Psychosis in Kids

Antipsychotics in Kids: What the TEOSS Study Taught Us About Balancing Risks and Results

Description:
Treating schizophrenia in children and teens often requires urgent intervention — but choosing the right medication isn’t always clear-cut. The TEOSS Study (Treatment of Early-Onset Schizophrenia Spectrum Disorders), published in the American Journal of Psychiatry, compared three commonly used antipsychotics in young people. It found that while symptoms can improve, side effects — especially metabolic ones — can be significant. The message? Treatment is essential, but we must weigh long-term health just as much as symptom control.

The Takeaway!

In youth with schizophrenia spectrum disorders, all three medications tested in TEOSS helped to some extent. But their side effect profiles varied greatly — and that’s where the real story lies.

• Molindone: 50% responded, but had more akathisia (a movement disorder causing inner restlessness)
• Risperidone: 46% responded, with moderate metabolic effects
• Olanzapine: Only 34% responded — and it caused the most weight gain, as well as increased cholesterol, insulin resistance, and liver enzyme levels

In short: efficacy is important, but side effect risks — especially metabolic ones — should guide medication choices in kids.

Why Should You Care?

Because antipsychotics in kids aren’t rare — and neither are their risks. One TEOSS finding that stands out: Olanzapine, while commonly used, led to major metabolic changes in youth, including weight gain and insulin resistance. These side effects aren’t just temporary — they can impact lifelong health. That’s why the medication you choose today can echo years into a child’s future.

The Article

The TEOSS Study was a randomized, double-blind, multi-site clinical trial — a gold-standard design for comparing treatments. Published in the American Journal of Psychiatry, it offers reliable data for pediatric psychiatrists, pediatricians, and families navigating early-onset schizophrenia. Its strength lies in both its head-to-head comparison and its focus on both efficacy and tolerability — something not all trials emphasize.

The Clinical Data

Here’s how the three medications performed:

Bottom line: symptom improvement matters — but metabolic safety matters more in the long run, especially in kids.

Study Design: How They Figured This Out

• Study Name: TEOSS (Treatment of Early-Onset Schizophrenia Spectrum Disorders)
• Type: Randomized, double-blind, multi-site clinical trial
• Participants: 119 youth, ages 8–19, with early-onset schizophrenia spectrum disorders
• Medications Compared: Molindone, Risperidone, Olanzapine
• Duration: 8 weeks of treatment, with longer-term monitoring
• Published in: American Journal of Psychiatry

This design allowed researchers to evaluate both how well the medications worked and how safe they were over time in a real-world pediatric population.

Why This Study Changed My Practice

Before TEOSS, I focused almost entirely on symptom control in youth with psychosis. But this study taught me something critical: the treatment that works short-term may carry heavy long-term costs.

Since then, I’ve changed how I talk to families.
Now I say:
“We’re not just treating the hallucinations — we’re protecting your child’s heart, metabolism, and future.”

Here’s what I do differently:

• I avoid starting with olanzapine in most pediatric cases unless other options fail
• I monitor weight, blood sugar, and lipids early and often
• I have honest conversations with families about side effect risks and alternatives
• I consider behavioral therapy and psychosocial support alongside medication

In short: I now treat early psychosis as a marathon, not a sprint.

What Parents Should Know

• Yes, antipsychotics can help. They often reduce hallucinations, paranoia, and disorganized thinking.
• But not all are the same. Some carry serious risks to weight, blood sugar, and liver function — especially olanzapine.
• It’s okay to ask questions. Monitoring side effects is essential, and safer alternatives may exist.
• This isn’t just about today. Every medication choice affects your child’s long-term health.
• Teamwork matters. You and your doctor should work together to find the safest, most effective option.

Final Thought

The TEOSS Study reshaped how we approach antipsychotic use in kids. In pediatric psychiatry, the stakes are higher — growing bodies need not just symptom relief, but protection. Treating early psychosis is vital. But treating it wisely — with both compassion and caution — is how we give kids the best chance at recovery and a healthy future.

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🔗 Link to the study: https://pubmed.ncbi.nlm.nih.gov/17667476/