La schizofrenia ad esordio prepuberale: Il trattamento farmacologico

Schizophrenia in children younger than 13 years is defined as very-early-onset schizophrenia (VEOS). This disorder can lead to a severe and progressive impairment in scholastic, familial and social functioning, and to a poor outcome. Reasons for underdiagnosis and delayed treatment are the high frequency of premorbid developmental impairments and an insidious prodromic phase. Early recognition of VEOS may improve prognosis of this condition by using appropriate treatments. In the context of a multimodal approach, including behavioral, social, scholastic and familial interventions, a pharmacological treatment can greatly increase the efficacy of psychosocial interventions. Few data are available on pharmacotherapy in prepubertal children with schizophrenia. An English-language Medline research has been conducted to retrieve all the uses of treatments with antipsychotics in children with VEOS, with particular reference to efficacy, safety and treatment procedures of atypical antipsychotics in the clinical practice. Antipsychotics seem to be effective in treating acute symptoms of schizophrenic children. Available evidence supports the use of atypical antipsychotics risperidone and olanzapine as first choice medications, while clozapine use should be limited to the treatment-refractory cases. New information is needed on newer atypical antipsychotics, namely quetiapine and aripiprazole, which may be promising options. Tolerability of antipsychotics in young children is a major issue, mostly in the long-term treatment. Weight gain and related complications on one side and hyperglicemia-hypercolesterolemia on the other require a careful monitoring. Further research is clearly warranted with placebo-controlled studies, as well as with long-term, naturalistic follow-up of large samples of these young patients.