NEUROLEPTIC THERAPY IN TREATING COMMON SCHIZOPHRENIA SPECTRUM DISORDERS IN CHILDREN AND ADOLESCENTS
Authors:   Scientific Center for Mental Health, Moscow, Shushpanova Olga V. 
Published: December 2024

Introduction. Antipsychotic (neuroleptic) medications are effective in treating various mental disorders in children and adolescents. Continuous neuroleptic therapy can lead to long-term remissions and sustained control of patients' conditions. Over the past three decades, research has shown an increasing prevalence and duration of neuroleptic use in the pediatric population, often in combination with other treatments. The use of second- and third-generation antipsychotics has significantly risen, allowing for a more tailored approach to therapy based on individual diagnoses and primary symptoms.

Objective. To describe the use of combination neuroleptic therapy in treating the most common schizophrenia spectrum disorders in children and adolescents.

Methods. This study was conducted at the Children's Clinical Department of the Federal State Budgetary Scientific Institution Scientific Center for Mental Health. We included 187 patients aged 7 to 16 years (in treated from 2018 through 2022) who were receiving combination therapy for schizophrenia spectrum disorders, as classified by the ICD-10 (psychopathic-like schizophrenia - F21.4; neurosis-like schizophrenia – F21.3; undifferentiated schizophrenia with less than a year of observation – F20.3; childhood schizophrenia – F20.8).

Results. The sample was divided into four diagnostic groups, all homogeneous in age (mean age: 12 years). The most frequently prescribed neuroleptic medications included chlorpromazine, chlorprothixene, alimemazine, trifluoperazine, perphenazine, aripiprazole, paliperidone, and quetiapine, administered at average therapeutic doses. Psychometric assessments using the PANSS and CGI scales were conducted for all patients upon admission and discharge. In the neurosis-like schizophrenia group, the mean scores before treatment were PANSS-∑ 78.6±6.55 and CGI-s 5.25±0.46, indicating moderate disorder severity. At discharge, scores improved significantly to PANSS-∑ 47.5±9.35 and CGI-i 3.83±0.38. For the psychopathic-like schizophrenia group, initial scores were PANSS-∑ 100.56±13.06 and CGI-s 5.26±0.89, reflecting significant disorder severity. Post-treatment scores showed partial symptom reduction: PANSS-∑ 62.86±12.7 and CGI-i 4.1±0.66. In the undifferentiated schizophrenia group, baseline scores were PANSS-∑ 100.73±10.5 and CGI-s 75±0.46, indicating severe severity. At discharge, scores improved slightly to PANSS-∑ 71.92±12.7 and CGI-i 5.5±0.56. Lastly, in the childhood schizophrenia group, initial scores were PANSS-∑ 107.53±11.3 and CGI-s 6.85±0.58, indicating severe to extremely severe severity. Discharge scores showed minimal improvement: PANSS-∑ 87.66±10.7 and CGI-i 5.9±0.46, suggesting limited response to high doses of neuroleptics, even when combined with strong sedatives.

Conclusion. In certain cases, treatment with one or two neuroleptics may be insufficient, leading to polypharmacy in clinical practice. Combination neuroleptic therapy can effectively address various psychopathological symptoms. However, further comparative studies of different therapeutic regimens, the development of treatment protocols that include both conventional and atypical neuroleptics, and evidence-based guidelines for dosage are necessary for treating children and adolescents with schizophrenia spectrum disorders.