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Aim: To establish significant risk factors for the development of adverse drug effects (ADEs) in children and adolescents with an acute psychotic episode taking antipsychotics. Materials and Methods: The research team randomly selected 15 patient records each month for 3 years (2016-2018). Overall, 450 patient records were included (223 boys and 227 girls, mean age was 14.52 ± 2.21 years). Adverse effects were identified using the standard algorithm of the Global Trigger Tool method. A "trigger" is an indication that an adverse reaction is likely to occur, e.g., an antihistamine prescription on a prescribing list. When a trigger was detected, the case history was studied in further detail to confirm the occurrence of ADEs. We divided patients into two groups: the "children" group (under 12 years old) and the "adolescents" group (13 years and older). Data were analyzed using the statistical package IBM SPSS Statistics 23.0. Results: Of the 450 patient records, 402 (89.3%) had at least one trigger detected. In total, 126 case histories contained evidence of ADE (28%). The total number of ADEs per 1000 patient days was 5.39 and the number of ADEs per 100 admissions was 32.0. Among adolescents, two or more triggers per patient were significantly more frequently identified (61.3% vs. 44.6%; p = 0.001). ADEs were rare in "Children" compared with "Adolescents" (13.8% vs. 30.4%; p = 0.006). The logistic regression analysis confirmed high predictive role of "Adolescence" (odds ratio [OR] = 2.58; 95% confidence interval [CI] 1.22-5.4; p = 0.013), "Polypharmacy" (OR = 1.96; 95% CI 1.23-3.1; p = 0.004), and "First-life hospitalization" (OR = 2.17; 95% CI 1.34-3.48; p = 0.001) for ADE fact in patient records. Conclusion: We found that significant risk factors for ADEs to antipsychotics in patients with acute psychotic episode were adolescence (13 years and older), polypharmacy, and first-life hospitalization. The fact that children (i.e., younger than 13 years of age) are less likely to experience ADEs was not associated with high-risk drugs or higher doses in our study.

The article presents a case of a teenage female patient illustrating the difficulties of diagnosis and treatment of mental pathology at the onset of juvenile parkinsonism, which developed as a result of compound heterozygous mutations and proceeds with moderate akinetic-rigid and pseudopyramidal syndromes and combined tremor. It is shown that before the appearance of distinct symptoms of parkinsonism and the genetic study that confirmed the diagnosis, the patient had been observed for several years with various psychiatric diagnoses and received psychotropic therapy. This case demonstrates the difficulties of differential diagnosis of juvenile parkinsonism in children at the initial stage due to multiple comorbid motor, affective and behavioral disorders. When neurological symptoms appear in patients, a multidisciplinary approach is required, including joint diagnostics by psychiatrists and neurologists to establish an accurate diagnosis and select the optimal therapy. The introduction of principles of interdisciplinary interaction in the management of such patients will improve the timeliness of diagnosis and pathogenetically based therapy.

Objective: To analyze the premorbid features, clinical manifestations, dynamics and outcomes of ARFID in adolescent girls, as well as to clarify the relationship of ARFID with other eating disorders (EDs) and comorbid mental pathology., Material and Methods: The study included 52 female adolescents, aged 10.2-16.7 years (mean age 13.1±1.9 years) who, at the time of admission, met the DSM-5 ARFID criteria. The average follow-up period was 5.6±1.6 years, the average age at the time of the last follow-up examination was 19.1±2.7 years., Results: Patients with ARFID accounted for 8.4% of the sample of female adolescents with EDs. The stability of the clinical manifestations of ARFID indicates the validity of considering ARFID as an independent diagnostic category. The clinical picture of ARFID is determined by specific symptom complexes amalgamated with constitutional features. The latter are manifested from early childhood by neuroticism, anxiety, a weakened and somewhat perverted food instinct, metabolic features, partly determining the low need for food, immaturity and weakness of autonomic regulation that may form a predisposition for the development of psychosomatic/somatopsychic disorders., Conclusion: The study allows us to talk about a special predisposition, in the form of psychosomatic diathesis, which predisposes to ARFID and is a significant component of the response to psychogenic factors. It is assumed that diathesis as an abnormal constitution that determines the regulation of mental, autonomic and metabolic processes is a significant pathogenetic mechanism for other EDs. A certain commonality of the etiology and pathogenesis of ARFID and the entire group of EDs is confirmed by the high burden of family history of patients with various forms of EDs (13.5%) and a significant frequency of transformation of ARFID into other EDs.

