title: Efficacy and safety of pharmacological and psychological interventions for the treatment of psychosis and schizophrenia in children, adolescents and young adults: a systematic review and meta-analysis.
abstract: BACKGROUND
  Studies report contrasting results regarding the efficacy and safety of pharmacological, psychological, and combined interventions in psychosis and schizophrenia in children, adolescents and young adults.
  
  
  METHODS
  Systematic review and meta-analysis. Embase, Medline, PreMedline, PsycINFO, and CENTRAL were searched to July 2013 without restriction to publication status. Randomised trials comparing any pharmacological, psychological, or combined intervention for psychosis and schizophrenia in children, adolescents and young adults were included. Studies were assessed for bias, and GRADE criteria were used to describe the quality of the results.
  
  
  RESULTS
  Twenty-seven trials including 3067 participants were identified. Meta-analyses were performed for 12 comparisons: symptoms, relapse, global state, psychosocial functioning, depression, weight and discontinuation. Low quality evidence demonstrated that antipsychotics have small beneficial effects on psychotic symptoms (SMD = -0.42, 95% CI -0.58 to -0.26), and a medium adverse effect on weight gain (WMD = 1.61, 95% CI 0.61 to 2.60) and discontinuation due to side effects (RR = 2.44, 95% CI, 1.12 to 5.31). There were no trials of psychological treatments in under-18 year olds. There was no evidence of an effect of psychological interventions on psychotic symptoms in an acute episode, or relapse rate, but low quality evidence of a large effect for family plus individual CBT on the number of days to relapse (WMD = 32.25, 95% CI -36.52 to -27.98).
  
  
  CONCLUSIONS
  For children, adolescents and young adults, the balance of risk and benefit of antipsychotics appears less favourable than in adults. Research is needed to establish the potential for psychological treatments, alone and in combination with antipsychotics, in this population.
authors: National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, London, United Kingdom.
authors: Megan R
authors: MR
authors: Stafford
authors: Centre for Outcomes, Research & Effectiveness (CORE), University College London, London, United Kingdom.
authors: Evan
authors: E
authors: Mayo-Wilson
authors: National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, London, United Kingdom.
authors: Christina E
authors: CE
authors: Loucas
authors: Highfield Adolescent Unit, Warneford Hospital, Oxford, United Kingdom.
authors: Anthony
authors: A
authors: James
authors: Faculty of Medicine & Health Sciences, Queen's Medical Centre, Nottingham, United Kingdom.
authors: Chris
authors: C
authors: Hollis
authors: Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors: Max
authors: M
authors: Birchwood
authors: National Collaborating Centre for Mental Health (NCCMH), Royal College of Psychiatrists, London, United Kingdom.
authors: Tim
authors: T
authors: Kendall
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D012449:Safety; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents