Evidence on the efficacy and safety of atypical
antipsychotics in children and adolescents with
schizophrenia is limited. The purpose of this review is to assess the published data on the use of atypical
antipsychotics in children and adolescents with
schizophrenia alone and with comorbid disorders, and to establish benefit-risk guidelines for clinicians.Risperidone,
olanzapine and
clozapine were found to be effective in the treatment of aggression and
mania.
Risperidone, and possibly also
olanzapine, may be the drugs of choice in children with comorbid
tic disorders.
Ziprasidone has some monoamine reuptake inhibition properties and may be administered as an augmenting agent in children and adolescents with
schizophrenia and comorbid anxiety and
mood disorders. Compared with the typical
antipsychotics, the atypical drugs seem to be more effective, better tolerated and lead to better patient adherence. Importantly, the atypical
antipsychotics have a lower propensity to induce extrapyramidal symptoms and a potential (shown so far only in adults) to improve cognitive function and inhibit suicidal behaviour (especially
clozapine). Yet, the adverse effects associated with these agents, especially
weight gain, which may also have long-term effects, can lead to non-compliance in the young population. In children and adolescents receiving
clozapine,
olanzapine and
quetiapine (but not
ziprasidone, which does not have a pro-appetite effect), particularly those with
obesity or a family history of
diabetes mellitus, fasting
blood glucose and
lipid levels must be monitored frequently.
Weight gain might be better controlled when the children and their parents are properly informed about this adverse effect and diet is regulated. Another major disadvantage of the atypical
antipsychotics, especially
risperidone, is their association with
hyperprolactinaemia, which can lead to
hypogonadism-induced
osteoporosis, galactorrhoea, gynaecomastia,
irregular menstruation and sexual dysfunction, all seen also with typical
antipsychotics. Other atypical
antipsychotics, namely
olanzapine and
ziprasidone, have been reported to be
prolactin sparing in adults, but may not be completely devoid of hyperprolactinaemic effects in children and adolescents. Thus,
prolactin levels should be assessed routinely in young patients treated with atypical
antipsychotics. Further, children and adolescents with
hyperprolactinaemia-related effects should be switched to a
prolactin-sparing agent, such as
quetiapine. All atypical
antipsychotics may induce sedation and they are not devoid of extrapyramidal symptoms (especially
risperidone). The use of typical
antipsychotics has been limited to patients who are resistant to atypical
antipsychotics, intolerant to their adverse effects, or require
injections or
depot preparations. Further double-blind, placebo-controlled trials and long-term safety assessments are needed before definitive conclusions can be reached about the place of atypical
antipsychotics in the therapeutic armamentarium of
childhood-onset schizophrenia.