Psychopharmacology for Pediatric Schizophrenia and Psychotic Disorders

The natural course of schizophrenia in children/adolescents is notable for earlier onset of psychosis and worse outcomes relative to adult onset. Early-onset schizophrenia (EOS, before 18 years) has a prevalence of approximately 0.5%, whereas very early-onset or childhood-onset schizophrenia (VEOS/COS, onset ≤12 years of age) has an estimated incidence of ≤0.04%. This chapter reviews the evidence for efficacy and safety of antipsychotic medications as determined by randomized controlled trials in the context of the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. Additionally, it provides prescribers with guidance on approaches to balancing medication’s benefits versus risks. Included figures and tables outline salient aspects of available published data, prescribing practices, and guidelines for treatment. This chapter offers a clinically useful evidence-based guide to pharmacological treatment of pediatric psychotic disorders for physicians and other clinicians.