Antipsychotic Use in Children and Adolescents: Minimizing Adverse Effects to Maximize Outcomes

Abstract

In children and adolescents, antipsychotics are being used in large and increasing quantities for a wide range of disorders and psychopathology, including psychotic, mood, and disruptive behavior disorders. 1 Olfson M Blanco C Liu L Moreno C Laje G National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry. 2006; 63: 679-685 Crossref PubMed Scopus (453) Google Scholar Moreover, antipsychotics are also being used in children and adolescents to treat irritability associated with autism, tic disorders, obsessive-compulsive disorder, posttraumatic stress disorder and aggression 2 Cheng-Shannon J McGough JJ Pataki C McCracken JT Second-generation antipsychotic medications in children and adolescents. J Child Adolesc Psychopharmacol. 2004; 14: 372-394 Crossref PubMed Scopus (129) Google Scholar , 3 Schur SB Sikich L Findling RL et al. Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY): I. A review. J Am Acad Child Adolesc Psychiatry. 2003; 42: 132-144 Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar , 4 Pappadopulos E McIntyre II, JC Crismon ML et al. Treatment recommendations for the use of antipsychotics for aggressive youth (TRAAY): II. J Am Acad Child Adolesc Psychiatry. 2003; 42: 145-161 Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar ; however, the widespread use exceeds the database regarding efficacy as well as safety and tolerability in this population. At the time of this writing, only three antipsychotics-haloperidol, thioridazine, and risperidone-have been approved for use in children and adolescents by the U.S. Food and Drug Administration, with most randomized controlled data being available for risperidone. To appropriately use this potent class of medications, clinicians need to actively weigh the potential risks and benefits of individual agents. The present article aims to succinctly review available data on antipsychotic-related adverse effects in children and adolescents and provide a practical guide for the evaluation and management of antipsychotic-related adverse effects in this vulnerable population.