Kennedy E, Kumar A, Datta S S
Tavistock Clinic, Child and Family Department, 120 Belsize Lane, Hampstead, London, UK, NW3 5BA.
Cochrane Database Syst Rev. 2007 Jul 18;2007(3):CD004027. doi: 10.1002/14651858.CD004027.pub2.
Childhood-onset schizophrenia is schizophrenia with onset prior to the age of 13 years. Although it is rare, people who suffer from schizophrenia at an early age appear to have a clinically severe form of the illness with poor long-term prognosis. Antipsychotic medication is one way of managing this rare but serious mental illness.
To examine the effects of antipsychotic medication for childhood-onset schizophrenia.
We searched the Cochrane Schizophrenia Group Trials Register (November 2006 and February 2007), inspected references of all identified studies for further trials and contacted relevant pharmaceutical companies and authors of trials for additional information.
We included all randomised clinical trials involving children and young people with a diagnosis of childhood onset schizophrenia (i.e. with a diagnosis of schizophrenia before the age of 13) comparing any antipsychotic drug with another antipsychotic or placebo.
We reliably selected, quality assessed and extracted data from trials. We excluded data where more than 50% of participants in any group were lost to follow up. For homogenous dichotomous data we calculated random effects, relative risk (RR) and its 95% confidence interval (CI) and, where appropriate, number needed to treat (NNT) on an intention-to-treat basis. For normal continuous data we calculated the weighted mean difference (WMD).
From a total of 2062 citations, we identified six relevant trials. We categorised trials into three comparisons: atypical versus typical, atypical versus atypical and typical versus typical antipsychotic drugs. The only comparison to find any differences between treatment groups was atypical versus typical antipsychotic drugs. A few results from one study favoured the atypical antipsychotic clozapine over haloperidol in treating treatment resistant childhood-onset schizophrenia (n=21, WMD CGAS 17.00 CI 7.74 to 26.26; n=21, WMD Bunney-Hamburg Psychosis Rating Scale -3.60 CI -6.64 to -0.56). Participants on clozapine, however, were three times more likely to have drowsiness (1 RCT, n=21, RR 3.30 CI 1.23 to 8.85, NNH 2 CI 2 to 17) and half of the children receiving clozapine had neutropenia (1 RCT, n=21, RR 12, CI 0.75 to 192.86).
AUTHORS' CONCLUSIONS: There are few relevant trials and, presently, there is little conclusive evidence regarding the effects of antipsychotic medication for those with early onset schizophrenia. Some benefits were identified in using the atypical antipsychotic clozapine compared with haloperidol but the benefits were offset by an increased risk of serious adverse effects. Larger, more robust, trials are required.
儿童期起病的精神分裂症是指发病于13岁之前的精神分裂症。尽管这种情况很罕见，但早年患精神分裂症的人似乎患有临床症状严重的疾病，长期预后较差。抗精神病药物是治疗这种罕见但严重的精神疾病的一种方法。
研究抗精神病药物治疗儿童期起病的精神分裂症的效果。
我们检索了Cochrane精神分裂症研究组试验注册库（2006年11月和2007年2月），查阅了所有已识别研究的参考文献以寻找更多试验，并联系了相关制药公司和试验作者以获取更多信息。
我们纳入了所有涉及诊断为儿童期起病精神分裂症（即13岁之前诊断为精神分裂症）的儿童和青少年的随机临床试验，比较任何抗精神病药物与另一种抗精神病药物或安慰剂。
我们从试验中可靠地选择、评估质量并提取数据。如果任何组中超过50%的参与者失访，我们将排除该数据。对于同质的二分数据，我们基于意向性分析计算随机效应、相对风险（RR）及其95%置信区间（CI），并在适当情况下计算治疗所需人数（NNT）。对于正态连续数据，我们计算加权均数差（WMD）。
从总共2062条引用文献中，我们识别出6项相关试验。我们将试验分为三组比较：非典型药物与典型药物、非典型药物与非典型药物、典型药物与典型药物。唯一发现治疗组之间存在差异的比较是非典型药物与典型药物。一项研究的一些结果表明，在治疗难治性儿童期起病精神分裂症方面，非典型抗精神病药物氯氮平优于氟哌啶醇（n = 21，WMD 临床总体印象量表17.00，CI 7.74至26.26；n = 21，WMD 邦尼 - 汉堡精神病评定量表 -3.60，CI -6.64至 -0.56）。然而，服用氯氮平的参与者出现嗜睡的可能性是服用氟哌啶醇参与者的三倍（1项随机对照试验，n = 21，RR 3.30，CI 1.23至8.85，NNH 2，CI 2至17），并且接受氯氮平治疗的儿童中有一半出现中性粒细胞减少（1项随机对照试验，n = 21，RR 12，CI 0.75至192.86）。
相关试验较少，目前几乎没有确凿证据表明抗精神病药物对早发性精神分裂症患者的疗效。与氟哌啶醇相比，使用非典型抗精神病药物氯氮平有一些益处，但这些益处被严重不良反应风险增加所抵消。需要进行更大规模、更有力的试验。