Objective: To study disorders of mental development and psychopathological symptoms in young children with autistic disorders of various origins., Material and Methods: Two hundred and sixty-five children, aged 9 months to 4 years, (201 boys, 64 girls) with symptoms of autistic disorder were examined. The patients were divided into two age groups - the 1st group consisted of 36 children, aged 9 months to 2 years, the 2nd group consisted of 229 children from 2 years to 4 years. Psychopathological, neurological and clinical-dynamic methods were used, taking into account the results of consultations with a speech therapist, defectologist, psychologist., Results: The number of visits to a psychiatrist by parents of children older than two years becomes significantly higher - 13.6% ( n =36) and 86.4% ( n =112), respectively ( p ≤0.05), as well as the diagnosis of autistic disorder - 8.3% ( n =3) and 16.2% ( n =37) respectively, p ≤0.05). In both age groups, the diagnosis of «Other general developmental disorders» (F84.8) was most often established, with a significant predominance in the younger group - 80.5% and 72%, respectively ( p ≤0.05). Characteristic symptoms-markers of autism for both age groups are highlighted. It is shown that the diagnoses of childhood autism, Kanner syndrome, exposed at the first treatment, were preserved in all patients after three years. By the age of four, it was possible to clarify the diagnosis in 32% of cases. At the same time, 68% of patients, aged 4 years, retained a clinically undifferentiated diagnosis of F84.8., Conclusion: The study showed an increase in the diagnosis of autistic disorder during the first years of life. The necessity of increasing the knowledge of early-age psychiatry among specialists and the organization of a system of early detection, timely treatment and rehabilitation of autistic disorders in children of the first years of life in children's polyclinics is noted.

Objectives: To identify possible associations of CYP2D6, CYP3A4/5 , and ABCB1 gene polymorphisms with the efficacy and safety of antipsychotics in adolescents with acute psychotic episodes., Methods: We examined the associations of pharmacogenetic factors with the efficacy and safety of antipsychotics in 101 adolescents with acute psychotic episodes. The diagnosis on admission was "Brief psychotic disorder" (F23.0-23.9 by ICD-10). All patients were administered antipsychotics for 14 days. Treatment efficacy and safety were assessed using the PANSS, CGAS, CGI-S(I), UKU SERS, BARS, and SAS scales. Pharmacokinetic genotyping was performed for the CYP2D6 * 4, * 10 , ABCB1 1236C>T, 2677G>T, and 3435C>T genes., Results: CYP2D6 intermediate metabolisers had "Micturition disturbances" more often than extensive metabolisers (24.2 vs. 7.4%; p=0.026). "Wild" homozygote ABCB1 3435C>T CC was associated with more prominent akathisia. Haplotype analysis of three ABCB1 polymorphisms revealed that the "wild" alleles "C-G-C" (ABCB1 1236-2677-3435) were associated with higher risk of "Reduced salivation" (OR=2.95; 95% CI=1.35-6.45; p=0.0078)., Conclusions: CYP2D6 intermediate metabolism was associated with the risk of urinary difficulties under treatment with antipsychotics. We found that "wild" homozygotes ABCB1 1236C>T, 2677G>T, and 3435C>T were predictors of adverse drug effects caused by treatment with antipsychotics., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Objectives: To identify possible associations of CYP2D6, CYP3A4/5 , and ABCB1 gene polymorphisms with the efficacy and safety of antipsychotics in adolescents with acute psychotic episodes., Methods: We examined the associations of pharmacogenetic factors with the efficacy and safety of antipsychotics in 101 adolescents with acute psychotic episodes. The diagnosis on admission was "Brief psychotic disorder" (F23.0-23.9 by ICD-10). All patients were administered antipsychotics for 14 days. Treatment efficacy and safety were assessed using the PANSS, CGAS, CGI-S(I), UKU SERS, BARS, and SAS scales. Pharmacokinetic genotyping was performed for the CYP2D6 * 4, * 10 , ABCB1 1236C>T, 2677G>T, and 3435C>T genes., Results: CYP2D6 intermediate metabolisers had "Micturition disturbances" more often than extensive metabolisers (24.2 vs. 7.4%; p=0.026). "Wild" homozygote ABCB1 3435C>T CC was associated with more prominent akathisia. Haplotype analysis of three ABCB1 polymorphisms revealed that the "wild" alleles "C-G-C" (ABCB1 1236-2677-3435) were associated with higher risk of "Reduced salivation" (OR=2.95; 95% CI=1.35-6.45; p=0.0078)., Conclusions: CYP2D6 intermediate metabolism was associated with the risk of urinary difficulties under treatment with antipsychotics. We found that "wild" homozygotes ABCB1 1236C>T, 2677G>T, and 3435C>T were predictors of adverse drug effects caused by treatment with antipsychotics., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)

