Current data and approaches related to treatment of childhood-onset schizophrenia

Early onset schizophrenia is defined as the onset of psychosis before the age of 18 years and very early-onset schizophrenia is a term used for cases developing before the age of 13 years. The aim of this presentation is to review the recent studies related to treatment of childhood-onset schizophrenia. A computerized-aided literature search was performed in PubMed database for recent studies that assessed the effectiveness, safety and tolerability of first-generation and second- and third-generation antipsychotics in children and adolescents with schizophrenia. The main treatment modality in schizophrenia is pharmacological in both children and adults. Antipsychotic drugs are the first-line of treatment and atypical antipsychotics should be preferred to typical antipsychotics as they show at least the same efficacy and a better tolerability in childhood-onset schizophrenia. Recent randomized controlled trials have shown the efficacy of some atypical antipsychotics in childhood-onset schizophrenia. As a result, aripiprazole, olanzapine, quetiapine, paliperidone and risperidone have received formal indications for the treatment of schizophrenia between the ages of 13-17 years. The pediatric use of atypical antipsychotic drugs has increased considerably over the past decade. Risperidone was the most often prescribed atypical antipsychotic in a naturalistic longitudinal study of early-onset first psychotic episodes in children and adolescents, followed by quetiapine and olanzapine. Clozapine, which is the prototype of the atypical antipsychotic class, is reserved for cases unresponsive or intolerant of other antipsychotics because of the risk of serious side effects. Risperidone is associated with a higher frequency of extrapyramidal symptoms than other antipsychotics, while olanzapine is associated with marked weight gain. Hyperprolactinemia and QTc interval prolongation are the other side effects that raise concern for the clinical use of antipsychotics in children and adolescents. Early detection and treatment of childhood-onset schizophrenia may improve outcomes of the disorder. Current data provides evidence for the effectiveness and safety of atypical antipsychotic use in children and adolescents with schizophrenia. Although atypical antipsychotics are associated with a lower risk of extrapyramidal symptoms, metabolic abnormalities such as weight gain, hyperglycemia and dyslipidemia require careful monitoring in children and adolescents. Antipsychotic drugs may also differ with regard to their pharmacokinetics, which should be kept in mind for improving utilization of these drugs in children and adolescents.