Rapoport et al stated in "Childhood-Onset Schizophrenia" (Arch Gen Psychiatry. 1997;54:897-903) that "the possibility that clozapine treatment accelerates adolescent brain change cannot be ruled out"^(p902) as a cause of brain abnormalities found on magentic resonance imaging studies. All the children diagnosed schizophrenic in this study were also participating in a double-blind comparison study of haloperidol and clozapine therapy. At a 2-year prospective follow-up study 12 patients were taking clozapine and the remaining 4 were taking risperidone. In addition, many patients were taking multiple psychiatric medications.

Polypharmacy would very likely increase this risk. This study should be taken as one more indication that neuroleptics can cause organic brain disease as detected by magnetic resonance imaging.^1,2 It probably indicates that children are even more vulnerable to this unfortunate outcome than are adults.