Section - CAP Smart Takes

04. Efficacy, Tolerability, and Acceptance of Long-Lasting Antipsychotics in Youth

Published on April 1, 2023 Certification expiration date: April 1, 2026

David R. Rosenberg, M.D.

Chair of the Department of Psychiatry & Behavioral Neuroscience - Wayne State University School of Medicine

Key Points

Despite FDA not approving long-lasting antipsychotics for youth, the American Academy of Child and Adolescent Psychiatry recommends their off-label use in patients with schizophrenia and a history of medication nonadherence.
A systematic review of long-lasting antipsychotics in youth revealed limited evidence supporting their efficacy, tolerability, and acceptance, highlighting the urgent need for longer-term, randomized controlled trials in this population.

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Text version

Hi! David Rosenberg here for the Psychopharmacology Institute. In this CAP—or Child and Adolescent Psychiatry—Smart Take, we will examine the role of long-lasting antipsychotics in children and adolescents, specifically their efficacy, tolerability, and acceptance. Moreover, this has particularly high clinical relevance because antipsychotics are one of the most prescribed psychotropic medications in youth. We also know that nonadherence in youth treated with oral antipsychotics is very common. Also, nonadherence in youth with chronic psychosis predicts decreased symptomatic improvement, more functional impairment, lower quality of life, and higher rehospitalization rates.

So, the stakes are very high. Long-lasting injectable antipsychotics offer the benefit of missed medication doses, hopefully being eliminated, limiting gaps in treatment, and in adults with schizophrenia, have been found to decrease relapse and rehospitalization compared with oral antipsychotics. It is important to point out that national agencies, such as the FDA, have not approved the use of long-lasting antipsychotics

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05. Disparities in Pharmacologic Restraint Use in Pediatric Emergency Departments

Learning Objectives:

Understand that balovaptan failed to significantly improve socialization and communication in children and adolescents with ASD.
Understand that no substantial link exists between ADHD medications and the risk of cardiovascular disease in children, adolescents, and adults with ADHD.
Recognize the association between being younger within school grades and a higher prevalence of psychostimulant prescriptions among preterm and term populations.
Understand the clinical relevance of long-lasting antipsychotics for children and adolescents.
Identify the factors associated with the increased utilization of pharmacologic restraints in pediatric emergency departments.

Original Release Date: April 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: April 1, 2026

Expert: David Rosenberg, M.D.

Medical Editor: Lorena Rodriguez, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.