Editorial: Making Use of What We Know: Medical Decision-Making and Antipsychotics

Abstract

Minimizing the duration of untreated psychosis and providing comprehensive early intervention including the use of antipsychotics reflects best practice in the treatment of first-episode psychosis (FEP).¹ The adverse effects of second-generation antipsychotics (SGAs) are well known, namely, weight gain, hyperglycemia, and dyslipidemia that are associated with an increased risk of obesity, type 2 diabetes, and cardiovascular disease. Youth appear to be more vulnerable to deleterious cardiometabolic effects than adults.² Child and adolescent psychiatrists (CAPs) treating FEP have an ethical duty to carefully select an effective antipsychotic medication, being cognizant of the metabolic profile of the considered SGAs and of the likelihood of prolonged antipsychotic exposure. Which is the "right" antipsychotic medication for the young person in front of me? What is known about the adverse effects of available antipsychotics and how do they compare to each other, not just to placebo? Does information exist to help me anticipate whether my patient is more or less susceptible to adverse cardiometabolic effects?