Antipsychotic Use in Children

In recent months, the use of antipsychotic medications in children and adolescents has been debated largely because these agents are increasingly being used in youth for non-psychotic disorders and off-label indications. In addition, there has been disagreement about the validity of certain childhood diagnoses. For example, bipolar disorder data suggest that there may be a lack of psychosocial interventions for disruptive and aggressive spectrum disorders, even if antipsychotic treatment is prescribed. Furthermore, there has been concern surrounding the adverse effects related to antipsychotic use. These effects may be more severe and have long-term health implications when they occur during early human development. “A careful risk-benefit evaluation is necessary before deciding to initiate and to maintain antipsychotic treatment in younger patients.” Even though the debate over use of antipsychotic medications in younger patients continues, there has been an increase in the available controlled efficacy database for antipsychotics for schizophrenia, bipolar mania, and autistic disorder. In turn, this has led to FDA approval of four of the most prescribed atypical antipsychotics in youth. Aripiprazole, olanzapine, quetiapine, and risperidone have FDA-approved pediatric indications for bipolar mania and for schizophrenia. Aripiprazole and risperidone are also indicated for irritability and aggression associated with autistic disorder, and we now have controlled trial data for disruptive behavior disorders (mostly with risperidone) and tic disorders. Assessing Tolerability Studies comparing antipsychotic adverse effect rates in children and adolescents with those in similar adult studies have indicated that younger patients were at higher risk for a number of antipsychotic-induced side effects, including sedation, extrapyramidal side effects, withdrawal dyskinesia, prolactin elevation, weight gain, and some metabolic abnormalities. There is a concern that...