Anthony C. James is a consultant child and adolescent psychiatrist and honorary senior lecturer at the University of Oxford. His research interests are in early-onset psychoses and bipolar disorder.
Correspondence: Correspondence Dr Anthony C. James, Highfield Adolescent Unit, Warneford Hospital, Oxford OX3 7JX, UK. Email: anthony.james{at}psych.ox.ac.uk
The prescription of antipsychotic medication in children and adolescents (<18 years of age) has increased immensely for a wide range of disorders including psychoses, bipolar disorder, conduct disorder, pervasive developmental disorder and obsessive–compulsive disorder. This has led to some concerns particularly as the evidence base in some areas is not strong, and antipsychotic medication – both first generation (FGA) and second generation (SGA) – is associated with considerable side-effects. Evidence from an increasing number of randomised controlled trials (RCTs) points to therapeutic efficacy with moderate to large effect sizes. However, some RCTs have a small number of participants, are of short duration, and many are industry funded. The use of antipsychotics alongside psychosocial interventions can be recommended in certain disorders, provided there is continued, careful monitoring. It is important to note, however, that for many conditions the use of antipsychotics is not licensed in the UK.