CHILDHOOD PSYCHOSES: RESULTS OF DRUG TREATMENT

WITH DOWN AND NON-DOWN SUBJECTS

Renato COCCHI, a neurologist and a medical psychologist.

(Italian translation) // Testo in italiano

Summary

After 3-94 months of individualized drug therapy, the results of 44 psychotic Down children and 29 psychotic non-Down children were compared. The Down group (PDG) comprised 28 M and 16 F; average age at first consultation, 7;3 +/- 3;9 years; chromosomal diagnoses, 42 pure trisomy 21, 1 mosaicism and 1 not known; DSM-III, R diagnosis, 40 early onset and 4 late onset Pervasive Developmental Disorder.

The non-Down group (PnDG) comprised 16 M and 13 F; average age at first consultation, 7;3 +/- 3;8 years; DSM-III, R diagnosis, 19 early onset and 3 late onset Pervasive Developmental Disorder and 7 atypical Pervasive Developmental Disorders.

One Down child and 3 non-Down children definitely came out of their psychoses and the results werå_ directly correlated to the length of the drug therapy.

The high number of therapy interruptions, especially with the Down children, may have various explanations, among wich that of null or negative results does not seem the most prominent.

Key words: Childhood psychoses; Down children; non-Down children; drug therapy; individualized regimen; results.

Autism

Down syndrome

Drug modulation of stress reactions

Mental retardation

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The possibility of comparing directly a group of psychotic Down children (PDG) with a group of psychotic non-Down children (PnDG), both tretaed by the same child psychiatrist, has already allowed comparisons of notable interest in epidemiology and clinical features (Cocchi, 1988), in the area of self-injurious behaviour (Cocchi & Bonaduce, 1988) and susceptibility towards upper tract respiratory diseases (Cocchi & Bonaduce, 1988).

On first consultation the proposal of drug treatment had been made in the case of every subject in the two groups, although not necessarily accepted for various reasons (Cocchi, 1990c).

I therefore considered it of interest to compare the results obtained with children whose parentó accepted the treatment set along the guidelines adopted (Cocchi, 1990c).

As for fuller information, the two groups will be described complete with all the psychotic children diagnosed as such on first consultation.

Materials and method.

All the clinical records of psychotic Down and non-Down subjects who consulted me between 1979 and the end of September 1990 were re-examined.

The records of all those over 15 years of age (180 months to be precise) on first consultation were disregarded, despite their being clearly autistic or suffering from a long lasting atypical childood psychosis, having considered this age as the conventional limit of competence as regards pediatrics anä child neuropsychiatry.

The reords selected were those in which the assessment carried out during the first consultation revealed the following symptoms, in differently composed combinations:

• social isolation;
• language regression, echolalia or other language impairments of psychotic nature;
• motoric stereotypes;
• sudden unmotivated anxiety;
• mood troubles;
• need for sameness;
• sensory hypo- hypersensitivity;
• self-injurious behaviour;
• gaze aversion;
• rituals.

Other information asked and noted: sex, age at firts consultation, chromosomal diagnose (for the Down subjects, and also for the other children, if performed); age at which the parents first noted the abnormal behaviour in their child.

Hallucinations, delusions, incoherence or marked loosing of associations were never noted down, either at first visit or during following consultations.

The diagnosis of early onset or late onset or atypical Pervasive Developmental Disorder was made according to the DSM-III, R (1987).

Results

According to the diagnoses made during first consultation, 2 groups of children records were assembled.

1. Psychotic Down children group (PDG).

Nr. of Ss	44 Ss = 100.00 %.
Sex:	M = 28 e F = 16
	M/F ratio = 175/100
Chromosomal anomalies:
Standard trisomy 21	42 Ss = 95.45 %
Translocations	0 " =  0.00 %
Mosaicisms	1 " =  2.27 %
Only clinical diagnose	1 " =  2.27 %
Average age at 1^st consult (years)	7;3 +/- 3;9
Diagnosis according to DSM-III, R
Early onset PDD	40 Ss = 90.91 %
Late onset PDD	4 " = 9.09 %

Table 1: Length of drug therapy in the PDG.

Subgroup	Nr. of Ss and %
0. Non started	8 Ss =  18.18%
1. from 3 to 6 months	3 " = 6.82%
2. from 7 to 12 months	5 " =  11.36%
3. from 13 to 24 months	10 " =  22.73%
4. from 25 to 36 months	8 " =  18.18%
5. from 37 to 60 months	6 " =  13.64%
6. from 61 to 84 months	4 " =   9.09%
Totals	44 Ss = 100.0 %

Table 2: results; keys: (-) worsening; (=) null; (+) slight improvement; (++) marked improvement; (+++) very marked improvement; (++++) normalized behaviour.

