Ultrasound In examining the ventricular size of fetuses of mothers with schizophrenia, mild ventriculomegaly was apparent and associated with older mothers and a shorter gestation.95,96 Psychopharmacological treatment This section presents pharmacological approaches to treating psychosis in children, which can be divided into three categories: (i) COS; (ii) psychosis related to depression; and (iii) psychosis related to bipolar disorder. Neuroleptics may be Inhibitors,research,lifescience,medical needed for acute management of substance-induced psychosis

or psychosis related to a general medical condition or delirium, but the details are beyond the scope of this manuscript. PNOS that cannot be better conceptualized in children and adolescents as part of the schizophrenia spectrum or a mood disorder may be better managed with observation and psychosocial interventions, unless

severe aggression or agitation warrants Inhibitors,research,lifescience,medical acute use of a neuroleptic. Treatment of childhood-onset schizophrenia The majority Inhibitors,research,lifescience,medical of data on neuroleptic treatment of schizophrenia is from adult studies of typical and atypical neuroleptics. Several neuroleptics are Food and Drug Administration (FDA)-indicated for psychotic disorders in children and adolescents, but none of the indications is based on adequate controlled treatment data in individuals below age 18 years97 : chlorpromazine (Thorazine®) for ages ≥6 months; thioridazine (Mellaril®) for ages ≥2 years; and haloperidol Inhibitors,research,lifescience,medical (Haldol®)

for ages ≥3 years. Only two published controlled studies of typical neuroleptics demonstrated efficacy (both included haloperidol; one also included loxitane) in the treatment of COS. Only one published controlled study of an atypical neuroleptic (clozapine) demonstrated efficacy in the treatment of COS. Despite the presence of efficacy data, haloperidol, loxitane, and Clozaril are not considered to be first-line treatments of COS or any psychosis in children and adolescents because of their adverse effect Inhibitors,research,lifescience,medical (AE) profiles. Atypical agents, such as risperidone and olanzapine, are more likely first choices because of easier tolerability, although weight gain has emerged as a problematic AE. Typical, neuroleptics Both haloperidol Astemizole (2-16 mg/day) and loxitane (10-200 mg/day) proved superior to placebo in a 4-week treatment study of 75 adolescents (aged 13-18 years) with acute schizophrenia.98 All treatment groups showed noticeable improvement based on ratings on the BPRS; subjects rated as severe or very severe tended to show more improvement on CB-839 active medication. Sedation occurred in more than half the subjects on active drug: about 50% on haloperidol and about 80% on loxitane experienced sedation. Extrapyramidal symptoms (EPSs) occurred in about 70% of treated subjects.