Monitoring and Treatment of Weight Gain in Children and Adolescents Treated with Second Generation Antipsychotics (SGAs)

2011 ◽  
Vol 1 (1) ◽  
pp. 3-5
Author(s):  
Shannon N. Saldaña ◽  
Jaclyn Kawsky
Keyword(s):  
Insulin Resistance ◽  
Weight Gain ◽  
Children And Adolescents ◽  
Second Generation ◽  
Adverse Outcomes ◽  
Metabolic Effects ◽  
Psychiatric Illnesses ◽  
Metabolic Monitoring ◽  
Second Generation Antipsychotics

ABSTRACT The use of second generation antipsychotics (SGAs) for the treatment of psychiatric illnesses in children and adolescents is increasing. Adverse effects of SGAs include weight gain, dyslipidemia, insulin resistance, and glucose intolerance that can subsequently progress to diabetes. Data suggest that the metabolic effects of SGAs may be more severe in children and adolescents than in adults. The mechanism of SGA-related weight gain is not fully understood and almost certainly due to a combination of factors. A vital first step to minimize risk and long-term adverse outcomes from SGA treatment is to implement consistent metabolic monitoring.

scholarly journals Patient, Treatment, and Health Care Utilization Variables Associated with Adherence to Metabolic Monitoring Practices in Children and Adolescents Taking Second-Generation Antipsychotics

2018 ◽  
Vol 63 (4) ◽  
pp. 240-249 ◽  
Author(s):  
Mary Coughlin ◽  
Catherine Lindsay Goldie ◽  
Joan Tranmer ◽  
Sarosh Khalid-Khan ◽  
Deborah Tregunno
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Children And Adolescents ◽  
Second Generation ◽  
Retrospective Chart Review ◽  
Patient Treatment ◽  
Care Utilization ◽  
Metabolic Monitoring ◽  
Second Generation Antipsychotics ◽  
Outpatient Psychiatry

Objective: Children and adolescents with a range of psychiatric disorders are increasingly being prescribed atypical or second-generation antipsychotics (SGAs). While SGAs are effective at treating conduct and behavioural symptoms, they infer significant cardiometabolic risk. This study aims to explore what patient, treatment, and health care utilization variables are associated with adherence to Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) metabolic monitoring guidelines. Method: A retrospective chart review of 294 children and adolescents accessing a large outpatient psychiatry setting within a 2-year study period (2014-2016) was conducted. Baseline and follow-up metabolic monitoring, demographic, treatment, and health care utilization variables were then assessed over a 1-year period of interest. Results: Metabolic monitoring practices did not adhere to CAMESA guidelines and were very poor over the 1-year observation period. There were significant differences between children (ages 4-12 years, n = 99) and adolescents (ages 13-18 years, n = 195). In adolescents, factors associated with any baseline metabolic monitoring were a higher number of psychiatry visits (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.10 to 1.41), longer duration of contact (OR, 14; 95% CI, 2.31 to 82.4), and use of other non-SGA medications (OR, 3.2; 95% CI, 1.17 to 8.94). Among children, having an emergency room visit (OR, 3.4; 95% CI, 1.01 to 11.71) and taking aripiprazole (OR, 7.4; 95% CI, 2.02 to 27.45) increased the odds of receiving baseline metabolic monitoring. Conclusion: Findings from this study highlight the need for better metabolic monitoring for children and adolescents taking SGAs. Enhanced focus on opportunities for multidisciplinary collaboration is needed to improve the quality of care offered to this population.

