Use of atypical neuroleptics in child and adolescent psychiatry

Background: This article reviews the published clinical experience with aty pical neuroleptics in children and adolescents. Method: A computerized literature search was conducted (MEDLINE , 1974-1998 ) to retrieve all reports on the use of atypical neuroleptics in children a nd adolescents. A hand search was performed as well. All relevant clinical data were collated by type of drug. Results: We found 5 blind placebo-controlled clinical trials (105 patients) , 24 open-label clinical trials (387 patients), and 33 case series (115 pat ients) describing the use of the atypical neuroleptics clozapine, risperido ne, olanzapine, sulpiride, tiapride, amisulpride, remoxipride, and clothiap ine in children and adolescents. Some of these agents, especially clozapine , risperidone, and olanzapine, were found to be efficacious in the treatmen t of schizophrenia, bipolar disorders, and pervasive developmental disorder s. The role of atypical neuroleptics as augmenters of serotonin reuptake in hibitors in obsessive-compulsive disorder is unclear. Risperidone appears t o possess anti-tie properties in patients with Tourette's disorder. Conclusion: The most convincing evidence of the efficacy of atypical neurol eptics in children and adolescents concerns clozapine in the treatment of s chizophrenia. Data on other atypical neuroleptics in other disorders are st ill sparse, and further research is needed. Some of the atypical neurolepti cs may become the first-line treatment for childhood schizophrenia and perv asive developmental disorders.