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31.16  Adolescent Substance Abuse

behavioral and remediation interventions combined with phar- macotherapy are likely to be the most effective approach to early-onset schizophrenia. R eferences Bechdolf A, Wagner M, Ruhrmann S, Harrigan S, Putzfild V, Pukrop R, et al. Pre- venting progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry. 2012;200:22–29. Biswas P, Malhotra S, Malhotra A, Gupta N. Comparative study of neuropsycho- logical correlates in schizophrenia with childhood onset, adolescence and adult- hood. Eur Child Adolesc Psychiatry. 2006;15:360. Clark C, Narr KL, O’Neill J, Levitt J, Siddarth P, Phillips O, Toga A, Caplan R. White matter integrity, language, and childhood onset schizophrenia. Schizo- phrenia Res. 2012;138:150–156. Correll CU. Symptomatic presentation and initial treatment for schizophrenia in children and adolescents. J Clin Psychiatry. 2010;71:11. David CN, Greenstein D, Clasen L, Gochman P, Miller R, Tossell JW, Mattai AA, Gogtay N, Rapoport JL. Childhood onset schizophrenia: High rate of visual hal- lucinations. J Am Acad Child Adolesc Psychiatry. 2011;50:681–686. Fagerlund B, Pagsberg AK, Hemmingsen RP. Cognitive deficits and levels of IQ in adolescent onset schizophrenia and other psychotic disorders. Schizophr Res. 2006;85(1–3):30. Findling RL, Johnson JL, McCLellan J, et al. Double-blind maintenance safety and effectiveness findings from the treatment of Early- Onset Schizophrenia Spectrum Disorders (TEOSS) study. J Am Acad Child Adolesc Psychiatry. 2010;49:583–594. Findling Rl, Robb A, Nyilas M, et al. A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia. Am J Psychiatry. 2008;165:1432–1441. Frazier JA, Giuliano AJ, Hohnson JL, Yakutis L, Youngstrom EA, Breiger D, Sikich A, et al. Neurocognitive outcomes in the Treatment of Early-Onset Schizophrenia Spectrum Disorders study. J Am Acad Child Adolesc Psychiatry, 2012;51:496–505. Gentile S. Clinical usefulness of second-generation antipsychotics in treating chil- dren and adolescents diagnosed with bipolar or schizophrenic disorders. Pediatr Drugs. 2011;13:291–302. Haas M, Unis AS, Armenteros J, et al. A 6-week randomized double-blind pla- cebo-controlled study of the efficacy and safety of risperidone in adolescents with schizophrenia. J Child Adolesc Psychopharmacol. 2009;19:611–621. Haas M, Eerdekens M, Kushner SF, et al. Efficacy, safety and tolerability of two risperidone dosing regimens in adolescent schizophrenia: A double-blind study. Br J Psychiatry. 2009;194:158–164. Jacquet H, Rapoport JL, Hecketsweiler B, Bobb A, Thibaut F, Frebourg T, Cam- pion D. Hyperprolinemia is not associated with childhood onset schizophrenia. Am J Med Genet B Neuropsychiatr Genet. 2006;141:192. Kryshanovskaya L, Schulz C, McDougle C et al. Olanzapine versus placebo in adolescents with schizophrenia: a 6-week, randomized, double-blind, placebo- controlled trial. J Am Acad Child Adolesc Psychiatry. 2009;48:60–70. Kumra S, Kranzler H, Gerbine-Rosen G, Kester H,M, De Thomas C, Kafantaris V, Correll C, Kane J. Clozapine and ‘high-dose’ olanzapine in refractory early- onset schizophrenia: A 12-week randomized and double-blind comparison. Biol Psychiatry. 2008;63:524–529. Sikich L. Early onset psychotic disorders. In: Sadock BJ, Sadock VA, Ruiz P, eds. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 9 th ed. Vol. 2. Phila- delphia: Lippincott Williams & Wilkins; 2009:3699. McGurk SR, Twamlety EW, Sitezer DL, McHugo JG, Mueser KT. A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry. 2007;164:1791– 1802. Peterson L, Heppesen P, Thorup A, Abel M, Ohlenschlaeger J, Christenson T, et al. A randomised multicentre trial of integrated verus standard treatment of patients with a first episode of psychotic illness. BMJ. 2005;331:602. Rapoport JL, Gogtay N. Childhood onset schizophrenia: Support for a progressive neurodevelopmental disorder. Int J Dev Neurosci. 2011;29:251–258. Remschmidt J, Theisen FM. Early-onset schizophrenia. Neuropsychobiology. 2012;66:63–69. Schimmelmann BG, Schmidt AJ, Carbon M, Correll CU. Treatment of adoles- cents with early-onset schizophrenia spectrum disorders: In search of a rational, evidence-informed approach. Curr Opin Psychiatry. 2013;26:219–230. Seal JL, Gornick MC, Gotgay N, Shaw P, Greenstein DK, Coffee M, Gochman PA, Stromberg T, Chen Z, Merriman B, Nelson SF, Brooks J, Arepalli S, Wavrant- De Vrieze F, Hardy J, Rapoport JL, Addington AM. Segmental uniparental isodisomy on 5q32-qter in a patient with childhood-onset schizophrenia. J Med Genet. 2006;43(11):887–892. Shaw P, Sporn A, Gogtay N, et al. Childhood onset schizophrenia: a double-blind clozapine-olanzapine comparison. Arch Gen Psychiatry. 2006;63:721–730. Sikich L, Frazier JA, McClellan J, Findling RL, Vitiello B, Ritz L, Ambler D, et al. 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Starling J, Williams LM, Hainsworth C, Harris AW. The presentation of early- onset psychotic disorders. Aust N Z J Psychiatry. 2013;47:43–50 Vyas NS, Gogtay N. Treatment of early onset of schizophrenia: Recent trends, challenges and future considerations. Front Psychiatry. 2012;3:1–5. Vyas NS, Patel NH, Puri BK. Neurobiology and phenotypic expression in early- onset schizophrenia. Early Interv Psychiatry. 2011;5:3–14.

