Thursday, 14 November 2013

Atypical antipsychotic medications for adolescents with psychosis

Schizophrenia and other serious mental illnesses often begin in adolescence, and treatment of adolescents with psychosis usually involves use of antipsychotic drugs. Newer drugs (atypical antipsychotics) are more popular than older ones (typical antipsychotics). However, this determination is based on the generalisation of adult treatment to a younger age group, with evidence from studies on adults generally guiding the treatment of adolescents. Adolescents may respond differently to medication compared with adults. This review looks at evidence derived from trials in which the participants are adolescents receiving atypical or typical antipsychotics or a placebo (dummy treatment) and/or high or low doses of medication. A total of 13 trials consisting of 1112 people between 13 and 18 years of age are included. Most studies were short‐term trials (completed within 12 weeks). In the main, no convincing evidence shows that newer drugs (atypical antipsychotics) are better than older ones (typical antipsychotics) in terms of their ability to treat the symptoms of psychosis. However, newer drugs may be more acceptable for young people to take because they produce fewer side effects in the short term. Furthermore, very little evidence is available to support the superiority of one atypical antipsychotic over another atypical antipsychotic. The nature of side effects also differs markedly between medications. For example, treatment with olanzapine, risperidone and clozapine is associated with weight gain, but aripiprazole is not associated with weight gain. Some evidence indicates that adolescents respond better to standard‐dose as opposed to lower‐dose risperidone. However, for aripiprazole and ziprasidone, a lower dose and a standard dose may be equally effective. Longer, clearer and more detailed research trials that use systematic ways of reporting and comparing the side effects of different antipsychotic drugs are much needed. So too is a research focus on other important outcomes such as hospital admission, service use, costs, behaviour change and possible improvements in people’s thinking. Until such research is completed, very little evidence suggests that newer drugs (atypical antipsychotics) are better than older drugs (typical antipsychotics) for the treatment of adolescents with schizophrenia.

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