Childhood-Onset Schizophrenia: A Double-blind Clozapine-Haloperidol Comparison

doi:10.1001/archpsyc.1996.01830120020005

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Vol. 53 No. 12, December 1996

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Childhood-Onset Schizophrenia

A Double-blind Clozapine-Haloperidol Comparison

Sanjiv Kumra, MD; Jean A. Frazier, MD; Leslie K. Jacobsen, MD; Kathleen McKenna, MD; Charles T. Gordon, MD; Marge C. Lenane, MSW; Susan D. Hamburger, MA, MS; Amy K. Smith; Kathleen E. Albus; Javad Alaghband-Rad, MD; Judith L. Rapoport, MD

Arch Gen Psychiatry. 1996;53(12):1090-1097.

Abstract

Background
Childhood-onset schizophrenia is a rare but severe form of thedisorder that is often treatmentrefractory. In this study, theefficacy and adverse effects of clozapine and haloperidol werecompared for children and adolescents with early-onset schizophrenia.

Methods
Twenty-one patients (mean [±SD] age, 14.0 ±2.3years) with onset of Diagnostic and Statistical Manual of MentalDisorders, Revised Third Edition— defined schizophreniathat began by age 12 years and who had been nonresponsive totypical neuroleptics participated in the study. Patients wererandomized to a 6-week double-blind parallel comparison of clozapine(mean [ ±SD] final dose, 176± 149 mg/d), or haloperidol,(16±8 mg/d).

Results
Clozapine was superior to haloperidol on all measures of psychosis(P=.04-.002). Positive and negative symptoms of schizophreniaimproved. However, neutropenia and seizures were major concerns.To date, one third of the group has discontinued using clozapine.

Conclusions
Clozapine has striking superiority for positive and negativesymptoms in treatment-refractory childhood-onset schizophrenia.However, due to possibly increased toxic effects in this pediatricpopulation, close monitoring for adverse events is essential.

Author Affiliations

From the Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Md (Drs Kumra, Jacobsen, Alaghband-Rad, and Rapoport and Mss Lenane, Hamburger, Smith, and Albus); Harvard University School of Medicine, Boston, Mass (Dr Frazier); Northwestern University School of Medicine, Chicago, Ill (Dr McKenna); and University of Maryland School of Medicine, Baltimore (Dr Gordon).

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