Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics

Carbon, Maren; Kapoor, Sandeep; Sheridan, E. Marcia; Al-Jadiri, Aseel; Azzo, Sally; Sarkaria, Tania; Kane, John M.; Saito, Ema; Correll, Christoph U.

doi:10.1016/j.jaac.2015.06.015

Cited by 33 publications

(24 citation statements)

References 58 publications

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“…The overall methodological quality of the included non-randomized studies (retrospective chart reviews [34, 36, 48, 50, 52, 63, 67]; other non-randomized studies [33, 35, 37, 43, 45, 46, 49, 51, 53–62, 64–66, 68, 73, 75, 76]) was low to moderate (see Table S3 in the ESM).…”

Section: Resultsmentioning

confidence: 99%

“…The meta-analysis includes 41 studies [24–31, 33–37, 43, 45, 46, 48–68, 73–76], with a total of 2114 pediatric patients (see Table S1 in the ESM). Of the 41 studies included, 37 [24–31, 33–37, 43, 45, 46, 48–59, 62, 65–68, 73–76] described the mean age of the participants.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 41 studies included, 37 [24–31, 33–37, 43, 45, 46, 48–59, 62, 65–68, 73–76] described the mean age of the participants. The weighted average age was 11.7 years, with a few outliers: Findling and colleagues [26, 33] focused on participants aged 4–9 years, Bildik et al [34] focused on adolescents aged 15–19 years, and the mean age in the study by Woods et al [35] was 17.1 years.…”

Section: Resultsmentioning

confidence: 99%

“…Meta-analysis revealed a mean EPS incidence of 17.1 % (95 % CI 0.128–0.223) (Table 1). We calculated the incidence of akathisia in 24 trials, with 1660 patients [24–31, 33–36, 46, 48, 52, 54, 55, 57, 58, 64, 66, 68, 73, 75]. Meta-analysis revealed a mean akathisia incidence of 8.8 % (95 % CI 0.059–0.130).…”

Section: Resultsmentioning

confidence: 99%

“…The mean incidence of dystonia, parkinsonism, tremor, and tardive dyskinesia could only be analysed in a smaller group of patients because available data were limited. The mean incidence of tardive dyskinesia was 1.7 % (95 % CI 0.010–0.028; N = 15, n = 1261) [24–27, 30, 33, 34, 46, 55, 56, 58, 65, 67, 68, 73], the mean incidence of tremor was 10.5 % (95 % CI 0.065–0.165; N = 17, n = 1055) [24, 28–30, 34, 48, 50, 55–59, 62, 65, 66, 68, 76], the mean incidence of dystonia was 4.8 % (95 % CI 0.026–0.087; N = 11, n = 785) [24, 25, 27, 29, 31, 34, 46, 48, 55, 64, 68], and the mean incidence of parkinsonism was 20.8 % (95 % CI 0.159–0.269; N = 10, n = 755) [24, 25, 27, 45, 46, 52, 55, 56, 68, 73]. …”

Section: Resultsmentioning

confidence: 99%

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Aripiprazole and Acute Extrapyramidal Symptoms in Children and Adolescents: A Meta-Analysis

et al. 2016

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BackgroundBoth the US FDA and the European Medicines Agency (EMA) have approved aripiprazole for use in adolescents for specific indications. Given the assumed favorable side-effect profile of aripiprazole, its use in children and adolescents has increased for both official and off-label indications (anxiety disorders, eating disorders, personality disorders). However, several cases of children and adolescents with new-onset extrapyramidal symptoms (EPS) after commencing treatment with aripiprazole have been reported, and a more systematic appraisal of this possible risk is lacking.ObjectiveWe conducted a systematic review and a meta-analysis to assess the evidence for acute EPS (acute dystonia, akathisia, Parkinsonism) associated with the use of aripiprazole in children and adolescents.MethodWe searched the MEDLINE and Embase databases (2003–10 April 2016) for clinical trials in pediatric patients (aged 0–18 years) using the keywords ‘aripiprazole’ (regardless of the formulation) and ‘extrapyramidal symptoms’. We evaluated the abstracts of papers using the following exclusion criteria: (1) study design: case report, letter to the editor, editorial, or poster presentation data; (2) unrelated PICOS (population, intervention, comparators, outcomes, study) structure. We performed a meta-analysis, in which we used effect sizes with 95 % confidence intervals (CIs). To examine the homogeneity of the effect size distribution, we used a Q-statistic. When we observed heterogeneity in effect sizes, we assessed the possible influence of moderator variables (age and sex, mean dose, study duration, and method of measuring EPS incidence) and evaluated the suitability of either a fixed or a random model. Finally, we assessed the incidence of EPS in children and adolescents treated with aripiprazole compared with placebo.ResultsAn initial search via PubMed and Embase yielded 328 hits. A manual search of the reference lists of review papers revealed seven additional relevant articles. We included 41 studies, with 2114 pediatric patients, in the meta-analysis. For the analysis of the mean incidence of EPS, data were provided by 24 studies, with a total of 1446 pediatric patients. Meta-analysis revealed a mean EPS incidence of 17.1 % (95 % CI 0.128–0.223). In terms of the incidence of various extrapyramidal side effects, overall, no significant effects of age, sex, mean dose, study duration, or measuring method could be demonstrated. The side effects ‘EPS’, ‘parkinsonism’, and ‘tremor’ were significantly more common in children and adolescents treated with aripiprazole than in those treated with placebo.ConclusionOur meta-analysis provides evidence for a non-negligible incidence of acute EPS in children and adolescents treated with aripiprazole. Although the study has several limitations and further investigation is needed, these findings may help clinicians make more balanced treatment choices and more closely monitor the use of this drug in youth.Electronic supplementary materialThe online version of this article (doi:10.1007/s40...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Aripiprazole and Acute Extrapyramidal Symptoms in Children and Adolescents: A Meta-Analysis

et al. 2016

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Providers’ Behaviors and Beliefs on Prescribing Antipsychotic Medication to Children: A Qualitative Study

Lohr

Davis

Rich

et al. 2017

Community Ment Health J

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Fragmentation in behavioral and mental health care to children has resulted in suboptimal care and high rates of psychotropic medication use, especially antipsychotic medications (APM). A qualitative study, based on the Theory of Planned Behavior (TPB), aimed to better understand prescribing practices, barriers to optimal treatment, and potential interventions to safeguard the use of APM for children in Kentucky. The most common barrier to optimal care was access to mental health specialists. Social norms and pressure from families contribute to increased medication use. We identify promising interventions to safeguard the use of APM through the lens of the TPB.

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Antipsychotic-related EPS: youth vs adult comparisons

2015

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Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics

Cited by 33 publications

References 58 publications

Aripiprazole and Acute Extrapyramidal Symptoms in Children and Adolescents: A Meta-Analysis

Aripiprazole and Acute Extrapyramidal Symptoms in Children and Adolescents: A Meta-Analysis

Providers’ Behaviors and Beliefs on Prescribing Antipsychotic Medication to Children: A Qualitative Study

Antipsychotic-related EPS: youth vs adult comparisons

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