Atypical antipsychotics for psychosis in adolescents

• Published in: Cochrane database of systematic reviews 2013-10, Vol.2013 (10), p.CD009582
• Main Authors: Kumar, Ajit, Datta, Soumitra S, Wright, Stephen D, Furtado, Vivek A, Russell, Paul S
• Format: Article
• Language: English
• Subjects: Adolescent; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Aripiprazole; Benzodiazepines - adverse effects; Benzodiazepines - therapeutic use; Child health; Humans; Mental health; Molindone - adverse effects; Molindone - therapeutic use; Olanzapine; Piperazines - adverse effects; Piperazines - therapeutic use; Psychotic Disorders - drug therapy; Quinolones - adverse effects; Quinolones - therapeutic use; Randomized Controlled Trials as Topic; Risperidone - adverse effects; Risperidone - therapeutic use; Schizophrenia - drug therapy
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD009582.pub2

Schizophrenia often presents in adolescence, but current treatment guidelines are based largely on studies of adults with psychosis. Over the past decade, the number of studies on treatment of adolescent-onset psychosis has increased. The current systematic review collates and critiques evidence obtained on the use of various atypical antipsychotic medications for adolescents with psychosis. To investigate the effects of atypical antipsychotic medications in adolescents with psychosis. We reviewed in separate analyses various comparisons of atypical antipsychotic medications with placebo or a typical antipsychotic medication or another atypical antipsychotic medication or the same atypical antipsychotic medication but at a lower dose. We searched the Cochrane Schizophrenia Group Register (October 2011), which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies and contacted study authors and relevant pharmaceutical companies to ask for more information. We included all relevant randomised controlled trials (RCTs) that compared atypical antipsychotic medication with placebo or another pharmacological intervention or with psychosocial interventions, standard psychiatric treatment or no intervention in children and young people aged 13 to 18 years with a diagnosis of schizophrenia, schizoaffective disorder, acute and transient psychoses or unspecified psychosis. We included studies published in English and in other languages that were available in standardised databases. Review authors AK and SSD selected the studies, rated the quality of the studies and performed data extraction. For dichotomous data, we estimated risk ratios (RRs) with 95% confidence intervals (CIs) using a fixed-effect model. When possible, for binary data presented in the 'Summary of findings' table, we calculated illustrative comparative risks. We summated continuous data using the mean difference (MD). Risk of bias was assessed for included studies. We included 13 RCTs, with a total of 1112 participants. We found no data on service utilisation, economic outcomes, behaviour or cognitive response. Trials were classified into the following groups. 1. Atypical antipsychotics versus placebo: Only two studies compared one atypical antipsychotic medication with placebo. In one study, the number of non-responders treated with olanzapine was not different from the number treated with placebo (1 RCT, n = 107, RR