Antipsychotic medication in adolescents suffering from schizophrenia: a meta-analysis of randomized controlled trials.

BACKGROUND: The aim was to perform a meta-analysis on the efficacy, safety and tolerability of antipsychotic drugs in adolescents aged between 13 and 17 suffering from schizophrenia. METHODS: Enclosed studies - were multicentric, randomized, double-blind clinical trials; - included only adolescents (aged 13-17) with DSM-IV diagnosis of schizophrenia; - used standardized scales to assess efficacy, safety and tolerability of antipsychotics. RESULTS: All treatments resulted in significant improvements in Positive and Negative Syndrome Scale (PANSS) total score (p < 0.001), in PANSS positive subscale score (p < 0.001) and in Clinical Global Impression Scale-Severity of Illness score (p < 0.001) at the endpoint. Patients with a considerable weight gain were significantly higher in the olanzapine-treated group. Data about extrapyramidal side-effects were not available for olanzapine. Risperidone group was associated with a significantly major incidence of akathisia, tremor and dystonic events than controls. High dose of aripiprazole was associated with a significant major incidence of tremor and Parkinsonism (p < 0.01) than controls. CONCLUSIONS: Results demonstrated that antipsychotic treatment with risperidone, olanzapine or aripiprazole in adolescents affected by schizophrenia led to significant improvements in symptomatology. A pharmacological treatment for adolescents suffering from schizophrenia must fulfil several prerequisites, to grant the most favourable outcomes, avoiding acute and long term side-effects. Treatment with a 10 mg daily dose of aripiprazole was associated with the lowest incidence of extrapyramidal symptoms and showed no significant weight gain. If a treatment with antipsychotic drugs associated with significant weight gain as olanzapine or risperidone is needed, compensative measures should be soon considered.

[Autistic dimension in obsessive-compulsive disorder in adolescence]. / La dimensione autistica nel disturbo ossessivo-compulsivo in adolescenza.

AIM: This study examines the obsessive-compulsive disorder (OCD) with normal and poor insight of illness and it detects the presence of autistic traits. The aim is to establish the relationship between OCD and Autistic Spectrum Disorder (ASD): comorbidity or subtype of OCD? METHODS: The sample consists of 48 adolescents (aged 12-18) with a clinical diagnosis of OCD (according DSM-IV-TR). After administering the Children's Yale Brown Obsessive-Compulsive Scale (CYBOCS) and the Brown Assessement Beliefs Scale (BABS), the sample is divided into two groups according to insight of illness. Autism Diagnostic Observation Schedule (ADOS) and Social Communication Questionnaire (SCQ) were used to assist in the ASD diagnosis; Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) was administered to assess personality disorders. RESULTS: 47% of subjects presents poor insight and 27% are included within the diagnostic criteria for autistic spectrum disorder. Poor insight in obsessive-compulsive symptoms is significantly associated with the presence of autistic traits. There is also a significant association between cluster hoarding and poor insight. DISCUSSION: This study suggests the existence of an obsessive autistic atypical subtype, where the compulsive dimension of repetitive behaviours vanishes in an autistic dimension with stereotyped manifestations. Further research should be conducted to better understand this obsessive autistic atypical subtype and to put it in the obsessive-compulsive spectrum in adolescence.