University Hospital of Child & Adolescent Psychiatry, University of Bern, Bern, Switzerland.
Curr Opin Psychiatry. 2013 Mar;26(2):219-30. doi: 10.1097/YCO.0b013e32835dcc2a.
We aimed to review literature on the efficacy and tolerability of psychosocial and psychopharmacological interventions in youth with early-onset schizophrenia spectrum disorders (EOS). A rationale for pragmatic psychopharmacology in EOS, including dosing, switching and adverse effect monitoring and management, is provided.
Three randomized controlled trials (RCTs) over the last 8 years demonstrated benefits of psychosocial interventions (i.e. psychoeducation, cognitive remediation, cognitive behavioural therapy) for EOS without clear advantages of one psychosocial treatment over another. Six large, placebo-controlled, short-term RCTs over the last 4 years demonstrated that aripiprazole, olanzapine, paliperidone, quetiapine and risperidone, but not ziprasidone, were superior to placebo. Except for clozapine's superiority in treatment-refractory EOS, efficacy appeared similar across studied first-generation and second-generation antipsychotics, but tolerability varied greatly across individual agents.
Antipsychotics are efficacious in the treatment of EOS. Given the lack of efficacy differences between antipsychotics (except for clozapine for treatment-refractory EOS), we propose that tolerability considerations need to guide choice of antipsychotics. Further and longer-term efficacy and effectiveness studies are urgently needed that should also explore pharmacologic and nonpharmacologic augmentation strategies.
本研究旨在回顾青少年早期发病的精神分裂症谱系障碍（EOS）患者的心理社会和精神药理学干预的疗效和耐受性的文献。本文还提供了 EOS 中实用精神药理学的原理，包括剂量、换药以及不良反应监测和管理。
过去 8 年的 3 项随机对照试验（RCT）表明心理社会干预（即心理教育、认知矫正、认知行为疗法）对 EOS 有效，但没有一种心理社会治疗明显优于另一种。过去 4 年的 6 项大型、安慰剂对照、短期 RCT 表明，阿立哌唑、奥氮平、帕利哌酮、喹硫平和利培酮，而不是齐拉西酮，优于安慰剂。除氯氮平对治疗抵抗性 EOS 的优越性外，研究的第一代和第二代抗精神病药的疗效似乎相似，但个体药物的耐受性差异很大。
抗精神病药对 EOS 的治疗有效。鉴于抗精神病药之间没有疗效差异（除了氯氮平对治疗抵抗性 EOS 外），我们提出耐受性考虑因素需要指导抗精神病药的选择。迫切需要进一步和更长期的疗效和有效性研究，还应探索药物和非药物增效策略。
