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M. was an 8-year-old boy referred to an inpatient child and adolescent psychiatry (CAP) service for a 3-week history of escalating aggression, suicidal ideation, and low lethality suicide attempts. Although diagnostically M. presented a mixed picture, it was felt that M.'s reverse neurovegetative symptoms and persistent episodic irritability were consistent with both diagnoses. M.'s obesity was evidence of a metabolic syndrome produced by antipsychotic medication, but this was unconfirmed by laboratory studies. A recent meta-analysis (Zhuo et al. [26]) found that topiramate is the most effective medication to reduce BMI in patients on antipsychotic medications. [Extracted from the article]

This article discusses the case of a 17-year-old Hispanic adolescent boy who developed psychosis after immigrating to the United States. The article explores the patient's background and history, including his psychiatric, developmental, educational, social, and family background. The patient was diagnosed with schizophreniform disorder with catatonia and received treatment with medications. The article also discusses the factors that contribute to the development of psychosis, including genetic and environmental factors. The case highlights the importance of early recognition and targeted pharmacotherapy in improving outcomes for youth with psychosis. [Extracted from the article]

And while clozapine is the drug of choice for patients with treatment-resistant psychosis, (Lopez-Morinigo et al., [13]), nonadherence with follow-up and laboratory monitoring were obstacles in K.'s treatment. Whereas first-generation antipsychotics and LAIs may not be the first line of treatment in child and adolescent patients with psychosis, these medications may be useful treatment options for those with difficulty to treat symptoms and medication nonadherence. K. was a 16-year-old adolescent boy with a history of schizoaffective disorder, bipolar type, and cannabis use referred to the psychiatric Emergency Department (ED) for disorganized behavior and aggression in the context of medication nonadherence. Past Psychiatric History See Table 1 below for a full history of K.'s prior treatments and medication trials. [Extracted from the article]

Predisposing factors include preterm birth and low birth weight that are associated with increased rates of ASD, ADHD, and problems with self-regulation and impulse control. ASD, like other neurodevelopmental disorders, can present with a variety of symptoms and severities across patients, making individual treatment important and also challenging. V. was an 11-year-old girl with a history of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and a complex medical history that includes pulmonary atresia (PA), chronic lung disease, atrial septal defect, precocious puberty, and seizure disorder, who was initially referred by pediatric neurology for psychiatric evaluation of maladaptive behaviors and impaired sleep. Studies of children with oppositional defiant or conduct symptoms in the context of ASD and ADHD have demonstrated that disruptive behaviors may respond more fully to dual therapy with methylphenidate and clonidine than monotherapy (Connor et al., [4]; Kollins et al., [8]). [Extracted from the article]

Discussion This case highlights multiple interesting and important points that should be considered during evaluation and treatment of patients with somatoform disorders, especially functional neurological symptom disorder (conversion disorder) with comorbid mood symptoms. A. is a 14-year-old adolescent girl referred to the emergency department for involuntary psychiatric assessment for suicidal ideation with diagnoses of cluster B traits, obsessive-compulsive disorder (OCD), depression, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). On the contrary, functional neurological symptom disorder refers to the presence of one or more neurological symptoms of alterations in sensory or motor functions in which symptoms are incompatible with recognized neurological or medical conditions (American Psychiatric Association, [1]). As described in the DSM-5-TR, somatic symptom disorder is a more general disorder characterized by one or more somatic symptoms that are distressing or result in significant disruption of daily life accompanied by excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns (American Psychiatric Association, [1]). [Extracted from the article]

L. denied auditory and visual hallucinations, despite initially endorsing them in the ED. However, although L. denied suicidal ideation, when asked about homicidal ideation, L. did not respond, and instead was noted to laugh to himself. L. was a 14-year-old boy with a medical history of early childhood asthma referred to the psychiatric Emergency Department (ED) from school after endorsing suicidal ideation to his guidance counselor. [Extracted from the article]

P. was a 16-year-old adolescent girl with a history of Joubert syndrome, fetal malformations, schizophrenia, depression, and catatonia brought to the emergency department (ED) by her mother and grandmother due to bizarre behavior and self-neglect. P. had multiple comorbid conditions predisposing her to catatonia, such as depression, schizophrenia, and seizure disorder. Treatment Course On admission P. was diagnosed with an exacerbation of catatonia in the context of her history of Joubert syndrome, fetal malformations, schizophrenia, and depression. History of Present Illness Mother reported that P. had not been verbal for >1 year; however, at baseline P. was reported to be interactive, maintained eye contact, walked independently, and was able to bathe and dress herself. [Extracted from the article]

Reinstein et al ([17]) demonstrated that the dose of clozapine administered could be lowered by 25% by using quetiapine, which has less anticholinergic effects, as a clozapine sparing agent and substituting 2 mg of quetiapine for every 1 mg of clozapine. M. was a 14-year-old adolescent girl brought by her mother to an emergency department for worsening self-injurious behavior by scratching and suicidal ideation in the context of recurrent hospitalizations for similar symptoms. Although M. did not report constipation on admission, upon specific review of systems, M. reported that she had no bowel movements for 3 days after two doses of clozapine. Perhaps the most obvious strategy in preventing CIC would be to obtain a thorough medical history, focusing on risk factors for constipation and pre-existing conditions, such as irritable bowel syndrome, and provide psychoeducation to patients about symptoms and consequences of CIC before beginning clozapine treatment. [Extracted from the article]

Although there is discrepancy in the literature regarding the prevalence of co-occurring ASD and BD, BD is commonly associated with ASD (Dunalska et al, [11]; Espluga-Frigola et al, [12]; Frazier et al, [14]; Joshi et al, [18]; Skokauskas and Frodl, [32]). Difficult-to-Treat Aggression in a Child with Autism Spectrum Disorder: Did We Miss Something? C. was a 16-year-old adolescent boy with a history of autism spectrum disorder (ASD), intellectual disability (ID), and cerebral palsy (CP) who was brought to the emergency department (ED) by his mother due to worsening aggression and erratic behavior. Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD): Recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement. [Extracted from the article]

The article presents a case study of a nine-year-old Mexican-American boy who was diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and borderline intellectual functioning. It mentions that the patient was treated with guanfacine, sertraline, and aripiprazole. It notes that psychopharmacological interventions played an essential role in treatment of patient's symptoms.

A. was an obese 12-year-old girl admitted to a child and adolescent inpatient psychiatry service for making threats to kill her mother during an outpatient therapy appointment. A. received a diagnosis of PTSD and participated in therapy for treatment of anxiety and mood symptoms. There was a history of Child Protective Service involvement when A. was 8 years old for concerns arising from A.'s report of sexual abuse by maternal grandfather; mother had reported A.'s allegations to the police and a case was opened. On day 3, after coordination with A.'s outpatient provider and receipt of his prehospitalization recommendation to start amantadine, given our consensus that multiple alternate appropriate agents had been unsuccessful, aripiprazole was discontinued and amantadine initiated at 25 mg qam, with a plan to up-titrate by 25 mg each day barring any unforeseen problems or adverse effects. [Extracted from the article]

J. was a 15-year-old adolescent boy with a psychiatric history of bipolar 1 disorder, characterized by many suicide attempts, recently discharged from another psychiatric in-patient unit, referred by the police for erratic and aggressive behavior, not sleeping for days and refusing medications. J. had also become sexually preoccupied, as evidenced by inappropriate behavior on the inpatient unit involving female staff and patients. Medical History J. had experienced multiple concussions from playing football, and loss of consciousness during at least one concussion. Medication History The mother provided an approximate timeline of medication changes that J. went through. [Extracted from the article]