Objectives: Prediction of the antipsychotic's effectiveness is a relevant topic in the field of personalized medicine., Methods: The research design of this study is a prospective observation with posthoc analysis of associations of genetic polymorphisms with safety parameters and effectiveness of antipsychotic therapy. We observed 53 adolescents with an acute psychotic episode which were prescribed antipsychotics for 14 days. We evaluated the effectiveness of antipsychotics with the Positive and Negative Symptoms Scale and the safety with the UKU Side Effects Rating Scale, Simpson-Angus Scale, and Barnes Akathisia rating scale. We genotyped CYP3A4*22 (rs2740574), CYP3A5*3 (6986A>G, rs7767746), CYP2D6*4, *9, *10 (rs3892097, rs1065852), ABCB1 1236C>T (rs1128503), 2677G>T/A (rs2032582), 3435C>T (rs1045642), DRD2 (rs1800497), DRD4 (rs1800955), HTR2A (rs6313) by the real-time polymerase chain reaction method., Results: We found significantly more frequent "increased dream activity" between CYP2D6 intermediate metabolizers and normal metabolizers (54 vs. 22%; p=0.043). The «increased duration of sleep» was more often observed in homozygotes TT of ABCB1 2677G>T/A (50 vs. 15.8%, p=0.006) and TT of 3435C>T (41.7 vs. 8.2%, p=0.007)., Conclusions: We found that CYP2D6 and ABCB1 polymorphisms were associated with the safety of antipsychotics in adolescents with an acute psychotic episode., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

The authors review current data on the role of the synthetic aspartic acid analogue N-acetyaspartate (NAA) in various biochemical metabolic reactions in the CNS. Its importance as a biomarker for neuropsychiatric disorders identified using magnetic resonance spectroscopy (MRS) is noted. The authors present their own results of the use of cogitum, a synthetic analogue of NAA, in children with the effects of traumatic brain injury, mental retardation, hyperactivity disorder and in the complex therapy of schizotypal disorder. Effects of cogitum on cognitive deficit, asthenia are evaluated. The neurotrophic effect of the drug, which specifically affects cognitive and asthenic disorders in these diseases, is shown.

Children and adolescents are a special group in the context of psychopharmacotherapy. Given the limited choice of registered antipsychotics permitted in childhood, caution should be exercised in the choice of medication. This literature review reviews the current evidence base for pharmacotherapy of acute psychotic episode and schizophrenia in children and adolescents. The results of major systematic reviews and meta-analyses are compared. Meta-analyses of pharmacotherapy studies of the first psychotic episode are considered separately. Antipsychotics of the first and second generation are comparable in effectiveness for children and adolescents with acute psychotic episode. Olanzapine demonstrates higher efficacy in reducing negative symptoms. Ziprasidone and asenapine are less effective in treating schizophrenia in children and adolescents than other antipsychotics. Compared to adults, children and adolescents are at higher risk of metabolic impairments when taking antipsychotics.

Psychotherapeutic work with adolescents is a complex and challenging work. Clinical psychotherapy and creative psychotherapy (invented by M. Burno) have got an indisputable potential in use for the children and adolescents with mental disorders. A key feature of the psychotherapeutic approach for children and adolescents is obligatory taking into account all the aspects of mental ontogenesis/dysontogenesis of the patient. In the article we consider the basic clinical psychotherapeutic aspects of the new programme based on the creative psychotherapy (invented by М. Burno) to use in psychiatric departments for adolescents.