Metabolic and Cardiovascular Adverse Events Associated With Antipsychotic Treatment in Children and Adolescents

McIntyre, Roger S.; Jerrell, Jeanette M.

doi:10.1001/archpedi.162.10.929

Cited by 158 publications

(124 citation statements)

References 33 publications

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“…We were also unable to assess if the provision of pharmacological or non-pharmacological intervention influenced the MRR associated with DBDs. Atypical antipsychotics are increasingly used for the treatment of these disorders (Toteja et al, 2014) and are associated with increased risk of metabolic and cardiovascular events in children and adolescents (McIntyre and Jerrell, 2008). However, it is unknown if there is an excess mortality associated with atypical antipsychotics in children and young people which would be of interest in future studies.…”

Section: Discussionmentioning

confidence: 99%

Mortality in individuals with disruptive behavior disorders diagnosed by specialist services – A nationwide cohort study

Scott

Erskine

Bikic

et al. 2017

Psychiatry Research

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Section: Discussionmentioning

confidence: 99%

Mortality in individuals with disruptive behavior disorders diagnosed by specialist services – A nationwide cohort study

Scott

Erskine

Bikic

et al. 2017

Psychiatry Research

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“…244,245 Unfortunately, antimanic SGAs (with the exception of ziprasidone) have been shown to negatively impact each of the MetS components in pharmacoepidemiological studies and in controlled trials. 56,240,246,247 Despite metabolic monitoring guidelines (ie, glucose, lipids, weight, blood pressure) for patients treated with SGAs from the American Diabetes Association/American Psychiatric Association 248 and the International Society for Bipolar Disorder, 249 adherence to these monitoring guidelines is poor, particularly among youth. 250,251 Patient-, clinician-, and system-level strategies are warranted to increase the proportion of youth achieving guideline-concordant monitoring benchmarks.…”

Section: Second-generation Antipsychotic Drugsmentioning

confidence: 99%

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

Goldstein¹,

Carnethon²,

Matthews³

et al. 2015

Circulation

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383

288

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Abstract-In the 2011 "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children andAdolescents," several medical conditions among youth were identified that predispose to accelerated atherosclerosis and early cardiovascular disease (CVD), and risk stratification and management strategies for youth with these conditions were elaborated. Major depressive disorder (MDD) and bipolar disorder (BD) among youth satisfy the criteria set for, and therefore merit inclusion among, Expert Panel tier II moderate-risk conditions. The combined prevalence of MDD and BD among adolescents in the United States is ≈10%, at least 10 times greater than the prevalence of the existing moderate-risk conditions combined. The high prevalence of MDD and BD underscores the importance of positioning these diseases alongside other pediatric diseases previously identified as moderate risk for CVD. The overall objective of this statement is to increase awareness and recognition of MDD and BD among youth as moderate-risk conditions for early CVD. To achieve this objective, the primary specific aims of this statement are to (1) summarize evidence that MDD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD and (2)

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“…Unfortunately, all are associated with significant adverse effects (Kowatch et al 2005(Kowatch et al , 2009. A medical claim study found higher rates of a variety of adverse cardiometabolic effects in > 4000 youth who had been prescribed an atypical antipsychotic or one of two conventional antipsychotics, than in a random sample of 4500 youth not treated with psychotropics (McIntyre and Jerrell 2008). An open-label study of second-generation antipsychotic treatment in inpatient youth with various psychiatric diagnoses showed weight gain with all (including aripiprazole, olanzapine, quetiapine, and risperidone), after 12 weeks, compared with youth who had received no treatment.…”

Section: Introductionmentioning

confidence: 99%

Nutritional and Safety Outcomes from an Open-Label Micronutrient Intervention for Pediatric Bipolar Spectrum Disorders

Frazier

Gracious²,

Arnold³

et al. 2013

Journal of Child and Adolescent Psychopharmacology

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Objective: The purpose of this study was to report the safety, tolerability, and serum micronutrient concentrations and their correlations with mood changes from an 8 week pilot feasibility study of a 36 ingredient multinutrient supplement, EMPowerplus (EMP+), for pediatric bipolar spectrum disorders (BPSD). Methods: Ten children ages 6-12 received EMP + escalating from one to four capsules t.i.d., with four children increased to the maximum suggested dose, five capsules t.i.d. Outcome measures were micronutrient concentrations in serum and red blood cells, vital signs, body mass index (BMI), dietary intake (Food Frequency Questionnaire and 24 hour dietary recall interview), and mood and global functioning ratings. Results: Seven children (70%) completed the study. Three (30%) terminated early for tolerability and compliance issues. Adverse effects were mild and transient, and chiefly consisted of initial insomnia or gastrointestinal (GI) upset. No differences occurred in BMI ( p = 0.310) or waist-hip ratio (WHR; p = 0.674) pre-to postsupplementation. Four of the tested serum vitamin concentrations increased from pre-to postsupplementation: vitamin A-retinol, vitamin B6, vitamin E-a-tocopherol; and folate (all p < 0.05). The increase in serum 25-OH vitamin D approached significance ( p = 0.063). No differences were found in dietary intake pre-to postsupplementation, suggesting that blood nutrient level increases were caused by EMP + . Conclusions:In this open prospective study, short-term use of EMP + in children with BPSD appeared safe and welltolerated, with a side effect profile preferable to first-line psychotropic drugs for pediatric bipolar spectrum disorders. A double-blind, randomized clinical trial is feasible, appears safe, and is warranted by open-label clinical outcomes and plausible mechanisms of action, combined with documentation of increased serum concentrations of specific micronutrients.

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Metabolic and Cardiovascular Adverse Events Associated With Antipsychotic Treatment in Children and Adolescents

Abstract: Antipsychotics are associated with several metabolic and cardiovascular-related adverse events in pediatric populations, especially when multiple antipsychotics or classes of psychotropic medications are coprescribed, controlling for individual risk factors.

Cited by 158 publications

References 33 publications

Mortality in individuals with disruptive behavior disorders diagnosed by specialist services – A nationwide cohort study

Mortality in individuals with disruptive behavior disorders diagnosed by specialist services – A nationwide cohort study

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

Nutritional and Safety Outcomes from an Open-Label Micronutrient Intervention for Pediatric Bipolar Spectrum Disorders

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