Antipsychotics in early onset Schizophrenia - Systematic review and meta-analysis

Background To develop an evidence base for using antipsychotic medications for schizophrenia in children and adolescents. Method Data sources were identified in PsychINFO (1872-2003), MEDLINE (1966-2003), and articles in reference lists. Study selection criteria: (1) treatment with antipsychotics; (2) ages were between 5 and 18 years; (3) sample diagnosed with schizophrenia; (4) prospective design; (5) rating instruments used. Fifteen studies met inclusion criteria and were rated. Study quality was independently rated. Results Average response rate among 8 studies employing atypicals was 55.7% compared to 72.3% among 13 studies employing typicals. The difference was statistically different at the trend level (z=1.65, P < 0.10). The effect size on a continuous measure was 0.36 in favor of typicals. When study quality was included in the model, the effect of medication type remained unchanged. Average weight gain in patients treated with typicals was 1.4 Kg. compared to 4.5 Kg for those treated with atypicals. Sedation was more common among those on atypicals. The rate of extrapyramidal side effects was similar among the two groups Conclusions Antipsychotic medications seem effective for schizophrenia treatment in children and adolescents. Typicals appear to be more effective and cause less weight gain than atypicals. However, more rigorous clinical trials are necessary.