▲▲ 31.16 Adolescent

Substance Abuse Substance use is a public health concern among American youth. The most common substances used by adolescents in the United States are tobacco, alcohol, and marijuana. Adolescent substance use and abuse, however, includes a wider range of substances, including cocaine, heroin, inhalants, phencyclidine (PCP), lysergic acid diethylamide (LSD), dextromorphan, ana- bolic steroids and various club drugs, 3,4-methylenedioxymeth- amphetamine (MDMA or Ecstasy), flunitrazepam (Rohypnol), gamma-hydroxybutyrate (GHB), and ketamine (Ketalar). It is estimated that approximately 20 percent of 8 th graders in the United States have tried illicit drugs and about 30 percent of 10 th through 12 th graders have used an illicit substance. Alco- hol remains the most common substance used and abused by adolescents. Binge drinking occurs in about 6 percent of adoles- cents, and teens with alcohol use disorders are at greater risk of problems with other substances as well. The American Psychiatric Association’s Diagnostic and Sta- tistical Manual of Mental Disorders, Fifth Edition (DSM-5), in contrast to the previous Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV- TR), does not separate the diagnoses of substance abuse from substance dependence. Instead, the DSM-5 provides criteria for substance use disorder, accompanied by criteria for intoxica- tion, withdrawal, and substance-induced disorders. The previ- ous DSM-IV-TR criterion of recurrent substance-related legal problems has been deleted in the DSM-5, and a new criterion, craving, or a strong desire or urge to use a substance, has been added. In the DSM-5, a threshold of two or more criteria must be present. Cannabis withdrawal and caffeine withdrawal are new disorders in the DSM-5. The combined substance use criteria including both abuse and withdrawal phenomena may strengthen the validity of the disorder in adolescents, and the elimination of the criterion for “legal problems” is also an appropriate change for adolescents, since this is less common for younger adolescents and for adolescent females who use substances. Two recent commentaries raise concerns regarding the application of DSM-5 criteria to adolescents with respect to the symptom of tolerance, particularly to alcohol, that may occur across the board, and may be developmentally normal for adolescents who use alcohol but for whom there is no clinical impairment, and for withdrawal symptoms, which may have clinical significance but is only moderately associated with level of severity of substance use. Many risk and protective factors influence the age of onset and severity of substance use among adolescents. Psychosocial risk factors mediating the development of substance use disor- ders include parent modeling of substance use, family conflict, lack of parental supervision, peer relationships, and individual