Pharmacological treatment of early and very early onset schizophrenia

Early Onset Schizophrenia (EOS, before age 16–17) and Very Early Onset Schizophrenia (VEOS, before age 12–13) are severe and debilitating pathologies that require a global, multidisciplinary management, including an educational component. As far as pharmacological choices are concerned, most prescriptions are off-label, the international recommendations are overall similar to those of adult schizophrenic disorders, since they provide for treatment with Clozapine in cases of resistance to two lines of antipsychotics. However, some authors recommend a rapid use of Clozapine after failure of first-line treatment because of the superiority of this drug compared to other antipsychotics in EOS and VEOS. Antipsychotics are less effective and less well tolerated in children and teenagers than in adults. Owing to this low tolerance, other therapeutic options are being explored such as rTMS and TDCS. However, more studies would be required to evaluate the effectiveness and/or safety of these new treatment options in children and adolescents.