Treatments and drugs

By Mayo Clinic Staff

Schizophrenia in children requires lifelong treatment, even during periods when symptoms seem to go away. Treatment is a particular challenge for children with schizophrenia.

Treatment team

Childhood schizophrenia treatment is usually guided by a child psychiatrist. The team may include, for example, your:

  • Pediatrician or family doctor
  • Psychiatrist, psychologist or other therapist
  • Psychiatric nurse
  • Social worker
  • Family members
  • Pharmacist

Main treatment options

The main treatments for childhood schizophrenia are:

  • Medications
  • Individual and family therapy
  • Social and academic skills training
  • Hospitalization

Medications for childhood schizophrenia

Antipsychotic medications are at the heart of treatment for schizophrenia in children. Most of the medications used in children are the same as those used for adults with schizophrenia. Antipsychotic medications are often effective at managing symptoms such as delusions, hallucinations, loss of motivation and lack of emotion.

It can take several weeks after starting a medication to notice an improvement in symptoms. In general, the goal of treatment with antipsychotic medications is to effectively control signs and symptoms at the lowest possible dosage. Your child's doctor may try combinations, different medications or different dosages over time. Other medications also may help, such as antidepressants or anti-anxiety medications.

Second-generation antipsychotics

Newer, second-generation medications (atypical antipsychotics) are usually tried first in children because they have fewer side effects compared with older antipsychotics. However, they can cause weight gain, high blood sugar and high cholesterol. Examples of antipsychotics approved by the Food and Drug Administration (FDA) to treat childhood schizophrenia in children age 13 and older include:

  • Aripiprazole (Abilify)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)

First-generation antipsychotics

First-generation medications (typical antipsychotics), approved by the FDA to treat schizophrenia in children age 13 and older, are usually equally as effective as second-generation antipsychotics in controlling delusions and hallucinations. However, they may have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible.

Because of the increased risk of serious side effects with first-generation antipsychotics, they often aren't recommended for use in children until other options have been tried without success. Examples of these medications include:

  • Chlorpromazine
  • Perphenazine
  • Haloperidol (Haldol)

Medication side effects and risks

All antipsychotic medications have side effects and possible health risks, some life-threatening. Side effects in children and teenagers may not be the same as those in adults, and sometimes they may be more serious. Children, especially very young children, may not have the capacity to understand or communicate about medication problems.

Talk to your child's doctor about possible side effects and how to manage them. Be alert for problems in your child, and report side effects to the doctor as soon as possible. The doctor may be able to adjust the dosage or change medications and limit side effects.

Also, antipsychotic medications can have dangerous interactions with other substances. Tell your child's doctor about all medications and over-the-counter products your child takes, including vitamins, minerals and herbal supplements.

Psychotherapy

In addition to medication, psychotherapy (talk therapy) is important. Psychotherapy may include:

  • Individual therapy. Psychotherapy with a skilled mental health provider can help your child learn ways to cope with the stress and daily life challenges brought on by schizophrenia. Therapy can help reduce symptoms and help your child make friends and succeed at school. Learning about schizophrenia can help your child understand the condition, cope with symptoms and stick to a treatment plan. There are many types of psychotherapy, such as cognitive behavioral therapy.
  • Family therapy. Your child and your family may benefit from therapy that provides support and education to families. Involved, caring family members who understand childhood schizophrenia can be extremely helpful to children living with this condition. Family therapy can also help you and your family improve communication, work out conflicts and cope with stress related to your child's condition.

Social and academic skills training

Training in social and academic skills is an important part of treatment for childhood schizophrenia. Children with schizophrenia often have troubled relationships and school problems. They may have difficulty carrying out normal daily tasks, such as bathing or dressing. Treatment plans that include building skills in these areas can help your child function at age-appropriate levels when possible.

Hospitalization

During crisis periods or times of severe symptoms, hospitalization may be necessary. This can help ensure your child's safety and make sure that he or she is getting proper nutrition, sleep and hygiene. Sometimes the hospital setting is the safest and best way to get symptoms under control quickly. Partial hospitalization and residential care may be options, but severe symptoms are usually stabilized in the hospital before moving to these levels of care.

Feb. 28, 2014

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