However, data suggesting a significantly greater risk for parkinsonism, akathisia, and tardive dyskinesia and a lack of evidence for lower weight gain compared to aripiprazole and ziprasidone do not seem to argue sufficiently for first-generation antipsychotic use as a first-line strategy in youth.
Prescribing antipsychotics to anyone–especially children and adolescents–is a sobering task. The reality, however, is that some seriously ill patients need these medications to restore their functionality. If we choose to use these powerful medications, however, it is also our job to monitor each patient's treatment outcomes. This is particularly relevant when it comes to monitoring body weight, and fasting blood glucose and lipids. Such monitoring should be performed at the time of initiation of antipsychotic treatment, at 3 months and 6-monthly thereafter (J. Acad. Child Adoles. Psychiatry 2008;47:9-20).
Healthy lifestyle instruction and treatment, as well as psychosocial interventions, should be used to optimize outcomes. Moreover, medications should only be used for as long as needed.
Without such individualized approaches that adjust the treatment regimen based on quantified outcomes, we cannot optimize the treatment in youth who are developing and changing because of the environment they grow up in, their psychiatric condition(s), and the treatments we prescribe.