Metabolic consequences of second-generation antipsychotics in youth: appropriate monitoring and clinical management

Krill, Rebecca A; Kumra, Sanjiv

doi:10.2147/ahmt.s49807

Cited by 8 publications

(8 citation statements)

References 55 publications

(123 reference statements)

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“…A study which allowed participants to self-select exercise intensity consequently found that participants selected a moderate-intensity exercise . Due to the physical and psychological barriers to PA in this population (Kumra & Krill, 2014;Mangerud, Bjerkeset, Lydersen, & Indredavik, 2013), moderate-intensity exercise may be perceived as more acceptable (Stubbs et al, 2018). However, perceptions of a preferred intensity may differ between individuals.…”

Section: Study and Participant Characteristicsmentioning

confidence: 99%

Physical activity for adolescents with severe mental illness: a systematic scoping review

Anthony

Kinnafick

Papathomas

et al. 2020

International Review of Sport and Exercise Psychology

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Adolescents with severe mental illness (SMI) engage in lower levels of physical activity (PA), a modifiable risk factor for poor physical health. Although PA is associated with physical and psychological benefits in adult SMI populations, few studies focus exclusively on adolescents. This systematic scoping review aimed to identify the characteristics, outcomes, and feasibility of studies which have attempted to engage or increase PA in adolescents with SMI. Web of Science, PsycINFO, PubMed and psycARTICLES were used to identify articles published between 2007-2019. PRISMA guidelines were followed in reporting the results. Ten studies, with a total of 281 participants (mean age: 16.1 ± 0.72) met the inclusion criteria. Seven studies aimed to yield improvements in the primary diagnosis in addition to other clinical outcome measures. Five studies adopted a 3x weekly schedule, though exercise modality, duration and intensity varied. Seven found improvements in the primary diagnosis, with five reporting sustained improvement at follow-up. Participant completion of the intervention ranged between 73-90%. Adolescents with SMI will adhere to and experience a range of positive outcomes from a range of exercise modalities and intervention lengths. However, significant heterogeneity between studies limits conclusions with that can be drawn regarding beneficial outcomes and feasibility.

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Section: Study and Participant Characteristicsmentioning

confidence: 99%

Physical activity for adolescents with severe mental illness: a systematic scoping review

Anthony

Kinnafick

Papathomas

et al. 2020

International Review of Sport and Exercise Psychology

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“…Parents could be reluctant to administer antipsychotics to their children, and concern towards adverse events often leads parents to shift towards complementary and alternative medicines [ 12 , 13 ]. Adverse events related to antipsychotics, such as increased appetite, weight gain, diabetes mellitus, and hyperlipidemia [ 14 , 15 ], may also discourage clinicians from prescribing them in children and adolescents with ASD. Adverse events can as well lead to treatment discontinuation and switch to other drugs.…”

Section: Introductionmentioning

confidence: 99%

Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder: a systematic review

D’Alò¹,

Crescenzo

Amato³

et al. 2020

BMC Psychiatry

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Background It is unclear whether the administration of antipsychotics to children and adolescents with autism spectrum disorders (ASD) is acceptable, equitable, and feasible. Methods We performed a systematic review to support a multidisciplinary panel in formulating a recommendation on antipsychotics, for the development of the Italian national guidelines for the management of ASD. A comprehensive search strategy was performed to find data related to intervention acceptability, health equity, and implementation feasibility. We used quantitative data from randomized controlled trials to perform a meta-analysis assessing the acceptability and tolerability of antipsychotics, and we estimated the certainty of the effect according to the GRADE approach. We extracted data from systematic reviews, primary studies, and grey literature, and we assessed the risk of bias and methodological quality of the published studies. Results Antipsychotics were acceptable (dropouts due to any cause: RR 0.61, 95% CI 0.48–0.78, moderate certainty of evidence) and well tolerated (dropouts due to adverse events: RR 0.99, 95% CI 0.55–1.79, low certainty of evidence) by children and adolescents with ASD. Parents and clinicians did not raise significant issues concerning acceptability. We did not find studies reporting evidence of reduced equity for antipsychotics in disadvantaged subgroups of children and adolescents with ASD. Workloads, cost barriers, and inadequate monitoring of metabolic adverse events were indirect evidence of concerns for feasibility. Conclusion Antipsychotics in children and adolescents with ASD were likely acceptable and possibly feasible. We did not find evidence of concern for equity.

