TEA: Tolerance and Effect of Antipsychotics in Children and Adolescents With Psychosis
Study Details
Study Description
Brief Summary
The benefits and harms of antipsychotics are relatively well studied in adults. However, there is a lack of scientifically valid studies regarding the benefits and harms of antipsychotics in children and adolescents with psychosis.
The main objective of the TEA trial is to compare the efficacy and adverse reactions of two antipsychotics (quetiapine versus aripiprazole) in children and adolescents between 12-17 years of age with psychotic symptoms on psychopathology, cognitive deficits, and daily functioning. Furthermore, the trial will focus on adverse reaction profiles of the two antipsychotics as well as early predictors of later sustained clinical effects of these antipsychotics.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
| Phase 4 |
Detailed Description
A sex and age matched healthy control group will be included to form a reference group for cognitive and somatic measures. The healthy controls will not receive any trial medication.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Aripirazole
|
Drug: Aripiprazole
pill, 2,5-20 mg/day, maximum 16 weeks
|
| Experimental: Quetiapine prolong
|
Drug: Quetiapine
pill, 50-600mg/day, maximum 16 weeks
|
Outcome Measures
Primary Outcome Measures
- Psychopathology: improvement on PANSS positive scale (PANSS 'Positive and Negative Syndrome Scale') [12 weeks]
Secondary Outcome Measures
- Psychopathology [12 weeks]
Psychopathology (other PANSS scales, DIPI, SGI-S, CGI-I,and GAPD).
- Cognition [12 weeks]
Cognition and functioning (BACS Global Score, SCoRS-DK, Schizophrenia Cognition Rating Scale, BRIEF)
- Adverse reactions [12 weeks]
Adverse reactions (UKU side effect scale, AIMS, SAS, BARS, and other adverse events)
- Suicidal ideation [12 weeks]
Suicidal ideation (K-SADS-PL, specific questions for depressive disorders (current)
- Genetic and antipsychotic laboratory tests [12 weeks]
Genetic variants affecting metabolism of antipsychotics
- Prognostic factors [12 weeks]
Prognostic factors (DUP, and PAS)
- Quality of Life [52 weeks]
Quality of Life (measured with Kidscreen)
- Stigmatization [52 weeks]
Qualitative interviews
Eligibility Criteria
Criteria
Patients - Inclusion Criteria:
-
Diagnosis: Children and adolescents with a non-organic and non-drug-induced psychosis, meeting the criteria for ICD-10 diagnoses: F20, F22-F29 and F30.2, F31.2 F31.5, F32.3 and F33.3. This is verified with a semi-structured psychopathological interview using K-SADS-PL (Kaufmann 1997) four weeks after inclusion into the trial.
-
Psychopathology: Children and adolescents with psychotic symptoms, scoring ≥ 4 on at least one of the following PANSS items: P1 (delusions), P2 (conceptual disorganisation), P3 (hallucinations), P5 (grandiosity), P6 (suspiciousness/persecution) or G9 (unusual thought content); and a total PANSS score
- The treating physician has decided to prescribe an antipsychotic compound.
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Age: 12-17 years (both inclusive).
-
Sex: Both sexes are included.
-
Previous treatment: Patients must be antipsychotic-naïve. The maximum accepted previous treatment with antipsychotic compounds is two weeks cumulatively, and during the two weeks prior to inclusion no continuous treatment and a maximum of four dosages in total can have been received.
-
Somatic illness: No somatic contraindication to planned medication, documented by standard somatic examination
-
Written informed consent.
Patients - Exclusion Criteria:
-
Compulsory treatment: Patients that are compulsorily hospitalised against their will are excluded. If their status changes to voluntary hospitalisation, patients can be included. If the patient is already included in the trial and is briefly detained, confined, or subjected to other forceful treatment according to the Danish Psychiatric Care Act ('Psykiatriloven'), both the patient and parents have to agree to remain in the trial if exclusion is to be avoided. Compulsory treatment in the form of, e.g., brief forced immobilisation or single instances of forced medication, are not causes for exclusion.
-
Diagnoses: Patients with drug-induced or organic psychosis, severe chronic somatic illness, or a history of severe head-trauma are not included. Patients that do not have psychotic symptoms but are prescribed antipsychotic treatment on the indication of, e.g., severe behavioural problems or tics are not included.
-
Pregnancy: Pregnant or lactating patients are not included (a pregnancy test is undertaken at inclusion). Female participants, that are sexually active, must use safe contraception throughout the trial period (see section 6.4)
-
Substance abuse: People with severe alcohol or drug abuse are not included. Possible abuse is monitored both by interviewing participants and by taking a urine sample at inclusion and at 4, 12 and 52 weeks follow-up (if there is suspicion of substance abuse), testing for the presence of cocaine, amphetamine, cannabis, opiates, metamfetamine (inclusive for extacy), and benzodiazepines. When severe abuse is suspected during the trial, an ad hoc urine sample is taken. Brief periods of large alcohol/cannabis intake are not a cause of exclusion from the trial; however, cognitive and other examinations are not carried out while patients are under the influence of drugs or alcohol.
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Aggravation: Patients may be excluded if there is a significant worsening of clinical state during the course of the trial (i.e., increases of 30% or more from baseline on the PANSS total score).
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Allergy and intolerance: Patients with allergy towards the investigational drugs, or is lactose intolerant are not included.
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Lack of informed consent.
Healthy volunteers - Inclusion Criteria:
-
Matching: Healthy controls (n=100) are included, in the way that they are matched to the first 100 patients included in the study (i.e., corresponding to the number of patients required in each treatment group). They will be matched according to:
-
age;
-
sex; and
-
socioeconomic status (based on a combination of parental education and income, according to criteria from the National Institute of Public Health (earlier Danish Institute of Clinical Epidemiology, DIKE)).
-
Informed consent.
Healthy volunteers - Exclusion Criteria:
-
Psychopathology: People with a previous psychotic disorder (ICD 10, F20-F29 and F30.2, F31.2, F31.5, F32.3 and F33.3) or current psychiatric disorder (multiaxial axis 1) are not included. This is verified by diagnostic screening using K-SADS-PL at eligibility assessment before inclusion into the study of healthy controls. The presence of psychotic psychiatric diagnoses in first-degree relatives is also a cause for exclusion.
-
Somatic illnesses: People with severe chronic somatic illness or a history of severe head-trauma are not included.
-
Intelligence: People with known mild mental retardation (i.e., IQ between 50-70) prior to inclusion are excluded; however, if mild mental retardation is found during the study, participants are not excluded, since they must be considered a marginal part of the normal distribution. People with moderate to severe mental retardation (i.e., IQ <
- are excluded.
-
Substance abuse: People with severe alcohol- or drug abuse are excluded. Possible abuse is monitored both by interviewing participants and by taking a urine sample at inclusion and at 4, 12 and 52 weeks follow-up (if there is suspicion of substance abuse), testing for the presence of cocaine, amphetamine, cannabis, opiates, metamfetamine (inclusive for extacy) and benzodiazepines. Brief periods of large alcohol/cannabis intake are not a cause of exclusion from the study; however, cognitive and other examinations are not carried out while participants are under the influence.
-
Lack of informed consent.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Aalborg Psychiatric Hospital | Aalborg | Denmark | 9000 | |
| 2 | Psychiatric Centre Copenhagen, Rigshospitalet | Copenhagen | Denmark | 2100 | |
| 3 | Bispebjerg Hospital | Copenhagen | Denmark | 2400 | |
| 4 | Glostrup Hospital | Glostrup | Denmark | 2600 | |
| 5 | Hillerød Hospital | Hillerød | Denmark | 3400 | |
| 6 | Odense University Hospital | Odense | Denmark | 5000 | |
| 7 | Psychiatric Hospital for Children and Adolescents, Aarhus | Risskov | Denmark | 8240 | |
| 8 | Child and Adolescent Psychiatric Department, Region Zealand | Roskilde | Denmark | 4000 | |
| 9 | Psychiatric Centre Sct. Hans | Roskilde | Denmark | 4000 |
Sponsors and Collaborators
- Anne Katrine Pagsberg
- The Psychiatric Centre for Children and Adolescents in Bispebjerg, Denmark
- Psychiatric Centre Copenhagen, Denmark
- Copenhagen Trial Unit, Center for Clinical Intervention Research
- Albert Einstein College of Medicine
- Research Institute for Biological Psychiatry, Sct. Hans Hospital, Denmark
- Capital Region Pharmacy, Denmark
- The Research Council for Health and Disease, Denmark
- Allocated inheritance from Elizabeth Stevn and Niels Rindom, Denmark
- AP Moeller Foundation
- Tryg Fonden, Denmark
Investigators
- Principal Investigator: Anne Katrine Pagsberg, MD, Ph.D., Bispebjerg Centre for Child and Adolescent Psychiatry. University of Copenhagen.
- Principal Investigator: Pia Jeppesen, MD, Ph.D., Glostrup Centre for Child and Adolescent Psychiatry. University of Copenhagen.
- Principal Investigator: Maj-Britt Lauritsen, MD, Hillerød Centre for Child and Adolescent Psychiatry.
- Principal Investigator: Per Hove-Thomsen, Professor, MD, D.M.Sci., Psychiatric Hospital for Children and Adolescents, Aarhus University Hospital.
- Principal Investigator: Marlene Briciet Lauritsen, MD., Child- and Adolescent Psychiatric Department, Aalborg.
- Principal Investigator: Niels Bilenberg, Professor, MD., Child and Adolescent Psychiatric Department, University of Southern Denmark, Odense
- Principal Investigator: Thomas Werge, Professor, Ph.D., Research Institute for Biological Psychiatry, Sct. Hans Hospital, Roskilde.
- Principal Investigator: Anders Fink-Jensen, MD, professor, DMSci., Psychiatric Centre Copenhagen. University of Copenhagen.
- Principal Investigator: Jesper Pedersen, MD., Psychiatric Hospital for Children and Adolescent; Region Zeeland
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- TEAprotocolversion5-11 03 2010
- 2009-016715-38