Pediatric Drugs

, Volume 13, Issue 5, pp 291–302 | Cite as

Clinical Usefulness of Second-Generation Antipsychotics in Treating Children and Adolescents Diagnosed with Bipolar or Schizophrenic Disorders

Review Article

Abstract

The onset of severe, chronic or recurrent psychiatric illnesses, such as schizophrenia-spectrum and bipolar disorders, is a dramatic clinical event often detectable during adolescence and even in childhood. At any age, pharmacotherapy, along with enhancement of social skills and family support, is the mainstay for the management of such disorders. The aim of this review is to critically analyze findings from randomized controlled trials (RCTs) that have investigated the clinical utility of second-generation antipsychotics (SGAs) for the treatment of early-onset schizophrenia and bipolar disorders. Eighteen studies were considered, all of which were unfortunately impaired by methodologic limitations, such as the paucity of long-term data and lack of a three-arm comparison (SGA vs SGA vs placebo).

Nevertheless, the results of this review allow us to suggest the effectiveness of three SGAs (aripiprazole, olanzapine, and risperidone) in the short-term treatment of both early-onset schizophrenia and bipolar mania, although such agents show different safety profiles. The use of clozapine should be strictly limited to patients with non-affective, psychotic symptoms who do not respond to any of these three SGAs. In contrast, the use of quetiapine and ziprasidone in young patients with either affective or non-affective psychosis is not yet supported by evidence-based information.

Given our findings, further studies are urgently required to identify the best treatment option(s) for pediatric bipolar disorder (especially the depressive phase) and the long-term management of early-onset schizophrenia.

Notes

Acknowledgements

Dr Gentile has received speakers’ bureau/consultant honoraria from Almirall, Boehringer Ingelheim, and Eli Lilly Italia SpA. During the last 5 years, Dr Gentile has also received travel funds from Almirall, Bristol-Myers Squibb, Eli Lilly, Lundbeck, and Novartis. He has no potential conflicts of interest that are directly related to the subject of this review. No financial support for the study has been received.

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Authors and Affiliations

  1. 1.Department of Mental HealthASL Salerno, Mental Health Center Cava de’ TirreniCava de’ Tirreni, SalernoItaly

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