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.
Adolescent ; Anesthesia, General ; Child ; Electroconvulsive Therapy* ; Female* ; Hallucinations ; Humans ; Prevalence ; Psychomotor Agitation ; Risperidone ; Schizophrenia* ; Schizophrenia, Childhood ; Quetiapine Fumarate

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.
Adolescent ; Ambulatory Care Facilities ; Antipsychotic Agents ; Child* ; Clozapine ; Executive Function ; Hospitals, General ; Humans ; Indonesia ; Intellectual Disability ; Odds Ratio ; Prevalence ; Risperidone ; Schizophrenia* ; Schizophrenia, Childhood ; Weights and Measures

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.
Adolescent ; Antipsychotic Agents ; therapeutic use ; Benzodiazepines ; therapeutic use ; Clozapine ; therapeutic use ; Dibenzothiazepines ; therapeutic use ; Humans ; Male ; Quetiapine Fumarate ; Schizophrenia, Childhood ; diagnosis ; drug therapy ; pathology ; Septum Pellucidum ; pathology