Treatment Analysis of Very Early and Early Onset Psychosis in the Youth Inpatient Setting

The United States Food and Drug Administration approved 6 atypical antipsychotics for pediatric treatment of schizophrenia. However, little has been published on the effectiveness of these medications in the acute treatment setting of adolescents with psychosis. Since the clinical uncertainty and poor prognosis proceeding the early onset of schizophrenia has a significant impact on a child's development, there is a critical need for evidence-based data on this population. The aim of our study was to investigate the effect of various antipsychotics on young patients admitted to the inpatient ward presenting with acute psychosis.

A retrospective analysis was performed to review the medical records of the patients with specified schizophrenia disorders who were admitted to the inpatient psychiatric unit for treatment with antipsychotics. We analyzed the efficiency of treatment by measuring 30-day readmissions (yes/no), number of readmissions in 30 days, and the length of stay in the inpatient ward. Negative binomial regression and binary logistic regression were used to count the discrete occurrences of an outcome and predict the likelihood of that outcome.

We analyzed the medical records of 1117 patients who were assigned to groups based on whether they were treated with aripiprazole (31.9%), risperidone (26.0%), quetiapine (16.2%), and olanzapine (26.0%). Pairwise comparisons revealed receiving risperidone increased the log count of days by an incidence response ratio of 1.15 (1/0.87) compared to receiving aripiprazole (P < .05, 95% CI [0.76, 0.98]). Similarly, quetiapine increased the count of hospital days by a factor of 1.22 (1/0.82) (P < .01, 95% CI [0.70, 0.94]), as well as olanzapine by a factor of 1.23 (1/0.82) compared to receiving aripiprazole (P < .001, 95% CI [0.72, 0.93]). The number of admissions in 30 days was not significantly associated with medication groups (χ² = 3.93, P = .270) when controlling for other variables. The medication group was also not significantly associated with the likelihood of readmission (χ² = 5.594, P = .133) when controlling for other variables.

Aripiprazole was significantly associated with shortening the log count of days (χ² = 21.82, P < .0001) when compared to olanzapine and quetiapine. There was no statistical evidence to conclude a difference in readmission rates when comparing medication groups. To our knowledge, these results provide the largest cohort describing the efficacy of different antipsychotics for acute stabilization of psychosis in the inpatient setting.