Enhancing metabolic monitoring for children and adolescents using second-generation antipsychotics

2017 ◽  
Vol 27 (3) ◽  
pp. 1188-1198 ◽  
Author(s):  
Mary Coughlin ◽  
Catherine L. Goldie ◽  
Deborah Tregunno ◽  
Joan Tranmer ◽  
Marina Kanellos-Sutton ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Second Generation ◽  
Metabolic Monitoring ◽  
Second Generation Antipsychotics

scholarly journals Pathophysiology of drug induced weight and metabolic effects: findings from an RCT in healthy volunteers treated with olanzapine, iloperidone, or placebo

2018 ◽  
Vol 32 (5) ◽  
pp. 533-540 ◽  
Author(s):  
Jacob S Ballon ◽  
Utpal B Pajvani ◽  
Laurel ES Mayer ◽  
Zachary Freyberg ◽  
Robin Freyberg ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Body Weight ◽  
Weight Gain ◽  
Food Intake ◽  
Energy Expenditure ◽  
Glucose Tolerance ◽  
Healthy Volunteers ◽  
Second Generation ◽  
Metabolic Effects ◽  
Insulin Metabolism

Second generation antipsychotics are prescribed for an increasing number of psychiatric conditions, despite variable associations with weight gain, dyslipidemia, and impaired glucose tolerance. The mechanism(s) of the apparent causal relationships between these medications and metabolic effects have been inadequately defined and are potentially confounded by genetic risk of mental illness, attendant lifestyle, and concomitant medications. Therefore, we conducted a study in which 24 healthy volunteers were randomized to olanzapine (highly weight-gain liability), iloperidone (less weight-gain liability), or placebo treatment for 28 days under double-blind conditions. We hypothesized that antipsychotics induce weight gain primarily through increased caloric intake, which causes secondary dyslipidemia and insulin resistance. Subjects were phenotyped pre- and post-treatment for body weight, adiposity by dual energy X-ray absorptiometry, energy expenditure by indirect calorimetry, food intake, oral glucose tolerance, plasma lipids, glucose, insulin, and other hormones. We found significantly increased food intake and body weight but no change in energy expenditure in olanzapine-treated subjects, with associated trends towards lipid abnormalities and insulin resistance the extent of which were presumably limited by the duration of treatment. Iloperidone treatment led to modest non-significant and placebo no weightgain, lipid increases and alterations in insulin metabolism. We conclude that second generation antipsychotic drugs, as represented by olanzapine, produce their weight and metabolic effects, predominantly, by increasing food intake which leads to weight gain that in turn induces metabolic consequences, but also through other direct effects on lipid and glucose metabolism independant of food intake and weight gain.

scholarly journals Long-Term Metabolic Monitoring of Youths Treated with Second-Generation Antipsychotics 5 Years after Publication of the CAMESA Guidelines Are We Making Progress? Surveillance Métabolique à Long Terme des Jeunes Traités par Antipsychotiques de Deuxième Génération, Cinq ans Après la publication des Lignes Directrices Camesa: Faisons-Nous des Progrès?

2020 ◽  
pp. 070674372097484
Author(s):  
Sarra Jazi ◽  
Leila Ben-Amor ◽  
Pascale Abadie ◽  
Marie-Line Menard ◽  
Rachel Choquette ◽  
...  
Keyword(s):  
Second Generation ◽  
Diagnostic Category ◽  
Fisher Exact Test ◽  
Anthropometric Measures ◽  
Psychiatric Comorbidities ◽  
Mental Health Clinics ◽  
Exact Test ◽  
Metabolic Monitoring ◽  
Second Generation Antipsychotics