Order nr.	Isolat.	Linguage	Stereotip.	Sameness	Mood	Self-aggr.	Soc. bhv.	Learn. bhv.
Subgr.. 1
182	=	+	+		=	+	=	= (*)
353	+	=	+		+	++	+	+ (*)
455	=	+	=		+	++++	+	=
Subgr. 2
32	=	=	-	+	+		+	= (*)
34	+	++	++	+	+		+	= (*)
316	+	=	+		++	-	+	(*)
332	+	+++	=		+		++	+ (*)
430	+	++	++	++	++	+	++	++
Subgr. 3
124	+	++	+		ì	++	++	(*)
173	+	+	+		- (#)		+	= (*)
186	+	+	++		+	++++	++	+ (*)
289	+	+	+		=	=	++	= (*)
325	+	+	+		+	+++	++	+ (*)
330	=	=	-		+	-	=	+ (*)
333	+	=	=		-	-	+	= (*)
345	++	++	++	++	++		++	++ (*)
400	+++	+++	+++	+++	++		+++	+++
433	++	+++	++	++	+++	++++	+++	++
Subgr. 4
93	+++	++	+++	+++	++	++++	+++	++ (*)
101	++	++	+	++++	++		+++	++ (*)
120	+	=	++		++	++	++	= (*)
191	+	=	+	+	+	++	++	= (*)
225	+	=	=		+	++	+	+ (*)
281	+++	++	++		++		++	+ (*)
319	+	+	+	++	+	+++	+	= (*)
372	+++	+++	+++	++++	++++	++++	+++	++
Subgr. 5
49	+++	++	+++		+++	++++	+++	++
85	+	=	++	+	++		++	= (*)
242	++	+	++	++	++		++	=
268	++	++	++		++		+++	+
284	+++	+	++		+++	++++	+++	++
308	+	=	+	=	+	+	+	=
Subgr. 6
7	+++	+++	+++	++++	++++	++++	+++	+++
206	++++	+++	++++	++++	+++	++++	+++	++
217	++	+++	++		+	- @	++	+
226	+++	+++	+++		+++		+++	++

(*) therapy interrupted by the parents; (#) repeated episodes of manic excitment; (@) onset of severe aggressiveness against the mother.

2. Psychotic non-Down group (PnDG).

Nr. of Ss	29 Ss = 100.00 %.
Sex:	M = 16 e F = 13
	M/F = 123/100
Average age at 1^st consult (years)	7;5 +/- 3;8
Diagnosis according to DSM-III, R
Early onset PDD	19 Ss = 65.52%
Late onset PDD	3 " = 10.34%
Atypical PDD	7 " = 24,14%

Table 3: Lenght of drug therapy in the PNDG.

Subgroup	No. of Ss and %
0. Non taken	5 Ss =  17.24%
1. from 3 to 6 months	4 " = 13.79%
2. from 7 to 12 months	3 " =  10.34%
3. from 13 to 24 months	6 " =  20.69%
4. from 25 to 36 months	2 " =   6.90%
5. from 37 to 60 months	5 " =  17.24%
6. from 61 to 84 months	4 " = 13.79%
Totals	29 Ss = 100.00 %

Table 4: results; keys: (-) worsening; (=) null; (+) slight improvement; (++) marked improvement; (+++) very marked improvement; (++++) normalized behaviour.

Order nr.	Isolat.	Linguage	Stereotip.	Sameness	Mood	Self-aggr.	Soc. bhv.	Learn. bhv.
Subgr.. 1
F	+	+	=	+	+	=	+	=
M	=	=	+		+		*	=
F	+	++	+		+	++	+	=
M	=	=	+	=	+	++	=	=
Sottogr.2
M	++	+	++	+	++	++	++	+ (*)
M	++	++	+		++		+	+
M	++	=	+		++		++	+
Sottogr. 3
F (#)	+	-	-		++	++++@	-	(*)
F	++	=	++		++		++	+ (*)
M	+	++	++	++	++	++	++	+
F	++	=	+		++	+++	++	+ (*)
F	++	++	+	+++	++	++++	++	=
M	++	+	++	+++	++	++++	++	+
Sottogr.4
M	+++	++++	+++		+++		+++	++
M	++	+	++	++	++		++	+
Sottogr. 5
M	++	++	++		+	++	++	= (*)
M	+++	+++	++++	+++	+++		+++	=
F	+	+	++		++	+	+	=
F	++++	++++	++++		++++		++++	+++
F	+	=	=		+	=	+	+ (*)
Sottogr. 6
M	++	=	+++		+++		++	+
M	++++	++++	+++	++++	++++	++++	++++	+++
F	+++	+++	++++	++++	+++		++++	+++
F	+++	+	+++	++++	++++		+++	+

(*) therapy interrupted; (#) Rett's Syndrome (diagnosis made during the drug therapy); (@) it could be an outcome of the motory regression.

Table 5: comparison of the lenghts of the therapies

Field investigated	PDG / Ss nr.	%	PnDG / Ss nr.	%	% Diff.
0. Non started	8	18.18	5	17.24	- 0.94
1. from 3 to 6 months	3	8.28	4	13.79	+ 6.97
2. from 7 to 12 months	5	11.36	3	10.34	- 1.02
3. from 13 to 24 months	10	22.73	6	20.69	- 2.04
4. from 25 to 36 months	8	18.18	2	6.90	-11.20
5. from 37 to 60 months	6<