Schizophrenia Bulletin Advance Access published online on August 1, 2007
Schizophrenia Bulletin, doi:10.1093/schbul/sbm080
© The Author 2007. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.
Antipsychotic Medication for Childhood-Onset Schizophrenia
Eilis Kennedy1,2,
Ajit Kumar3 and
Soumitra S. Datta4
2 Child and Family Department, Tavistock Clinic, 120 Belsize Lane, London NW3 5BA, UK
3 Academic unit of Psychiatry, Leeds, UK
4 Department of Child and Adolescent Psychiatry, Royal Manchester Children's Hospital, Manchester, UK
Keywords: cochrane / childhood onset / schizophrenia
Childhood-onset schizophrenia is defined as schizophrenia with
onset prior to the age of 13 years. Although it is rare, those
who suffer from schizophrenia at an early age appear to have
a clinically severe form of the illness with a poor long-term
prognosis. Antipsychotic medication is one way of managing this
rare but serious mental illness. A new Cochrane review examines
antipsychotic medication for childhood-onset schizophrenia.
1
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Objective
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To determine the effects of antipsychotic medication in the
treatment of childhood-onset schizophrenia.
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Search Strategy
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We searched the Cochrane Schizophrenia Group Trials Register
(February 2007), inspected references of all identified studies
for further trials, and contacted relevant pharmaceutical companies
and authors of trials for additional information.
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Selection Criteria
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We included all randomized clinical trials involving children
and young people with a diagnosis of childhood-onset schizophrenia
(ie, with a diagnosis of schizophrenia before the age of 13)
comparing any antipsychotic drug with another antipsychotic
or placebo.
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Data Collection and Analysis
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Studies were reliably selected, quality assessed, and data extracted.
For homogenous dichotomous data, we calculated random effects,
relative risk (RR) and its 95% confidence interval (CI), and,
where appropriate, number needed to treat on an intention-to-treat
basis. For normal continuous data, we calculated the weighted
mean difference (WMD).
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Main Results
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From a total of 2062 citations, 6 relevant trials were identified.
These studies were small (total
N = 256 participants) and short
(all duration 12 weeks or less) and reported data for 3 comparisons
(atypical vs. typical, atypical vs atypical, and typical vs.
typical antipsychotic drugs), only one of which (atypical vs.
typical) was to suggest differences between treatment groups.
A few results from one study favored the atypical antipsychotic clozapine over haloperidol for treating treatment-resistant childhood-onset schizophrenia (n = 21, WMD children's global assesment scale 17.00, CI 7.74–26.26; n = 21, WMD Bunney-Hamburg Psychosis Rating Scale –3.60, CI –6.64 to –0.56). Participants on clozapine, however, were 3 times more likely to have drowsiness (1 randomized controlled trial [RCT], n = 21, RR 3.3, CI 1.2–8.9, number needed to harm 2, CI 2–17) and half of the children receiving clozapine in this small short study experienced neutropenia (1 RCT, n = 21, RR 12, CI 0.75–193; figure 1).
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Reviewers' Conclusions
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There are few relevant trials and, presently, little conclusive
evidence regarding the effects of antipsychotic medication for
those with the rare but difficult problem of very early-onset
schizophrenia. Some benefits were identified in using the atypical
antipsychotic clozapine compared with haloperidol, but the benefits
were offset by an increased risk of serious adverse effects.
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Implications for Practice
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As yet there are few data to support the use of one antipsychotic
medication over another in the treatment of schizophrenia with
onset in childhood. The superiority of atypical antipsychotic
medications over typical antipsychotic drugs is not reflected
in studies using typical medications such as chlorpromazine
as the comparator medication, rather than haloperidol. Routine
practice may be best within the context of an evaluative trial.
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Implications for Research
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Further RCTs with larger samples and longer treatment duration
are needed to evaluate the effectiveness and safety of antipsychotic
medication in the treatment of childhood-onset schizophrenia.
There has been no significant increase in the number of trials
in the last 3 decades possibly reflecting the challenges of
undertaking research with this age group. Given the relative
rarity of childhood-onset schizophrenia, future treatment studies
will require multicenter collaboration and extensive case-finding
efforts.
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Footnotes |
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1 To whom correspondence should be addressed; tel: 0207-435-7111, fax: 0207-447-3733, e-mail: EKennedy{at}tavi-port.nhs.uk.
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Acknowledgments
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We would like to thank the Cochrane Schizophrenia Group for
their help and support with this review. Disclosures: None.
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References
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- Kennedy E, Kumar A, Datta SS. Antipsychotic medication for childhood-onset schizophrenia. In: Cochrane Database Syst Rev (2007) Chichester, UK: John Wiley & sons. Disc issue 3.
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Objective
Search Strategy