Antipsychotic Therapy for Childhood Schizophrenia
Antipsychotic Therapy for Childhood Schizophrenia
Armenteros JL, Davies M
Eur Child Adolesc Psychiatry. 2006;15:141-148
The United States Food and Drug Administration (FDA) has not approved any antipsychotic drugs for treating childhood schizophrenia; yet, clinicians routinely use medications for this disorder. To examine the available evidence, published articles reporting prospective treatment of subjects 5-18 years old diagnosed with schizophrenia were identified and then rated, using instruments to measure outcomes. Of 26 articles containing primary data, 15 met inclusion criteria:
The studies included a total of 294 subjects; 209 received first-generation antipsychotics (FGAs), 85 received second-generation antipsychotics (SGAs), and 36 received placebo. In FGA studies, the mean response rate was 72.3% with a range of 35% to 93%. In SGA studies, the mean response rate was 55.7% with a range of 13% to 75%. The difference in response rate comparing the 2 classes of medication demonstrated a significant trend (P < .10). In analysis of studies that used the Brief Psychiatric Rating Scale as an outcome measure, the effect size for FGAs vs SGAs was 0.36 in favor of FGAs.
Analysis of adverse effects found mean weight gain of 1.4 kg with FGAs and 4.5 kg with SGAs, more sedation with SGAs, but a similar rate of extrapyramidal side effects in the 2 medication classes of approximately 57%.
The finding of better treatment response with FGAs may be surprising, but the studies of SGAs were of lower quality. The 2 best-designed studies employed FGAs. Furthermore, as the investigators suggest, the subjects of SGA studies may have failed treatment with FGAs and may have been more treatment-resistant. A flaw in the meta-analysis is exclusion of unpublished data, omission of which may have, conceivably, led to overestimation of response rates.
The major finding of this meta-analysis is that the evidence base for pharmacotherapy of childhood schizophrenia is poor, reflecting a paucity of medication trials most of which are of low quality. The data on adverse effects is likewise deficient and lacks standardized reporting. The conclusion for clinicians is that FGAs seem to be an appropriate and relatively safe choice, but long-term outcomes and risk of tardive dyskinesia are not addressed in this article.
Abstract (PubMed) URL:www.medscape.com/medline/abstract/16470340
Armenteros JL, Davies M
Eur Child Adolesc Psychiatry. 2006;15:141-148
The United States Food and Drug Administration (FDA) has not approved any antipsychotic drugs for treating childhood schizophrenia; yet, clinicians routinely use medications for this disorder. To examine the available evidence, published articles reporting prospective treatment of subjects 5-18 years old diagnosed with schizophrenia were identified and then rated, using instruments to measure outcomes. Of 26 articles containing primary data, 15 met inclusion criteria:
1 case series;
2 randomized, double-blind, placebo-controlled trials;
7 were open trials; and
5 randomized, either single- or double-blind, non-placebo-controlled trials.
The studies included a total of 294 subjects; 209 received first-generation antipsychotics (FGAs), 85 received second-generation antipsychotics (SGAs), and 36 received placebo. In FGA studies, the mean response rate was 72.3% with a range of 35% to 93%. In SGA studies, the mean response rate was 55.7% with a range of 13% to 75%. The difference in response rate comparing the 2 classes of medication demonstrated a significant trend (P < .10). In analysis of studies that used the Brief Psychiatric Rating Scale as an outcome measure, the effect size for FGAs vs SGAs was 0.36 in favor of FGAs.
Analysis of adverse effects found mean weight gain of 1.4 kg with FGAs and 4.5 kg with SGAs, more sedation with SGAs, but a similar rate of extrapyramidal side effects in the 2 medication classes of approximately 57%.
The finding of better treatment response with FGAs may be surprising, but the studies of SGAs were of lower quality. The 2 best-designed studies employed FGAs. Furthermore, as the investigators suggest, the subjects of SGA studies may have failed treatment with FGAs and may have been more treatment-resistant. A flaw in the meta-analysis is exclusion of unpublished data, omission of which may have, conceivably, led to overestimation of response rates.
The major finding of this meta-analysis is that the evidence base for pharmacotherapy of childhood schizophrenia is poor, reflecting a paucity of medication trials most of which are of low quality. The data on adverse effects is likewise deficient and lacks standardized reporting. The conclusion for clinicians is that FGAs seem to be an appropriate and relatively safe choice, but long-term outcomes and risk of tardive dyskinesia are not addressed in this article.
Abstract (PubMed) URL:www.medscape.com/medline/abstract/16470340
