IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Via dei Giacinti 2, Calambrone, Pisa, Italy.
Drugs. 2011 Jan 22;71(2):179-208. doi: 10.2165/11585350-000000000-00000.
Schizophrenia in subjects younger than 13 years is defined as very-early-onset schizophrenia, and its prevalence is estimated at 1 in 10 000, while early-onset schizophrenia occurs between 13 and 17 years, and its prevalence is about 0.5%. Only a minority of youths show a complete recovery, and the majority of patients present a moderate to severe impairment at the outset. Treatment of schizophrenia always needs both pharmacological and nonpharmacological interventions. Nonpharmacological interventions include counselling for the patients and the family, psychological support, behavioural treatments, social and cognitive rehabilitation, assistance in social and scholastic activities, enhancement of social skills and family support. Pharmacological treatment is necessary for remission and control of positive and negative symptoms. Furthermore, proper pharmacotherapy can greatly increase the efficacy of psychosocial interventions. Available literature on pharmacotherapy in children and adolescents with schizophrenia is critically reviewed, including both first- and second-generation antipsychotics. Data on efficacy and safety are reported for all the marketed atypical antipsychotics (clozapine, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole), based on randomized, placebo-controlled studies and the most relevant open-label or naturalistic studies. Adverse effects of concern are closely analysed, such as extrapyramidal side effects and tardive dyskinesia, metabolic syndrome (including hyperglycaemia and hyperlipidaemia), weight gain, hyperprolactinaemia, hepatotoxicity, seizures, and cardiovascular and haematological adverse effects. Finally, practical guidelines for the management of specific clinical situations are provided: the first phases and the long-term approach to pharmacotherapy, the treatment refractoriness and the use of clozapine in youths, the agitated adolescent and the treatment of negative symptoms and of affective co-morbidity. Current experience indicates that, based on low rates of remission, low effect size of medications and frequent adverse effects, mainly metabolic syndrome, further research is warranted, with both randomized, placebo-controlled studies and long-term, naturalistic follow-up of large samples of patients with different age ranges.
13 岁以下的精神分裂症患者被定义为极早发性精神分裂症，其患病率估计为 1/10000，而早发性精神分裂症发生在 13 至 17 岁之间，其患病率约为 0.5%。只有少数青少年表现出完全康复，大多数患者在发病时存在中度至重度障碍。精神分裂症的治疗始终需要药物和非药物干预。非药物干预包括对患者和家属进行咨询、心理支持、行为治疗、社会和认知康复、社会和学业活动的帮助、社交技能的提高和家庭支持。药物治疗对于缓解和控制阳性和阴性症状是必要的。此外，适当的药物治疗可以大大提高心理社会干预的效果。对儿童和青少年精神分裂症的药物治疗进行了批判性的文献回顾，包括第一代和第二代抗精神病药物。报告了所有已上市的非典型抗精神病药物（氯氮平、利培酮、奥氮平、喹硫平、齐拉西酮和阿立哌唑）的疗效和安全性数据，这些数据基于随机、安慰剂对照研究和最相关的开放标签或自然主义研究。密切分析了关注的不良反应，如锥体外系副作用和迟发性运动障碍、代谢综合征（包括高血糖和高血脂）、体重增加、高催乳素血症、肝毒性、癫痫发作以及心血管和血液学不良反应。最后，提供了处理特定临床情况的实用指南：药物治疗的初始阶段和长期方法、治疗抵抗和在青少年中使用氯氮平、激越的青少年以及治疗阴性症状和情感共病。目前的经验表明，基于缓解率低、药物效果小和频繁的不良反应，主要是代谢综合征，需要进一步研究，包括随机、安慰剂对照研究和对不同年龄范围的大样本患者进行长期、自然随访的研究。
