Evidence-Based Outcome for the Interventions in Childhood-Onset Schizophrenia

Abstract

Childhood-onset schizophrenia (COS), also known as very-early-onset schizophrenia, is a progressive and devastating developmental disorder, which manifests before the age of 12 years. COS is characterized by chronic course and poor clinical and social outcome in most patients. Early detection and treatment are important to improve the outcome in this vulnerable category of patients, who experience the disorder onset during the period of postnatal brain growth, development, and maturation. The first-line strategy of medical treatment emphasizes atypical antipsychotics due to their better safety profile compared to typical neuroleptics, although while superior, clinical efficacy is not proven for any of these agents. The side effects profile of each medication should be considered by the clinician and also by the parent/carer during the process of treatment choice. The patient’s opinion and experience are also of importance. The medications approved for schizophrenia in children and adolescents by the FDA (aripiprazole, risperidone, olanzapine, paliperidone, quetiapine) should be selected based on their adverse effects profiles and particularly by taking into consideration the possibly severe metabolic and hormonal side effects. Clozapine remains the drug of choice in otherwise refractory COS cases and demonstrates good efficacy both for the acute states and for maintenance treatment but requires careful monitoring of hematological side effects. The combination of antipsychotic pharmacotherapy with psychoeducation, family interventions, cognitive-behavioral psychotherapy in face-to-face and group formats, as well as a range of social support programs significantly improves both clinical and social outcomes in COS patients.