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Use of atypical antipsychotics in children and adolescents
Evidence on the efficacy and safety of with schizophrenia is limited. Toren et al. (2004) reviewed the literature on use of atypical antipsychotics in children and adolescents with schizophrenia. The major findings were:
Risperidone, and possibly also olanzapine, may be the drugs of choice in children with comorbid tic disorders.
Ziprasidone may be administered as an augmenting agent in children and adolescents with schizophrenia and comorbid anxiety and mood disorders.
Risperidone, olanzapine and clozapine are effective in the treatment of aggression and mania.
In children and adolescents receiving clozapine, olanzapine and quetiapine, 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.
Hyperprolactinaemia is another major disadvantage of the atypical antipsychotics, especially risperidone. Hyperprolactinaemia can lead to hypogonadism-induced osteoporosis, galactorrhoea, gynaecomastia, irregular menstruation and sexual dysfunction. 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.
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.
Ref: - Toren, P., Ratner, S., Laor, N. & Weizman, A. (2004) Benefit-risk assessment of atypical antipsychotics in the treatment of schizophrenia and comorbid disorders in children and adolescents. Drug Safety, 27, 14, 1135-1156. Sex Into Your 60s? It's the Norm, Study Says
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