Use of Antipsychotic Drugs for Psychotic Disorders in Children

Purpose of review: This review aims to provide evidence-based guidance regarding the use of antipsychotic medications for treatment of children and adolescents with psychotic disorders. Research findings from the past 3 years are emphasized. Recent findings: A number of studies have demonstrated the efficacy of antipsychotic medications for use in children and/or adolescents with psychotic disorders, but there is also high potential for significant side effects. Atypical antipsychotic drugs are often preferred instead of typical antipsychotics due to reduced risk of extrapyramidal symptoms, but the risk for weight gain and metabolic side effects is a particular concern with atypical antipsychotic drugs. Several antipsychotics are now FDA approved for the treatment of schizophrenia in the pediatric population, including the atypical antipsychotics aripiprazole, lurasidone, olanzapine, paliperidone, quetiapine, and risperidone. Although clozapine is not FDA approved for use in the pediatric population, and children may be more susceptible to serious side effects from this medication, studies have demonstrated its efficacy in treating early-onset schizophrenia. A recently reported rare but potentially serious side effect of the third-generation antipsychotic aripiprazole is new-onset impulse control symptoms (such as compulsive gambling and sexual urges), but there is not enough information available to show whether this particular adverse event is as common in children as in adults. Summary: Although the use of antipsychotic drugs is appropriate to control symptoms of early-onset primary psychotic disorders, the potential for medically significant side effects from these drugs warrants a need for careful diagnostic evaluation prior to starting antipsychotics in children, followed by careful monitoring and management of adverse events that may occur during treatment. Further research is needed to determine the relative efficacy of treatment options, investigate the value of polypharmacy, and develop methods of preventing and managing adverse effects.