We aimed to review literature on the efficacy and tolerability of psychosocial and psychopharmacological interventions in youth with early-onset schizophrenia spectrum disorders (EOS). A rationale for pragmatic psychopharmacology in EOS, including dosing, switching and adverse effect monitoring and management, is provided.
Three randomized controlled trials (RCTs) over the last 8 years demonstrated benefits of psychosocial interventions (i.e. psychoeducation, cognitive remediation, cognitive behavioural therapy) for EOS without clear advantages of one psychosocial treatment over another. Six large, placebo-controlled, short-term RCTs over the last 4 years demonstrated that aripiprazole, olanzapine, paliperidone, quetiapine and risperidone, but not ziprasidone, were superior to placebo. Except for clozapine's superiority in treatment-refractory EOS, efficacy appeared similar across studied first-generation and second-generation antipsychotics, but tolerability varied greatly across individual agents.
Antipsychotics are efficacious in the treatment of EOS. Given the lack of efficacy differences between antipsychotics (except for clozapine for treatment-refractory EOS), we propose that tolerability considerations need to guide choice of antipsychotics. Further and longer-term efficacy and effectiveness studies are urgently needed that should also explore pharmacologic and nonpharmacologic augmentation strategies.
aUniversity Hospital of Child & Adolescent Psychiatry, University of Bern, Bern, Switzerland
bThe Zucker Hillside Hospital, Psychiatry Research, North Shore – Long Island Jewish Health System, Glen Oaks, New York, USA
Correspondence to Dr Benno Graf Schimmelmann, University Hospital of Child and Adolescent Psychiatry, University of Bern, Bolligenstr. 111, 3000 Bern 60, Switzerland. Tel: +41 31 932 8564; fax: +41 31 932 8569; e-mail: firstname.lastname@example.org