In recent years we've witnessed a rapid rise in the off-label use of atypical antipsychotics (AAPs) in child and adolescent psychiatry practice despite still limited evidence base for their efficacy and safety.

To investigate the patterns of use and frequency of side effects of AAP therapy in children and adolescents with psychotic disorders in Latvia.

Retrospective chart review of all inpatients with schizophrenia spectrum disorder diagnosis, treated in Children's Clinical University Hospital, Riga, Latvia from September 2008 till September 2011.

We identified 126 admissions (F/M ratio - 1,5; mean age - 13,83 (SD 2,69) years), 32 being first-admissions. Most frequent diagnoses were juvenile-onset (34,1%) and paranoid (23.8%) schizophrenia. in 91,3% cases patients received antipsychotic therapy (28,6% only AAPs, 11,9% only typical antipsychotics (TAPs), 50,8% a combination of both). Most widely used AAPs were Quetiapine - 34,9%, Risperidone - 26,2%, Olanzapine - 19,8% and Aripiprazole - 15,9%. Haloperidol was still used in 49,2% cases. in 58,7% cases patients also received anticholinergic medication, so reports of extrapyramidal side effects were anecdotal. in 31,0% cases (9 patients on AAPs, 30 on combined treatment) there was a significant (>400 mU/L) increase of serum prolactin level. in 15,9% cases there was a significant (>450 ms) elongation of QTc interval.

AAPs are rapidly substituting TAPs as the firsthand treatment for children with schizophrenic psychoses, but the rate of side effects is significant, with as much as 1/3 of those receiving AAPs developing hyperprolactinaemia, and 1/5 - a prolongation of QTc interval.