Antipsychotics for Treatment of Adolescent Onset Schizophrenia: a Review

Schizophrenia is a leading cause of disease burden in youth and can significantly impair an adolescent’s peer and familial relationships and academic functioning. Therefore, safe and effective treatments are needed. This article reviews the pharmacological treatment of adolescents with schizophrenia, when possible, with a focus on the past five years of research. There are relatively few randomized controlled trials (RCTs) and head-to-head trials informing selection of a medication in pediatric schizophrenia. However, recent literature focusing on the efficacy and tolerability of atypical antipsychotics has led to the Food and Drug Administration (FDA) approval of multiple agents, specifically risperidone, olanzapine, quetiapine, aripiprazole, paliperidone, and lurasidone, for the treatment of pediatric schizophrenia. Asenapine has also been studied in a large RCT within the past five years, but participants randomized to asenapine treatment did not do statistically significantly better than those assigned to receive placebo. Comparison RCTs on clozapine have indicated benefit in treatment-resistant pediatric schizophrenia, but at the cost of significant side effect burden. Common adverse events with atypical antipsychotics include weight gain, akathisia, hyperprolactinemia, and somnolence. Atypical antipsychotics remain first-line treatment for children and adolescents with early onset schizophrenia. However, further study is required to develop more effective and better tolerated treatment options, and in addition to pharmacologic management, current guidelines recommend combination treatment with psychotherapy and psychoeducation.