Metabolic and Neurological Complications of Second-Generation Antipsychotic Use in Children

Pringsheim, Tamara; Lam, Darren; Ching, Heidi; Patten, Scott B.

doi:10.2165/11592020-000000000-00000

Cited by 124 publications

(110 citation statements)

References 48 publications

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“…Various studies show that the significant risk for metabolic and other SGA-induced adverse effects calls for appropriate monitoring (34)(35)(36)(37)(38). However, the content and schedule of the physical evaluations and follow-up practices of SGA medications have been diverse in child psychiatric clinical work (7,39,(44)(45)(46), as was also observed in this study.…”

Section: Discussionsupporting

confidence: 53%

“…Some children appear to be more vulnerable than others in developing metabolic adverse effects, and an important goal of an SGA monitoring procedure should be to identify as early as possible those children who are at particular risk for adverse effects (36,47). Some specific genes have already been linked with the increased risk of adverse effects with SGAs, but there are no gene tests available yet in everyday clinical work (47,48).…”

Section: Introductionmentioning

confidence: 99%

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Clinical use of second-generation antipsychotics in children

Kakko

Pihlakoski

Salmelin

et al. 2017

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: The use of second-generation antipsychotic (SGA) medication among child and adolescent psychiatric patients has increased worldwide in recent years. The increase appears to have been more extensive in the USA than in European countries, but the tendency is similar. However, after a peak the use seems to have declined in the USA. Simultaneously with the increasing numbers, the duration of SGA use has lengthened, indications have broadened, and off-label use has increased. Despite existing follow-up recommendations and evidence for the metabolic adverse effects of SGAs in children, research evidence has not translated into clinical practice. Objective: The aim of this study was to assess the clinical use and follow-up practices of SGA medication among child psychiatric patients of one university hospital in Finland. Method: This retrospective patient report-based study was conducted at the Child Psychiatric Clinic of Tampere University Hospital, Finland. The study sample consisted of 133 patients who were younger than 13 years when initiating SGA treatment and had an ongoing SGA medication during the study period. The study sample was divided into two groups according to diagnosis to examine whether there were differences between patients with an autistic or a developmental disorder (F83-84) and patients with other psychiatric diagnoses. Results: This study showed that SGA use in children younger than 13 years was mainly off-label. Irrespective of diagnosis, the most common indication was aggression. Especially children with psychiatric diagnoses other than developmental disorders had multiple socio-demographic risk factors and adverse life experiences in their background. The follow-up practices were diverse and partly irregular. Conclusions: A need for systematic SGA monitoring practices and dialogue between the medical specialities treating children and their families is evident.

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Clinical use of second-generation antipsychotics in children

Kakko

Pihlakoski

Salmelin

et al. 2017

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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“…The high health care costs among AAPtreated patients were consistent across all cost components and for both all-cause and mental health-related services. The current study did not evaluate the reasons behind the increased resources use, which could be potentially related to the degree of ADHD symptom control, 5,8 side effects of AAPs, [33][34][35] or other reasons. Further research is needed to investigate the exact causes.…”

Section: Limitationsmentioning

confidence: 97%

Comparative Treatment Patterns, Resource Utilization, and Costs in Stimulant-Treated Children with ADHD Who Require Subsequent Pharmacotherapy with Atypical Antipsychotics Versus Non-Antipsychotics

Sikirica¹,

Pliszka²,

Betts³

et al. 2012

JMCP

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“…5 Moreover, the upswing in off-label prescriptions is paralleled by safety concerns related to adverse events, such as weight gain, diabetes, hyperprolactinemia and abnormal movements (e.g., tardive dyskinesia). 6,7 In September 2013, the American Psychiatric Association sought to address health and safety concerns regarding the off-label use of antipsychotic medications in the US by publishing a list of best practices for prescribing antipsychotic drugs as part of an initiative called Choosing Wisely. 8 The American Psychiatric Association's list of best practices applies to both adults and children.…”

mentioning

confidence: 99%