Antipsychotics in children and adolescents: increasing use, evidence for efficacy and safety concerns

Second-generation antipsychotics (SGA) are increasingly used to treat children and adolescents. The European College of Neuro-psychopharmacology convened an expert panel to review relevant efficacy and safety data, and identify needs for further research. Controlled studies support the short-term efficacy of several SGA for treating psychosis, mania, and aggression within certain diagnostic categories. Except for clozapine, no clinically significant superiority in efficacy has been demonstrated for any specific antipsychotic, including both first- and second-generation agents, in children and adolescents. Major differences exist, however, with respect to type and severity of adverse effects; therefore the choice of treatment is primarily guided by tolerability and safety considerations. Children appear to be at higher risk than adults for a number of adverse effects, such as extrapyramidal symptoms and metabolic and endocrine abnormalities. While the safety profile during acute and intermediate treatment has been evaluated, the distal benefit/risk ratio during long-term treatment remains to be determined. Research is also needed to understand the mechanisms underlying antipsychotic-induced toxicities in order to develop effective preventive and treatment strategies.