The following assertions summarize the issues discussed in this chapter:

Antipsychotic medications are key components in the comprehensive treatment program of severely mood dysregulated children and adolescents with psychotic symptoms, and for children and adolescents with psychotic disorders.

The second generation antipsychotics (SGA) seem to offer advantages over classical antipsychotics, but they do have their own disadvantages.

The CATIE report (Lieberman, Stroup, et al., 2005) raises questions regarding the role of the first generation antipsychotics (FGAs) and of perphenazine in particular, in the treatment of adult schizophrenia. Perphenazine performed as well as most of the atypical studied (risperidone, quetiapine, ziprasidone, except for olanzapine which demonstrated a gradient of therapeutic superiority over all the medications tried, including perphenazine); olanzapine was, however, the most adiposogenic and prodyslipidemic antipsychotic. 1

For some SGAs, the purported advantages are counterbalanced by deleterious health risks: metabolic, cardiovascular, and others. Cost of medication is an increasing concern.

The SGAs have important tymoleptic functions: they demonstrate anti-manic and antidepressant effects.

Most of the knowledge base in the conceptualization and treatment of psychotic disorders in children and adolescents is derived from adults. It is encouraging that research of SGA medications in pediatric populations is on the rise.

By and large, there are no evidence-based data to support the broad and extensive use of antipsychotics in children and adolescents.

Atypical antipsychotics may pose serious health risks for children and adolescents; these medications can aggravate certain medical conditions or be the cause of new medical complications.