Purpose of review: Treatment of children who develop schizophrenia in childhood and early adolescence presents unique considerations. There has been increasing attention to the importance of early intervention and whether treatment effects may be affected by brain development.
Recent findings: Several recent trials support the use of antipsychotics for treatment of schizophrenia in children and adolescents. Clozapine shows greater efficacy in children and adolescents than it has in adults. A large-scale trial comparing a first-generation antipsychotic (molindone) with newer agents did not find significant differences in treatment response, although the newer antipsychotics were associated with more severe weight gain. Data regarding effects of antipsychotics on brain development in children and young adolescents with schizophrenia are sparse, although one report found no difference between effects of clozapine and olanzapine on cortical thickness.
Summary: Although psychosocial interventions are an important adjunctive treatment, antipsychotic medications continue to be the mainstay of treatment. Careful monitoring of metabolic side effects and age-appropriate intervention is particularly important, as children and adolescents appear to be more likely to develop metabolic abnormalities such as pronounced weight gain, which may significantly impact adherence as well as lead to other health issues.