title: Antipsychotics for children and young adults: a comparative effectiveness review.
abstract: OBJECTIVE
  Despite increasing on-label and off-label use of antipsychotics, prescribing antipsychotics to children remains controversial due to uncertainty of their relative benefits and safety. We systematically reviewed the effectiveness and safety of first- (FGA) and second-generation antipsychotics (SGA) for patients aged ≤24 years with psychiatric and behavioral conditions.
  
  
  METHODS
  We searched 10 databases from January 1987 to February 2011, gray literature, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodologic quality, and graded the evidence. One reviewer extracted, and a second verified, data. We summarized findings qualitatively and conducted meta-analyses when appropriate.
  
  
  RESULTS
  Sixty-four trials and 17 cohort studies were included. Most trials had a high risk of bias; cohort studies had moderate quality. All comparisons of FGAs versus SGAs, FGAs versus FGAs, and FGAs versus placebo had low or insufficient strength of evidence. There was moderate strength of evidence for the following comparisons. Olanzapine caused more dyslipidemia and weight gain, but fewer prolactin-related events, than risperidone. Olanzapine caused more weight gain than quetiapine. Compared with placebo, SGAs improved clinical global impressions (schizophrenia, bipolar and disruptive behavior disorders) and diminished positive and negative symptoms (schizophrenia), behavior symptoms (disruptive behavior disorders), and tics (Tourette syndrome).
  
  
  CONCLUSIONS
  This is the first comprehensive review comparing the effectiveness and safety across the range of antipsychotics for children and young adults. The evidence on the comparative benefits and harms of antipsychotics is limited. Some SGAs have a better side effect profile than other SGAs. Additional studies using head-to-head comparisons are needed.
authors.affiliation: Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. jennifer.seida@ualberta.ca
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Seida
authors.forename: Janine R
authors.initials: JR
authors.lastname: Schouten
authors.forename: Khrista
authors.initials: K
authors.lastname: Boylan
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton
authors.forename: Shima S
authors.initials: SS
authors.lastname: Mousavi
authors.forename: Amy
authors.initials: A
authors.lastname: Beaith
authors.forename: Ben
authors.initials: B
authors.lastname: Vandermeer
authors.forename: Donna M
authors.initials: DM
authors.lastname: Dryden
authors.forename: Normand
authors.initials: N
authors.lastname: Carrey
mesh_terms: D000293:Adolescent; D000367:Age Factors; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000188:drug therapy*; D019964:Mood Disorders / Q000175:diagnosis / Q000188:drug therapy; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents