Case report of S-ketamine as treatment option for suicidal ideation and treatment-resistant depression in adolescents with early-onset psychosis.

IF 1.9 Q4 PSYCHIATRY

NEUROPSYCHIATRIE Pub Date : 2026-08-25 DOI:10.1007/s40211-026-00587-1

Nicolas Schmelzle, Katrin Neubacher, Paul L Plener, Christian Scharinger

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Abstract

Background: Depressive symptoms and suicidality are highly prevalent in adolescents with early-onset psychosis (EOP) and often remain refractory to standard treatment. While S‑ketamine is an established treatment for treatment-resistant depression in adults (TRD), its use in primary psychotic disorders remains scarce due to risk of exacerbation of psychotic symptoms.

Case presentation: We present the case of a 16-year-old male with schizophrenia (ICD-10: F20.9) and chronic suicidality. Despite achieving remission of positive symptoms with amisulpride, severe depressive symptoms including suicidality persisted. Following the initiation of off-label intranasal S‑ketamine (titrated to 84 mg) at age 17 and 11 months, the patient showed a rapid clinical response. The Montgomery-Åsberg Depression Rating Scale (MADRS) score decreased by 50% within 3 weeks, accompanied by a significant reduction in the Positive and Negative Syndrome Scale (PANSS)-positive symptoms subscale score (from 22 to 10) and the PANSS-negative symptoms subscale score (from 33 to 17). Notably, no exacerbation of remitted positive symptoms occurred, and sustained functional recovery was achieved.

Conclusion: This case suggests that intranasal S‑ketamine may be a safe and effective augmentation strategy for TRD and suicidality in stable adolescent early-onset psychosis, highlighting the need for further research in this high-risk population.

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s -氯胺酮治疗早发性精神病青少年自杀意念和难治性抑郁的病例报告。

背景：抑郁症状和自杀倾向在早发性精神病（EOP）的青少年中非常普遍，并且通常对标准治疗仍然难治。虽然S -氯胺酮是成人难治性抑郁症（TRD）的既定治疗方法，但由于存在精神病症状恶化的风险，其在原发性精神障碍中的应用仍然很少。病例介绍：我们提出的情况下，16岁的男性精神分裂症（ICD-10: F20.9）和慢性自杀。尽管使用氨硫傲可以缓解阳性症状，但包括自杀倾向在内的严重抑郁症状持续存在。在患者17个月和11个月时开始使用标签外鼻内S -氯胺酮（滴定至84 mg）后，患者表现出快速的临床反应。Montgomery-Åsberg抑郁评定量表（MADRS）得分在3周内下降了50%，同时阳性和阴性综合征量表（PANSS）阳性症状亚量表得分（从22降至10）和PANSS阴性症状亚量表得分（从33降至17）显著下降。值得注意的是，已缓解的阳性症状没有恶化，并且实现了持续的功能恢复。结论：本病例提示，S -氯胺酮鼻注可能是稳定型青少年早发性精神病患者TRD和自杀的一种安全有效的增强策略，需要在这一高危人群中进行进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

NEUROPSYCHIATRIE PSYCHIATRY-

CiteScore

3.80

自引率

20.00%

发文量

期刊介绍： Die Zeitschrift ist das offizielle Organ der „Österreichischen Gesellschaft für Psychiatrie, Psychotherapie und Psychosomatik (ÖGPP)'', und wissenschaftliches Organ der Österreichischen Alzheimer Gesellschaft, der Österreichischen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, der Österreichischen Schizophreniegesellschaft, und der pro mente austria - Österreichischer Dachverband der Vereine und Gesellschaften für psychische und soziale Gesundheit.Sie veröffentlicht Übersichten zu relevanten Themen des Fachs, Originalarbeiten, Kasuistiken sowie Briefe an die Herausgeber. Zudem wird auch Buchbesprechungen sowie Neuigkeiten aus den Bereichen Personalia, Standes- und Berufspolitik sowie Kongressankündigungen Raum gewidmet.Thematisch ist das Fach Psychiatrie und die Methoden der Psychotherapie in allen ihren Facetten vertreten. Die Zeitschrift richtet sich somit an alle Berufsgruppen, die sich mit Ursachen, Erscheinungsformen und Behandlungsmöglichkeiten von psychischen Störungen beschäftigen. -----------------------------------------------------------------------------------------------------· The professional and educational journal of the Austrian Society of Psychiatry, Psychotherapy and Psychosomatics (Österreichische Gesellschaft für Psychiatrie, Psychotherapie und Psychosomatik; ÖGPP) and the Austrian Society of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (Österreichische Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie; ÖGKJP)· Overviews of all relevant topics pertaining to the discipline· Intended for all occupational groups committed to the causes and manifestations of, as well as therapy options for psychic disorders· All manuscripts principally pass through a double-blind peer review process involving at least two independent expertsThe official journal of the Austrian Societies of Psychiatry, Psychotherapy and Psychosomatics (ÖGPP) and Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP)The journal publishes overviews of relevant issues in the field, original work, case reports and letters to the editors. In addition, space is devoted to book reviews, news from the areas of personnel matters and professional policies, and conference announcements.Thematically, the discipline of psychiatry and the methods of psychotherapy are represented in all their facets. The journal is thus aimed at all professional groups committed to the causes and manifestations of, as well as therapy options for psychic disorders