title: Twenty-four months of antipsychotic treatment in children and adolescents with first psychotic episode: discontinuation and tolerability.
abstract: OBJECTIVE
  The Child and Adolescent First-Episode Psychosis Study is a longitudinal study of early-onset first psychotic episodes. This report describes the naturalistic psychopharmacological treatment administered during a 24-month follow-up period, as well as discontinuation rates, reasons for discontinuation, and adverse effects.
  
  
  METHODS
  The sample comprised 110 patients, aged 9 to 17 years, with a first psychotic episode. Pharmacological treatment, changes, reasons for discontinuation, and the UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale were registered at 6, 12, and 24 months of follow-up.
  
  
  RESULTS
  Second-generation antipsychotics, especially risperidone, quetiapine, and olanzapine, were the most commonly used. The discontinuation rate was 44.5% at 6 months, 59.1% at 12 months, and 70.9% at 24 months. Discontinuation rates or reasons for discontinuation (adverse reaction, insufficient response, and other) did not differ significantly between antipsychotics. At 6 months, significant differences were found in body mass index increase and body mass index z score increase, which were higher with olanzapine, and in neurological effects, which were higher with risperidone; at 12 and 24 months, these differences were no longer significant. High maintenance rates were found in the clozapine group, although they had higher scores on the autonomic subscale of the UKU.
  
  
  CONCLUSIONS
  A long follow-up period reveals high discontinuation rates similar to those observed in adults, particularly during the first year. No differences were found between antipsychotics. Differences in adverse effects were found at 6 months but not subsequently after changes in treatment. Clozapine had a high maintenance rate, and its tolerability was comparable to that of other antipsychotics.
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic of Barcelona, Barcelona, Spain. anoguera@clinic.ub.es
authors.forename: Ana
authors.initials: A
authors.lastname: Noguera
authors.forename: Patricia
authors.initials: P
authors.lastname: Ballesta
authors.forename: Immaculada
authors.initials: I
authors.lastname: Baeza
authors.forename: Celso
authors.initials: C
authors.lastname: Arango
authors.forename: Elena
authors.initials: E
authors.lastname: de la Serna
authors.forename: Ana
authors.initials: A
authors.lastname: González-Pinto
authors.forename: Mara
authors.initials: M
authors.lastname: Parellada
authors.forename: Montserrat
authors.initials: M
authors.lastname: Graell
authors.forename: Carmen
authors.initials: C
authors.lastname: Moreno
authors.forename: Soraya
authors.initials: S
authors.lastname: Otero
authors.forename: Josefina
authors.initials: J
authors.lastname: Castro-Fornieles
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000187:drug effects*; D000367:Age Factors; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015992:Body Mass Index; D002648:Child; D002652:Child Behavior / Q000187:drug effects*; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D014150:Antipsychotic Agents