Typical and atypical antipsychotics in adolescent schizophrenia: efficacy, tolerability, and differential sensitivity to extrapyramidal symptoms.
OBJECTIVE
To review the existing literature on the efficacy and tolerability of antipsychotics for adolescent psychosis. The review focuses in particular on literature regarding adverse effects that are thought to have an increased incidence in young patients and on the possible neurobiological bases for such differential sensitivity.


METHODS
Pertinent studies were sought using Medline searches, supplemented by selected bibliographies, and reviewed.


RESULTS
There is a relative paucity of research in this area; in particular, well-controlled trails are lacking. The existing literature suggests fairly good efficacy of both typical and atypical antipsychotics in the treatment of psychotic disorders in children and adolescents. However, the incidence of certain side effects, particularly extrapyramidal symptoms (EPS). is found to be higher in younger patients compared with adults. Positron emission tomography (PET) receptor studies in adults have demonstrated that the incidence of EPS is related to dose-dependent dopamine type-2 (D2) receptor occupancy and that there is a significant relationship between the number of these receptors and age.


CONCLUSIONS
Improved tolerability is leading to the increasing us of atypical antipsychotics for adolescent patients, though these new drugs to have specific adverse effects of their own. There is a need for more controlled studies of atypical antipsychotics in children and adolescents. In particular, dose-finding studies are needed to determine the optimal dose range to produce the greatest improvement with the least side effects for each of these drugs.
Lewis
R
R
Department of Psychiatry, University of Toronto, ON rle@clarke-inst.on.ca
D000293:Adolescent; D000296:Adolescent Psychiatry / Q000379:methods*; D000367:Age Factors; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000592:standards; D001569:Benzodiazepines; D002799:Cholinergic Fibers / Q000187:drug effects; D003024:Clozapine / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic / Q000706:statistics & numerical data; D003342:Corpus Striatum / Q000000981:diagnostic imaging / Q000187:drug effects; D004198:Disease Susceptibility; D004409:Dyskinesia, Drug-Induced / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D000077152:Olanzapine; D010890:Pirenzepine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017448:Receptors, Dopamine D2 / Q000187:drug effects; D018967:Risperidone / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy*; D014055:Tomography, Emission-Computed
D014150:Antipsychotic Agents; D017448:Receptors, Dopamine D2; D001569:Benzodiazepines; D010890:Pirenzepine; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine