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
Home Page // Pagina
iniziale
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:
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 1st 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 1st 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 |
13.64 |
5 |
17.24 |
- 3.60 |
|
6. from 61 to 84 months |
4 |
9.09 |
4 |
13.79 |
+ 4.70 |
Table 6: comparison of the results" keys:
(+) = improvement (any degree), (=) = null and (-) = worsening) according to
groups and length of the therapy.
|
Group |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
|
Therapy mnts |
6 |
12 |
24 |
36 |
60 |
84 |
||||||
|
Evaluation |
+ = |
+ = |
+ = - |
+ = |
+ = - |
+ = - |
+ = |
+ = |
+ = |
+ = |
+ = - |
+ = |
|
Isolation |
1 2 |
2 2 |
4 1 0 |
3 0 |
9 1 0 |
6 0 0 |
8 0 |
2 0 |
6 0 |
5 0 |
4 0 0 |
4 0 |
|
language |
2 1 |
2 2 |
3 3 0 |
2 1 |
8 2 0 |
3 2 1 |
5 3 |
2 0 |
4 2 |
4 1 |
4 0 0 |
3 1 |
|
Stereotypies |
2 1 |
3 1 |
3 1 1 |
3 0 |
8 1 1 |
5 0 1 |
7 1 |
2 0 |
6 0 |
4 1 |
4 0 0 |
4 0 |
|
sameness |
|
1 0 |
3 0 0 |
1 0 |
3 0 0 |
3 0 0 |
5 0 |
1 0 |
3 1 |
1 0 |
2 0 0 |
3 0 |
|
mood |
2 1 |
4 0 |
5 0 0 |
3 0 |
7 1 2 |
6 0 0 |
8 0 |
2 0 |
6 0 |
5 0 |
4 0 0 |
4 0 |
|
self.aggres. |
3 0 |
2 1 |
1 0 1 |
1 0 |
4 1 2 |
5 0 0 |
6 0 |
|
3 0 |
2 1 |
2 1 0 |
1 0 |
|
social bhv. |
2 1 |
3 1 |
5 0 0 |
3 0 |
9 1 0 |
5 1 0 |
8 0 |
2 0 |
6 0 |
5 0 |
4 0 0 |
4 0 |
|
learn. bhv. |
1 0 |
0 4 |
2 0 0 |
3 0 |
7 3 0 |
4 1 0 |
5 3 |
2 0 |
3 2 |
2 3 |
4 0 0 |
4 0 |
|
% of + |
.62 |
.57 |
.76 |
.95 |
.79 |
.86 |
.88 |
1.0 |
.88 |
.82 |
.97 |
.96 |
|
% of = |
.38 |
.43 |
.18 |
.05 |
.14 |
.09 |
.12 |
0.0 |
.12 |
.18 |
0.0 |
.04 |
|
% of - |
|
|
.06 |
|
.07 |
.05 |
|
|
|
|
.03 |
|
Table 7: comparison of % positive results
when the improvement degrees are summed up [e.g.: (+++) + (+) = 4 out of 8]
according to the length of drug taking.
|
Group |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
PDG |
PnDG |
|||
|
Therapy mnts |
6 |
12 |
24 |
36 |
60 |
84 |
|||||||||
|
Isolation |
.08 |
.13 |
.20 |
.50 |
.33 |
.42 |
.47 |
.63 |
.50 |
.55 |
.75 |
.75 |
|||
|
language |
.17 |
.19 |
.35 |
.25 |
.35 |
.21 |
.31 |
.63 |
.25 |
.50 |
.75 |
.67 |
|||
|
Stereotypies |
.17 |
.19 |
.25 |
.33 |
.33 |
.33 |
.41 |
.63 |
.50 |
.60 |
.75 |
.81 |
|||
|
sameness |
|
.13 |
.33 |
.25 |
.58 |
.67 |
.70 |
.50 |
.25 |
.75 |
.75 |
1.0 |
|||
|
mood |
.17 |
.25 |
.36 |
.50 |
.20 |
.50 |
.47 |
.63 |
.54 |
.55 |
.69 |
.88 |
|||
|
self.aggres. |
.50 |
.33 |
.13 |
.50 |
.46 |
.85 |
.71 |
|
.75 |
.19 |
.67 |
1.0 |
|||
|
social bhv. |
.17 |
.19 |
.40 |
.42 |
.45 |
.42 |
.53 |
.63 |
.58 |
.55 |
.69 |
.65 |
|||
|
learn. bhv. |
.08 |
0.0 |
.15 |
.25 |
.28 |
.25 |
.25 |
.50 |
.21 |
.20 |
.50 |
.50 |
|||
|
%average |
.19 |
.18 |
.27 |
.38 |
.37 |
.46 |
.48 |
.59 |
.45 |
.49 |
.69 |
.68 |
|||
Discussion.