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“…Over the last 2 decades, there has been increasing widespread use of second-generation antipsychotic (SGA) medications in nonpsychotic pediatric populations in the United States and Europe. [1][2][3] As the ubiquity of SGA drugs in treatment plans for these children and adolescents grows, so does the controversy surrounding them.…”

mentioning

confidence: 99%

“…These findings confirm previous reports using conventional anthropometry, which showed rapid-onset obesity and glucose dysregulation in children using SGA medications, as well as the greatest weight gain and adverse changes in glucose metabolism in those treated with olanzapine. 2,5 Anthropometric measurements, including body mass index measurements, are easy to use clinically but may misrepresent adiposity. Although insulin resistance is commonly diagnosed by pediatric clinicians, it is rarely measured directly in children or adolescents.…”

mentioning

confidence: 99%

“…12,13 There is thus an unmet need for appropriate monitoring and clinical treatment of youths receiving SGA medication. 2,3 All children and youngsters receiving any SGA drug should be screened at baseline to identify high-risk individuals (those with a personal or family history of obesity and/or diabetes) and to ensure early detection of changes in metabolic parameters. As weight markedly increases during the first weeks or months of treatment, it is important to measure weight and waist circumference weekly to identify early patients who gain weight (particularly abdominal weight) rapidly.…”

mentioning

confidence: 99%

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The Urgent Need for Optimal Monitoring of Metabolic Adverse Effects in Children and Youngsters Who Take On-label or Off-label Antipsychotic Medication

Hert

Detraux

2018

JAMA Psychiatry

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Over the last 2 decades, there has been increasing widespread use of second-generation antipsychotic (SGA) medications in nonpsychotic pediatric populations in the United States and Europe. 1-3 As the ubiquity of SGA drugs in treatment plans for these children and adolescents grows, so does the controversy surrounding them. Antipsychotic medications can induce cardiometabolic abnormalities (such as obesity, hyperglycemia, and dyslipidemia) that are associated with an increased risk of cardiovascular disease and type 2 diabetes mellitus (DM). 3-5 These adverse effects tend to appear faster and to a greater extent in children and adolescents than in adults. 4 In this vulnerable population, roughly the same hierarchy for risk of weight gain with these agents has been identified (with olanzapine having the highest risk, risperidone showing an intermediate risk, and aripiprazole having less effect on body weight) but at a higher rate. 4,5 Generally, this weight gain is rapid during the first few weeks or months of medication use, slows gradually thereafter, and often reaches a plateau within 1 year. 5 Although the occurrence of new cases of DM in antipsychotic-exposed youths remains small, SGA-treated children nevertheless have a 2-fold to 3-fold increased risk of developing type 2 DM compared with SGAnaive children. This risk increases with higher cumulative doses (particularly with olanzapine), longer treatment duration, and adjunctive antidepressant use, and it seems to remain high for a certain period of time after discontinuation. 3,6 High interindividual variability of these adverse effects among patients treated with a given agent suggests that underlying biological or genetic factors predispose children to metabolic adverse effects during SGA treatment. 5 This explains why not all children and adolescents show these adverse effects. Although these adverse effects have been known for a while, no prospective randomized clinical trial has focused on adverse antipsychotic effects on direct measures of both adiposity and insulin sensitivity in antipsychotic-naive children until recently. In this issue of JAMA Psychiatry, Nicol et al 7 used gold-standard measures of adiposity (dual-energy x-ray absorptiometry and magnetic resonance imaging) and insulin sensitivity (a hyperinsulinemic-euglycemic clamp) and found that 12 weeks of treatment with low-dose olanzapine, risperidone, or aripiprazole in children with disruptive behavioral disorders who were antipsychotic-naive produced rapid-onset adverse changes in adiposity and insulin, with larger increases

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Metabolic consequences of second-generation antipsychotics in youth: appropriate monitoring and clinical management

Cited by 8 publications

References 55 publications

Physical activity for adolescents with severe mental illness: a systematic scoping review

Physical activity for adolescents with severe mental illness: a systematic scoping review

Acceptability, equity, and feasibility of using antipsychotics in children and adolescents with autism spectrum disorder: a systematic review

The Urgent Need for Optimal Monitoring of Metabolic Adverse Effects in Children and Youngsters Who Take On-label or Off-label Antipsychotic Medication

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