For severe behavioral problems in children, which antipsychotics are indicated?

• A. Haloperidol
• B. Pimozide
• C. Haloperidol and Pimozide
• D. Risperidone

Answer: (C)

When severe behavioral problems in children are present, antipsychotics are considered for their ability to calm aggression and, in tic disorders, to reduce tic severity. Haloperidol has a long track record of effectiveness for managing aggressive behavior and motor/vocal tics, making it a common choice in pediatric care when these symptoms are prominent. Pimozide is another potent option with specific indications for Tourette syndrome and related tic disorders, where it can substantially lessen tic frequency and intensity.

Because both have demonstrated benefit in these contexts, either can be indicated depending on the individual patient’s symptoms and risk profile. However, safety considerations are crucial: haloperidol can cause extrapyramidal symptoms and other movement disorders with longer use, while pimozide carries a risk of QT prolongation and torsades de pointes, necessitating careful cardiac monitoring. In practice, clinicians weigh these risks against potential benefits and may choose between them based on the clinical picture and monitoring capacity.