Medications for childhood and early-onset schizophrenia

What is childhood and early-onset schizophrenia?

Childhood-onset schizophrenia is defined as schizophrenia with onset prior to the age of 13 years, and early-onset schizophrenia describes schizophrenia onset between the ages of 13 and 17 years.

What is the evidence for pharmaceutical treatments for childhood and early-onset schizophrenia?

Compared to first-generation antipsychotics, moderate quality evidence finds a small to medium-sized benefit of second-generation antipsychotics for global and mental state in children and adolescents with schizophrenia. There was greater improvement with standard dose than low-dose antipsychotics, although there are more side effects with standard doses.

Moderate quality evidence finds clozapine was the most effective antipsychotic and fluphenazine was the least effective antipsychotic for symptoms when compared to placebo and other antipsychotics (ziprasidone, loxapine, trifluperazine, asenapine, haloperidol, quetiapine, paliperidone, aripiprazole, risperidone, lurasidone, olanzapine, or molindone). There were few significant differences between the other antipsychotics, with only ziprasidone being less effective for symptoms than olanzapine, molindine and risperidone.

For positive symptoms in particular (e.g. hallucinations and delusions), moderate to high quality evidence finds medium-sized improvements with olanzapine, risperidone, and asenapine, and small improvements with quetiapine, aripiprazole, and paliperidone over placebo. For negative symptoms (e.g. social withdrawal), moderate to low quality evidence finds medium-sized improvements with aripiprazole, asenapine, molindone, olanzapine and risperidone over placebo.

For side effects, moderate quality evidence finds haloperidol, loxapine, risperidone and quetiapine resulted in the most extrapyramidal (movement) symptoms. Olanzapine showed the most weight gain, followed by clozapine, quetiapine, paliperidone, risperidone, asenapine and then aripiprazole. There was less weight gain with lurasidone than with olanzapine, quetiapine, risperidone, asenapine, and paliperidone. Clozapine showed the most sedation, followed by paliperidone, asenapine, loxapine, olanzapine, haloperidol, aripiprazole, and risperidone. Risperidone showed the most prolactin increase, followed by haloperidol, olanzapine, paliperidone, and quetiapine.

October 2020

Image: ©Brian Jackson – Fotolia –

Last updated at: 4:20 am, 30th August 2021
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