Psychotic Disorders in Children and Adolescents

Psychotic disorders can involve an extreme impairment in the ability to distinguish reality from fantasy, behave in an emotionally appropriate manner, and communicate effectively. The National Institutes of Health (NIH) indicates that schizophrenia is rare in children: Only about one in 1,000 have this disorder. Adolescent onset generally occurs between the ages of 11 and 15. Young people who do suffer from schizophrenia have psychotic periods that can involve hallucinations, social isolation, distorted reality, anhedonia (inability to experience pleasure) and delusional thoughts.

The latest research indicates that for the first time, the gene implicated in schizophrenia in adults has also been linked to schizophrenia in children. In June 2007, the NIMH and the NIH convened a meeting for discussion among basic, translational, and clinical investigators to review the current knowledge on causes, neurobiology, developmental trajectory, and treatment of child and adolescent onset schizophrenia. The scientific workshop focused on three important areas: opportunities for expanding current knowledge of causes and neurobiology of child and adolescent onset schizophrenia; critical next steps to translate current understanding of behavioral/cognitive characteristics and underlying neurobiology into treatment development; and current challenges to conducting research in this area, and strategies to overcome them.

Medication Management of Child and Adolescent Psychotic Disorders

The drugs of choice in the treatment of psychotic disorders in children and adolescents, regardless of the presentation, are the atypical antipsychotics. In 2007, Risperdal (risperidone) and Abilify (aripiprazole) gained FDA approval for the treatment of schizophrenia in teens. In December 2009, the FDA approved the use of two more antipsychotic medications – Zyprexa (olanzapine) and Seroquel (quetiapine) in this same age group.

Benefit-vs.-risk factors associated with the use of these drugs in youth are of considerable concern. In association with the recent approval of Zyprexa (olanzapine) and Seroquel (quetiapine), the FDA stated that it wants to know more about the risk of weight gain and diabetes in young people taking these drugs and other antipsychotics as well. It has been clear for years that weight gain and other endocrine risks are associated with these medications, and their warning labels say so. Evidence now suggests however, that these issues are even more paramount in youth.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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