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In child and adolescent psychiatry antipsychotics are used in large and increasing quantities for a wide range of disorders and psychopathology, including psychotic, mood and disruptive behaviour disorders.
The European Medicines Agency (EMA) has approved Paliperidone for the treatment of schizophrenia in adolescents from 15 years old.
To present our clinical experience with Paliperidone in the treatment of psychotic symptoms and other psychopathological disorders in adolescents.
To describe with data from clinical practice the potential usefulness of Paliperidone in adolescent disorders beyond Schizophrenia.
Five patients from an outpatient child and adolescent mental health service, on treatment with Paliperidone during 2014, were selected as clinical illustration. Case reports describe personal and family history, clinical presentation, management and treatment, course and outcome, with especial focus in treatment tolerance.
We present 3 males and 2 females, age between 15 and 17 years. Diagnoses were: autism, borderline personality disorder, schizotypal personality disorder, personality disorder not otherwise specified and schizophrenia. Prescribed dose was 3-9 mg/day, and actual mean time of treatment duration is 5,8 months. In 4 cases Paliperidone was initiated as a change from other antipsychotic. There were no adverse effects that required discontinuation and in all cases symptoms improved.
Our clinical experience evidences that Paliperidone is a valuable therapeutic option on behalf of its effectiveness and tolerance.
In our practice the symptoms that respond better to Paliperidone are: hallucinations, reference ideation, irritability, aggression, disorganized behaviour and stereotypies.
Conversion disorder (CD) is an uncommon but highly disabling condition. Affected children and adolescents are often severely impaired and at risk of serious long-term physical and psychosocial complications. Despite the enormous personal suffering and health resource implications of CD, little research has been done.
To update our knowledge about CD in adolescents, with a comprehensive review of the literature with special focus in prevalence, psychosocial factors, diagnosis, treatment and outcome.
To present the most relevant data of our review with a clinical illustration that provides a practical vision of this disorder.
A systematic literature review was performed in MEDLINE, with particular interest in papers published in the last 10 years. Clinical illustration is provided by a case selected from an outpatient child and adolescent mental health service.
Few reliable prevalence data are available; the range goes from 0.2 in a German study to 31% in non-western clinical settings. Diagnosis is based on a constellation of features and treatment should involve several heath care professionals. CD has a favourable outcome in children and adolescents. However, mood and/or anxiety disorders are encountered at a considerable rate even after recovery from conversion symptoms. Long clinical follow-up seems appropriate.
The expression of emotional distress in the form of physical complaints is common in children. Nevertheless, the most severe presentation of physical symptoms is not a common topic in literature. More research should be done to improve our understanding of this disabling disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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