner M, Haberhausen M, Bachmann CJ. Time to initiation of clozapine treatment in children and adolescents with early-onset schizophrenia. Pharmacopsychiatry. 2016;49(06):254-259.
Öz
ABSTRACT
Schizophrenia is a chronic disorder that affects 1% of the population and causes serious impairment in functioning. If symptoms associated with schizophrenia begin before the age of eighteen, it is called early-onset schizophrenia (EOS), and if it starts before the age of thirteen, it is called very early-onset schizophrenia (VEOS). Although there are many studies on the prevalence and risk factors of schizophrenia in the adult population, there are not enough studies yet on VEOS. Although the number of studies on this topic is limited, it is known that these cases have a more severe course than adult-onset schizophrenia. In very early-onset schizophrenia, it has been determined that the loss of gray matter continues from the onset of the disease, which accelerates during adolescence. Early diagnosis of cases and early initiation of treatment are critical, as neurocognitive deterioration is more rapid and severe. Also, treatment resistance is not uncommon. Considering its side effects, the use of clozapine, which we do not prefer to use in the pediatric population, should be considered in these cases. In this paper, we will present the successful management of a 10-year-old boy with schizophrenia using clozapine. The patient was brought to our clinic by his family. His symptoms were persecutory delusions, grandiose delusions, self-talk, disorganized behaviors, decreased communication, negativism, and agitation. He was hardly speaking to his family; he could not go to school. Since schizophrenia started at a very early age in this patient, neurocognitive deterioration was rapid and severe, and the symptoms didn't improve with three previously used antipsychotics, so we switched to clozapine. There were no serious adverse events after clozapine therapy, and the patient's psychotic symptoms significantly improved. There was a significant enhancement in the patient's daily functionality. Very early-onset schizophrenia is more severe, and resistance to treatment is commonly seen. It would be useful for clinicians to keep in mind clozapine, which is not a frequently used agent in the child-adolescent population, as a treatment option in treatment-resistant VEOS cases.
Anahtar Kelimeler
Kaynakça
- 1. Andreasen NC. Schizophrenia: The fundamental questions. Brain Res Brain Res Rev. 2000;31(2-3):106–112.
- 2. McClellan J, Stock S. Practice parameter for the assessment and treatment of children and adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry. 2013;52(9):976–990.
- 3. Röpcke B, Eggers C. Early-onset schizophrenia: A 15-year follow-up. Eur Child Adolesc Psychiatry. 2005;14(6):341–350.
- 4. Thompson PM, Vidal C, Giedd JN, Gochman P, Blumenthal J, Nicolson R, Toga AW, Rapoport JL. Mapping adolescent brain change reveals dynamic wave of accelerated gray matter loss in very early-onset schizophrenia. Proc Natl Acad Sci U S A. 2001;98(20):11650-11655.
- 5. Malla AK, Bodnar M, Joober R, Lepage M. Duration of untreated psychosis is associated with orbital–frontal grey matter volume reductions in first episode psychosis. Schizophr Res. 2011;125(1):13-20.
- 6. Di Luzio M, Pontillo M, Villa M, Attardi AG, Bellantoni D, Di Vincenzo C, Vicari S. Clinical features and comorbidity in very early-onset schizophrenia: a systematic review. Front Psychiatry. 2023;14:1270799.
- 7. Pagsberg AK, Tarp S, Glintborg D, Stenstrøm AD, Fink-Jensen A, Correll CU, Christensen R. Acute antipsychotic treatment of children and adolescents with schizophrenia-spectrum disorders: a systematic review and network meta-analysis. J Am Acad Child Adolesc Psychiatry. 2017;56(3):191-202.
- 8. Sadock BJ, Sadock VA, Kaplan HI. Kaplan & Sadock’s comprehensive textbook of psychiatry. Philadelphia: Lippincott Williams & Wilkins, 2005.
- 9. Wimberley T, Støvring H, Sørensen, HJ, Horsdal HT, MacCabe JH, Gasse C. Predictors of treatment resistance in patients with schizophrenia: a population-based cohort study. The Lancet Psychiatry. 2016;3(4):358-366.
- 10. Meltzer, HY. Treatment-resistant schizophrenia - The role of clozapine. Curr Med Res Opin. 1997;14(1):1–20.
- 11. Siskind D, McCartney L, Goldschlager, R, Kisely S. Clozapine v. first- and second-generation antipsychotics in treatment-refractory schizophrenia: systematic review and meta-analysis. Br J Psychiatry. 2016;209(5):385–392.
- 12. Rachamallu V, Elberson BW, Vutam E, Aligeti M. Off-Label Use of Clozapine in Children and Adolescents—A Literature Review. Am J of Ther. 2019; 26(3):406-416.
- 13. Pimenta de Figueiredo T, de Almeida IR, de Freitas FAC, Kubrusly CHC, Alvim-Soares Júnior AM, de Miranda DM. Beyond the off-label: a systematic review of what we know about clozapine use for children. J Child Adolesc Psychopharmacol. 2024;34(9):e419-e426.
- 14. Aneja J, Singhai K, Paul K. Very early-onset psychosis/schizophrenia: case studies of spectrum of presentation and management issues. J Family Med Prim Care. 2018;7(6):1566-1570.
- 15. Schneider C, Corrigall R, Hayes D, Kyriakopoulos M, Frangou S. Systematic review of the efficacy and tolerability of clozapine in the treatment of youth with early onset schizophrenia. Eur Psychiatry. 2014;29(1):1-10.
- 16. Karal BN, Özdemir YE, Karayağmurlu A. The Management of Very Early-Onset Schizophrenia With an Olanzapine and Amisulpride Combination. J Clin Psychopharmacol. 2022;10-1097.
- 17. Bailly D, De Chouly De Lenclave, MB. A rare and not very studied disorder: childhood-onset schizophrenia. A case report. Encephale. 2004;30(6):540-547.
- 18. Mozes T, Toren P, Chernauzan N, Mester R, Yoran-Hegesh R, Blumensohn R, Weizman A. Clozapine treatment in very early onset schizophrenia. J Am Acad Child Adolesc Psychiatry. 1995;33(1):65-70.
- 19. Mortensen PB, Pedersen MG, Pedersen CB. Psychiatric family history and schizophrenia risk in Denmark: Which mental disorders are relevant? Psychol Med. 2010;40(2):201–210.
- 20. Williams R, Malla A, Roy MA, Joober R, Manchanda R, Tibbo P, Banks N, Agid O. What Is the Place of Clozapine in the Treatment of Early Psychosis in Canada? n. 2017;62(2):109–114.
- 21. Trinczek E, Heinzel-Gutenbrunner M, Haberhausen M, Bachmann CJ. Time to initiation of clozapine treatment in children and adolescents with early-onset schizophrenia. Pharmacopsychiatry. 2016;49(06):254-259.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ruh Sağlığı Hizmetleri |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Erken Görünüm Tarihi | 29 Mart 2025 |
| Yayımlanma Tarihi | 29 Mart 2025 |
| Gönderilme Tarihi | 2 Kasım 2024 |
| Kabul Tarihi | 6 Ocak 2025 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 47 Sayı: 1 |
