What is known about research on antipsychotic medications and clozapine for schizophrenia in children and adolescents?

With regard to children, few research trials of antipsychotics have been done with children who have schizophrenia. There has been a review of the research literature regarding the efficacy and safety of antipsychotic medications in the treatment of children and adolescents with schizophrenia (Kumra et al, Schizophrenia Bulletin 2008). This found that antipsychotic medications were consistently effective for psychotic symptoms. And, clozapine has been shown to be superior to haloperidol and olanzapine. Schizophrenia starting before age 18 represents a more severe illness with significant functional impairment and worse response to the usual antipsychotic medications. Research in this area supports clozapine use (Meyer and Stahl, Cambridge University Press 2019). There are not unique safety concerns with clozapine in youth (vs. adults), except for children under 12, for whom some akathisia has been seen. Weight gain is a greater problem in youth taking antipsychotic medication, though that is not specific to clozapine. There is limited research on the comparative effectiveness of other antipsychotic medications, and a Cochrane review did not find evidence for a difference between first and second generation medications in adolescents (Kumar 2013). Side-effects are more common in youth, including extrapyramidal side-effects, sedation, prolactin elevation and weight gain. In 2009, an FDA advisory panel recommended approval of olanzapine and quetiapine for treatment of childhood psychotic disorders. Aripiprazole was approved for treatment of schizophrenia in adolescents in 2008. In older adolescents, psychotic syndromes begin to resemble those seen in adults and may be treated in a similar manner (Schatzberg and DeBattista, APA Publishing 2015).

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