Abstract
BackgroundStudies report contrasting results regarding the efficacy and safety of pharmacological, psychological, and combined interventions in psychosis and schizophrenia in children, adolescents and young adults.MethodsSystematic 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.ResultsTwenty-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).ConclusionsFor 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.
Highlights
Early-onset schizophrenia, that is, schizophrenia occurring prior to 17 years [1], affects approximately 1.6 to 1.9 per 100,000 of the child and adolescent population [2,3,4,5]
Low quality evidence demonstrated that antipsychotics have small beneficial effects on psychotic symptoms (SMD = -0.42, 95% confidence intervals (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)
While antipsychotic medications play an integral role in the treatment and management of schizophrenia in children, adolescents and young adults, the nature of adverse effects that can follow first exposure occurs during a vulnerable phase of physical growth and brain development, and at a time when young people may be vulnerable to rapid weight gain [11] and disturbances to the cardiometabolic system [12,13], bone growth [14] and sexual development [15]
Summary
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. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. The full review protocol is available from the authors. TK receives £1.4 million per year for the National Collaborating Centre for Mental Health from the National Institute for Health and Clinical Excellence to
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