Treatment challenges and safety considerations for antipsychotic use in children and adolescents with psychoses.

With increased prescribing of psychotropic medications to children and adolescents, more attention should be given to the safety and tolerability of these drugs in this population. Compared with adults, children are especially vulnerable to adverse effects, including extrapyramidal symptoms (EPS), sedation, weight gain, and prolactin elevation. The prevalence of EPS is much higher in children treated with conventional antipsychotics than in those given atypical antipsychotics. Sedation, which can be minimized through gradual dose escalation, is common with risperidone, olanzapine, quetiapine, and ziprasidone. The relative propensities for producing weight gain in children and adolescents are olanzapine > risperidone > quetiapine. All conventional and some atypical antipsychotics (e.g., risperidone) increase serum prolactin levels. Nonetheless, preclinical studies suggest that atypical antipsychotics may have neuroprotective effects in the central nervous system; further studies, especially in children and adolescents, are required to confirm these results.