CLINICAL HANDBOOK OF SCHIZOPHRENIA

46. Children and Adolescents 489KEY POINTS• Functional outcome in schizophrenia may be worse when the onset of the disorder occursduring childhood and adolescence.• Prior to the onset of psychotic symptoms, children may present with nonspecific symptomssuggestive of pervasive development disorder, learning disabilities, oppositional behavior/violent aggression, and attentional dysfunction.• Generalized neurocognitive performance for children–adolescents with schizophrenia is between1.5 and 2.0 standard deviations below that of healthy children, and may be manifestas early as the first grade.• Some data suggest a steep decline in IQ around the time of onset of psychosis, with relativestabilization in cognitive function thereafter.• Before switching, augmenting, combining, or discontinuing antipsychotic medications, physiciansshould ensure that patients have received adequate trials.• If patients fail to respond to an adequate trial of an initial atypical antipsychotic, then theirdiagnosis should be reassessed to rule out a comorbid condition.• Clozapine has shown superior efficacy over conventional and second-generation antipsychoticsin adolescents with treatment-refractory schizophrenia.• Weight gain has emerged as a major side effect of second-generation antipsychotics inadolescents, particularly for clozapine, olanzapine, and risperidone.• Very few data are available regarding the potential long-term side effects of all atypicalantipsychotics in children.REFERENCES AND RECOMMENDED READINGSAmerican Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4thed., rev. text). Washington, DC: Author.Barnea-Goraly, N., Menon, V., Eckert, M., Tamm, L., Bammer, R., Karchemskiy, A., et al. (2005).White matter development during childhood and adolescence: A cross-sectional diffusion tensorimaging study. Cerebral Cortex, 15, 848–1854.Bilder, R. M., Goldman, R. S., Robinson, D. E., Reiter, G., Bell, L., Bates, J. A., et al. (2000).Neuropsychology of first-episode schizophrenia: Initial characterization and clinical correlates.American Journal of Psychiatry, 157, 549–559.Gerbino-Rosen, G., Roofeh, D., Tompkins, A., Feryo, D., Nusser, L., Kranzeler, H., et al. (2005).Hemotological adverse events in clozapine-treated children and adolescents. Journal of theAmerican Academy of Child and Adolescent Psychiatry, 44, 1024–1031.Kranzler, H., Roofeh, D., Gerbino-Rosen, G., Dombrowski, C., McMeniman, M., DeThomas, C., etal. (2005). Clozapine: Its impact on aggressive behavior among children and adolescents withschizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 55–63.Kumra, S., Ashtari, M., Cervellione, K. L., Henderson, I., Kester, H., Roofeh, D., Wu, J., et al. (2005).White matter abnormalities in early-onset schizophrenia: A voxel-based diffusion tensor imagingstudy. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 934–941.Kumra, S., Ashtari, M., McMeniman, M., Vogel, J., Augustin, R., Becker, D. E., et al. (2004). Reducedfrontal white matter integrity in early-onset schizophrenia: A preliminary study. Biological Psychiatry,55, 1138–1145.Kumra, S., Frazier, J., Jacobson, L. K., McKenna, K., Gordon, C. T., Lenane, M. C., et al. (1996).Childhood-onset schizophrenia: A double-blind clozapine–haloperidol comparison. Archives ofGeneral Psychiatry, 53, 1090–1097.Pappadopulos, E., MacIntyre, J. C., II, Crismon, M. L., Findling, R. L., Malone, R. P., Derivan, A., etal. (2003). Treatment recommendations for use of antipsychotics for aggressive youth (TRAAY):Part II. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 145–161.Reichenberg, A., Weiser, M., Rapp, M., Rabinowitz, J., Caspi, A., Schneidler, J., et al. (2005). Elabora-