Section - CAP Smart Takes

05. Long-Acting Injectable Antipsychotics for Schizophrenia Spectrum Disorders in Youth

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

David R. Rosenberg, M.D.

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

Key Points

Early-onset schizophrenia is associated with a worse outcome compared with its onset in adulthood, and long-acting injectable antipsychotics can provide significant symptom improvement in managing the disorder in youth.
Although long-acting injectable antipsychotics show promise in the treatment of adolescents with schizophrenia, there is a critical lack of randomized controlled trials, especially for children under 12.
When considering antipsychotic treatment for youth, it's crucial to weigh the potential benefits of long-acting injectables against side effects and to monitor for comorbid substance use.

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Hi! David Rosenberg here for the Psychopharmacology Institute. In this CAP Smart Take, we focus on the role of long-acting injectable antipsychotics in managing schizophrenia spectrum disorders in children and adolescents. Early-onset schizophrenia is associated with a worse outcome compared with its onset in adulthood; poor treatment adherence and insight are common in early-onset schizophrenia. Baeza and colleagues conducted a comprehensive and systematic analysis of the available literature on this topic. Most articles reported the use of second-generation long-acting injectable antipsychotics. Risperidone was most commonly prescribed once every two weeks; paliperidone palmitate was prescribed monthly and was the second most common. Other medications included aripiprazole—prescribed monthly—and olanzapine pamoate—prescribed once monthly. Of note, 21 patients used first-generation long-acting injectable antipsychotics; however, their use has decreased over the years. Treatment nonadherence was a primary reason for prescribing these medications. Across studies, these antipsychotics led to significant symptom improvement.

A glaring absence is

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Learning Objectives:

Discuss the risks for reduced relapse for major depressive episodes in youth with continued antidepressant use vs placebo for 6-12 months.
Recognize the potential benefits and rare but severe side effects of antipsychotics in children with anorexia nervosa.
Recognize that there is no dose–response relationship in children and adolescents between sertraline exposure and cognitive, emotional, and behavioral outcomes as well as height.
Discuss the absence of an association between dissociative effects and depression improvement with ketamine or midazolam in treatment-resistant adolescents.
Discuss the potential efficacy of long-acting antipsychotics in adolescents with schizophrenia.

Original Release Date: October 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: October 1, 2026

Expert: David Rosenberg, M.D.

Medical Editor: Melissa Mariano, 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.