Usefulness of Antipsychotics in Children and Adolescents with Schizophrenia: A Review

Compared to adult onset schizophrenia, childhood onset schizophrenia (COS) is considered to be a more severe form of the disorder and recent evidence suggests that early detection and treatment can lead to improvement in the outcome of COS. The mainstay of treatment of COS is antipsychotic medications. This article reviews the data with respect to usefulness of various typical antipsychotics, clozapine, risperidone, olanzapine, quetiapine and aripiprazole in the management of COS. Data suggests that there are very few studies which have used double blind randomised control design and many studies are underpowered because of the small sample size. Evidence suggests that both typical and atypical antipsychotic are efficacious in COS, and there is no evidence to suggest superiority of one antipsychotic over another. In terms of side effects, typical antipsychotic more frequently lead to extrapyramidal symptoms, while atypical antipsychotics lead to weight gain and predispose to metabolic syndrome. There is some data to suggest that clozapine is superior in treatment refractory cases. Data on long term efficacy and safety of antipsychotics in COS has only recently accrued and suggest that atypical antipsychotics are useful for maintaining symptom control.