Bearing in mind that the therapies are
individualised, as can be seen from the case outlined in detail (Cocchi,
1990d), the statistical approach is exclusively descriptive, so much so that for
each case the clinical evaluation of the results has been reported here (Tables
2 & 4).
Besides this, another 3 cases in the PnDG
and 1 in the PDG have been reported in other papers, 3 of them have been also
evaluated by externaì observers (Bondanini, 1990; Grasso Rossetti, 1990) and
one by laboratory parameters (Cocchi, 1990b).
As for the length of the drug therapies, for
the many cases in which it was interrupted and the considerable number in which
it was never started, I can only confirm here what has already stated elsewhere
(Cocchi, 1990c).
The lack of results or the worsening of the
condition, which oæ course can exist and are reported here, are not the main
cause of this event.
The phenomenon is similar in both groups, as
regards not starting the cure, but is much more evident in the PDG for its
interruption.
It is possible, while on the subject, that
the double pathological condition of Down's syndrome and psychosis, adds to the
questionable external inflences a parental discouragement.
One child from the PDG and 3 from the PnDG
came out of their psychotic state (the absence of at least one of the 3 chief
symptoms: social isolation, language impairments, stereotypes, and a very
marked reduction of the other two or the other one).
As is evident from table 2 & 4, the
results are the outcome of therapy duration; at least 5 years in 3 cases and at
least 3 years in the remaining one.
Table 6, in which the results are indicated
along the lines of positive, null, and negative, is meant to show how already
after a brief period of cure it is possible to see some improvement in the
areas summarised, and how the number of positive results increase with the
length of drug therapy.
Table 7, which shows the percentage of
positive results evaluated taking into account the degree of improvement,
confirms in no mean terms the relationship between these positive results and
the length of therapy.
The results on the symptom
"self-aggression behaviour" also termed "self-abuse" has
already been the subject of specific research (Cocchi, 1990a).
Conclusion.
The hypothesis that it is possible to tackle
the therapy of child psychosis as a stress response _therapy which can be
improved through the use of drugs, does not seem lacking in empirical verification.
Eight years of experience in this field and
the full application of this to 2 groups of psychotic children, one of which
also affecteä by Down's syndrome, would seem to confirm its practicability, and
the poor relationship between DSM-III, R diagnosis and therapeutic results.
Since however stress responses differ from
individual to individual, and are dependent upon genetical and remote or recent
acquired factors, any therapy tryinç to act on these can be nothing else than
very personalised, according to individual variables present at the beginning
and which modify, sometimes for the worse, during the cure itself.
Aknowledgement
This research was supported by a grant
no. PSS */0201/00 of the Commission of the European Communities, Bruxelles.
References
American Pschiatric Asociation: Diagnostic
and Statistic Manual of Mental Disorders (3rd edition revised, DSM-III, R).
APA, Washington D.C., 1987.
Bondanini M.: Storia di Nicola, che cerca il
sole. Riv. It. Disturbo Intellet. 1990, 3: 95-101
Cocchi R.: Psicosi nel bambino Dowî e nel
bambino normale: analogie e differenze. Riv. It. Disturbo Intellet. 1988, 1:
89-95.
Cocchi R.: Drug therapy in self-abuse
behaviour. Proceedings of the VIIIth World Congress of Psychiatry, ICS 900,
Elsevier, Amsterdam 1990a.
Cocchi R.: Aminoacidi plasmatici in una
bambina autistica prima e dopo 7 anni di farmacoterapia. Riv. It. Disturbo
Intellet. 1990b, 3: 127-130.
Cocchi R.: The pharmacological approach to
treating childhood psychoses: Theoretical basis. It. J. Intellect. Impair.
1990c, 3: 185-193.
Cocchi R.: Autismo infantile e sordita` di
trasmissione. Si puo` supporre una relazione temporale diversa? Riv. It.
Disturbo Intellet. 1990d, 3: 313-320.
Cocchi R., Bonaduce D.: L'autoaggressivita`
nel bambino psicotico. Riv. It. Disturbo Intellet. 1988, 1: 185-191.
Grasso Rossetti A.: Il disegno della casa e
della figura umana in due soggetti psicotici trattati con farmacoterapia. Riv.
It. Disturbo Intellet. 1990, 3: 119-126.
Printed on It. J. Intellect. Impair. 1990,
3: 195-202.
Author's address: dr Renato COCCHI, via Rabbeno, 3
41100 Reggio Emilia (Italy)
renatococchi@libero.it
Italian translation // Testo in italiano
Autism
Down syndrome
Drug modulation of stress reactions
Mental retardation
Home Page // Pagina
iniziale