Very Early Use of Clozapine in a Case of Very Early-Onset Schizophrenia

ABSTRACT Schizophrenia is a chronic disorder that affects 1% of the population and causes serious impairment in functioning. If symptoms associated with schizophrenia begin before the age of eighteen, it is called early-onset schizophrenia (EOS), and if it starts before the age of thirteen, it is called very early-onset schizophrenia (VEOS). Although there are many studies on the prevalence and risk factors of schizophrenia in the adult population, there are not enough studies yet on VEOS. Although the number of studies on this topic is limited, it is known that these cases have a more severe course than adult-onset schizophrenia. In very early-onset schizophrenia, it has been determined that the loss of gray matter continues from the onset of the disease, which accelerates during adolescence. Early diagnosis of cases and early initiation of treatment are critical, as neurocognitive deterioration is more rapid and severe. Also, treatment resistance is not uncommon. Considering its side effects, the use of clozapine, which we do not prefer to use in the pediatric population, should be considered in these cases. In this paper, we will present the successful management of a 10-year-old boy with schizophrenia using clozapine. The patient was brought to our clinic by his family. His symptoms were persecutory delusions, grandiose delusions, self-talk, disorganized behaviors, decreased communication, negativism, and agitation. He was hardly speaking to his family; he could not go to school. Since schizophrenia started at a very early age in this patient, neurocognitive deterioration was rapid and severe, and the symptoms didn't improve with three previously used antipsychotics, so we switched to clozapine. There were no serious adverse events after clozapine therapy, and the patient's psychotic symptoms significantly improved. There was a significant enhancement in the patient's daily functionality. Very early-onset schizophrenia is more severe, and resistance to treatment is commonly seen. It would be useful for clinicians to keep in mind clozapine, which is not a frequently used agent in the child-adolescent population, as a treatment option in treatment-resistant VEOS cases.