Objective: The potential metabolic adverse effects of second-generation antipsychotics (SGA) need to be monitored. The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics (CAMESA) offers guidelines for this purpose. We aimed to evaluate the long-term rates of youths receiving monitoring in mental health clinics and document the factors that may influence them. Method: The charts of 180 patients (13.3 ± 3.1 years, 54.4% males) receiving SGA treatment for the first time between January 2016 and June 2018 were reviewed. Monitoring was divided into baseline and 1- to 6-month and 9- to 24-month periods. Population under study was stratified into children (4 to 12 years) and adolescents (13 to 18 years). Sociodemographic characteristics, psychiatric diagnosis and comorbidities, prescribed SGAs and comedications, anthropometric measures (AM), blood pressure (BP), blood tests (BT), electrocardiogram, and the psychiatrist’s years of practice were collected. Cross tables were used to present the monitoring rates. Categories were compared by covariate analysis. Rates of patients monitored across categories were compared using Fisher exact test. Results: Monitoring rates for AM, BT, and BP were 55%, 47.8%, and 46.7% at baseline; 50%, 41.7%, and 45.2% at 1 to 6 months; and 47.2%, 41.5%, and 40.6% at 9 to 24 months, respectively. Higher monitoring rates were significantly associated with adolescent status (baseline, 1 to 6 months), a diagnosis of psychotic and/or affective disorder (baseline, 1 to 6 months, 9 to 24 months), having ≤1 psychiatric comorbidities (1 to 6 months), high SGA dose (baseline, 1 to 6 months), and clinician’s experience (baseline, 9 to 24 months). Significantly lower monitoring rates were associated with the psychostimulant/atomoxetine comedication (baseline, 1 to 6 months, 9 to 24 months). Conclusion: Five years after publication of the CAMESA guidelines, metabolic monitoring is conducted for less than half of patients. In our sample, age, diagnostic category, psychiatric comorbidities, SGA dose, clinician’s experience, and comedications influenced the monitoring rates. Major progress still needs to be made before reaching a satisfactory level of monitoring.

Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: A systematic review of randomized, placebo controlled trials and guidelines for clinical practice

2011 ◽  
Vol 26 (3) ◽  
pp. 144-158 ◽  
Author(s):  
M. De Hert ◽  
M. Dobbelaere ◽  
E.M. Sheridan ◽  
D. Cohen ◽  
C.U. Correll
Keyword(s):  
Systematic Review ◽  
Weight Gain ◽  
Side Effects ◽  
Children And Adolescents ◽  
Second Generation ◽  
Controlled Trials ◽  
Paediatric Patients ◽  
Cardiovascular Morbidity And Mortality ◽  
Second Generation Antipsychotics ◽  
Wide Range

AbstractSecond-generation antipsychotics (SGA) are being used more often than ever before in children and adolescents with psychotic and a wide range of non-psychotic disorders. Several SGA have received regulatory approval for some paediatric indications in various countries, but off-label use is still frequent. The aim of this paper was to perform a systematic review and critically evaluate the literature on cardiometabolic and endocrine side-effects of SGA in children and adolescents through a Medline/Pubmed/Google Scholar search of randomized, placebo controlled trials of antipsychotics in children and adolescents (<18 years old) until February 2010. In total, 31 randomized, controlled studies including 3595 paediatric patients were identified. A review of these data confirmed that SGA are associated with relevant cardiometabolic and endocrine side-effects, and that children and adolescents have a high liability to experience antipsychotic induced hyperprolactinaemia, weight gain and associated metabolic disturbances. Only weight change data were sufficiently reported to conduct a formal meta-analysis. In 24 trials of 3048 paediatric patients with varying ages and diagnoses, ziprasidone was associated with the lowest weight gain (−0.04 kg, 95% confidence interval [CI]: −0.38 to +0.30), followed by aripiprazole (0.79 kg, 95% CI: 0.54 to 1.04], quetiapine (1.43 kg, 95% CI: 1.17 to 1.69) and risperidone (1.76 kg, 95% CI: 1.27 to 2.25) were intermediate, and olanzapine was associated with weight gain the most (3.45 kg, 95% CI: 2.93 to 3.97). Significant weight gain appeared to be more prevalent in patients with autistic disorder who were also younger and likely less exposed to antipsychotics previously. These data clearly suggest that close screening and monitoring of metabolic side effects is warranted and that the least cardiometabolically problematic agents should be used first whenever possible. A good collaboration between child- and adolescent psychiatrists, general practitioners and paediatricians is essential to maximize overall outcomes and to reduce the likelihood of premature cardiovascular morbidity and mortality.

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