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Antipsychotics for Treatment of Adolescent Onset Schizophrenia: a Review

Abstract

Purpose of Review

Schizophrenia is a leading cause of disease burden in youth and can significantly impair an adolescent’s peer and familial relationships and academic functioning. Therefore, safe and effective treatments are needed. This article reviews the pharmacological treatment of adolescents with schizophrenia, when possible, with a focus on the past five years of research.

Recent Findings

There are relatively few randomized controlled trials (RCTs) and head-to-head trials informing selection of a medication in pediatric schizophrenia. However, recent literature focusing on the efficacy and tolerability of atypical antipsychotics has led to the Food and Drug Administration (FDA) approval of multiple agents, specifically risperidone, olanzapine, quetiapine, aripiprazole, paliperidone, and lurasidone, for the treatment of pediatric schizophrenia. Asenapine has also been studied in a large RCT within the past five years, but participants randomized to asenapine treatment did not do statistically significantly better than those assigned to receive placebo. Comparison RCTs on clozapine have indicated benefit in treatment-resistant pediatric schizophrenia, but at the cost of significant side effect burden. Common adverse events with atypical antipsychotics include weight gain, akathisia, hyperprolactinemia, and somnolence.

Summary

Atypical antipsychotics remain first-line treatment for children and adolescents with early onset schizophrenia. However, further study is required to develop more effective and better tolerated treatment options, and in addition to pharmacologic management, current guidelines recommend combination treatment with psychotherapy and psychoeducation.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Author information

Correspondence to Nadia Zaim MD.

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Conflict of Interest

Dr. Nadia Zaim declares that she has no conflict of interest.

Dr. Amanda Sun declares that she has no conflict of interest.

Dr. Findling is a consultant for Acadia, receives grants from and is a consultant for Aevi, receives grants from and is a consultant for Akili, receives grants from and is a consultant for Alcobra, receives grants from and is a consultant for Allergan, is a consultant for Amerex, has an honoraria from Am Acad CAP, receives royalties from American Psychiatric Press, is a consultant for Arbor, is a consultant for Bracket, has an honoraria from Daiichi-Sankyo, is a consultant for Epharma Solutions, receives grants from Forest, is a consultant for Genetech, is a consultant for Ironshore, is a consultant for KemPharm, is a consultant for Luminopia, receives grants from and is a consultant for Lundbeck, is a consultant for Merck, receives grants from and is a consultant for NIH, receives grants from and is a consultant for Neurim, is a consultant for Noven, is a consultant for Nuvelution, is a consultant for Otsuka, receives grants from PCORI, receives grants from Pfizer, is a consultant for Physicians Postgraduate Press, is a consultant for Purinix, is a consultant for Receptor Life Sciences, receives grants from and is a consultant for Roche, receives personal fees from Sage, receives grants and is a consultant for Shire, receives grants and is a consultant for Sunovion, receives grants and is a consultant for Supernus Pharmaceuticals, receives grants from Syneurx, is a consultant for Teva, is a consultant for Touchpoint, is a consultant for Tris, and receives grants from and is a consultant for Validus, outside the submitted work.

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This article is part of the Topical Collection on Child and Adolescent Psychiatry

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Zaim, N., Findling, R.L. & Sun, A. Antipsychotics for Treatment of Adolescent Onset Schizophrenia: a Review. Curr Treat Options Psych 7, 23–38 (2020). https://doi.org/10.1007/s40501-020-00198-9

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Keywords

  • Adolescent
  • Schizophrenia
  • Treatment
  • Medication
  • Antipsychotic
  • Psychosis