Atypical antipsychotic poisoning in young children: a multicentre analysis of poisons centres data

Abstract

Although paediatric patients frequently suffer from intoxications with atypical antipsychotics, the number of studies in young children, which have assessed the effects of acute exposure to this class of drugs, is very limited. The aim of this study was to achieve a better characterization of the acute toxicity profile in young children of the atypical antipsychotics clozapine, olanzapine, quetiapine, and risperidone. We performed a multicentre retrospective analysis of cases with atypical antipsychotics intoxication in children younger than 6 years, reported by physicians to German, Austrian, and Swiss Poisons Centres for the 9-year period between January 1, 2001 and December 31, 2009. One hundred and six cases (31 clozapine, 29 olanzapine, 12 quetiapine, and 34 risperidone) were available for analysis. Forty-seven of the children showed minor, 28 moderate, and 2 severe symptoms. Twenty-nine cases were asymptomatic. No fatalities were recorded. Symptoms predominantly involved the central nervous and cardiovascular systems. Minor reduction in vigilance (Glasgow Coma Scale score >9) (62 %) was the most frequently reported symptom, followed by miosis (12 %) and mild tachycardia (10 %). Extrapyramidal motor symptoms were observed in one case (1 %) after ingestion of risperidone. In most cases, surveillance and supportive care were sufficient to achieve a good outcome, and all children made full recovery. CONCLUSIONS: Paediatric antipsychotic exposure can result in significant poisoning; however, in most cases only minor or moderate symptoms occurred and were followed by complete recovery. Symptomatic patients should be monitored for central nervous system depression and an electrocardiogram should be obtained.

Assessment of Acute Antipsychotic Poisoned Cases Admitted to Tanta University Poison Control Unit

“…The clinical profile of antipsychotic poisoning in our cases demonstrated that about half of the studied cases had mild general symptoms like tachycardia (46.67%), tachypnea (46.67%) and miosis (56.7%) while, small number were presented with serious manifestations like GCS less than 8 (8.3%) and dystonia (6.7%). This was in agreement with the previous reports of lower morbidity and lower lethal effect of antipsychotic poisoning in most of cases specially the atypical ones (Capel et al, 2000, Rasimas and Liebelt, 2012, Meli et al, 2014. Most of our cases didn't consume big doses and most of those who poisoned themselves intended only to seek attention not to kill themselves or ingested the drug accidentally.…”

“…The present study showed that pupil was constricted in more than half of cases (56.7%), dilated in 3.3% and normal in 40% of cases. Pupil size changes were recorded by some previous researches (Pickford, 2000, Meli et al, 2014. Miosis was explained by the α1 adrenergic receptor blocking effect of antipsychotics while mydriasis was explained by the anticholinergic effect of these drugs (Stahl, 2013).…”

“…Also, the unsafe medications storage in addition to unsafe environment and insufficient supervision of children behavior can explain the increased children rate in the sample. Pediatric poisoning with antipsychotics is remarkably increasing in the last years and became a significant cause of morbidity (Meli et al, 2014, Dayasiri et al, 2017.…”

ECG Changes as a Predictive Tool of Outcomes in Antipsychotics Poisoned Patients

“…Unlike our study which revealed a higher incidence of moderate and severe cases. Meanwhile, different literatures demonstrated occurrence of ECG changes in both typical and atypical antipsychotics overdose (Tan et al, 2009 andMeli et al, 2014).…”

“…According to the current increase in antipsychotics prescription, the clinicians confront more cases of antipsychotics poisoning in clinical practice. Thus, predicting major outcomes in such poisoned patients is important to guide management priorities for better outcome (Meli et al, 2014 andBhandari et al, 2018). The standard 12-lead electrocardiogram (ECG) is an available, inexpensive and non-invasive bedside test (Isiguzo et al, 2017).…”