1
|
Merino D, Gérard AO, Destere A, Saidessalam H, Askenazy F, Montastruc F, Drici MD, Thümmler S. Cardiac and metabolic safety profile of antipsychotics in youths: A WHO safety database analysis. Psychiatry Res 2024; 334:115786. [PMID: 38387164 DOI: 10.1016/j.psychres.2024.115786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/03/2024] [Accepted: 02/10/2024] [Indexed: 02/24/2024]
Abstract
A significant heterogeneity prevails in antipsychotics (APs) safety monitoring recommendations. Youths are deemed more vulnerable to cardiometabolic side effects. We aimed to assess age-dependent reporting of cardiac and metabolic disorders in youths, relying on the WHO safety database (VigiBase®). VigiBase® was queried for all reports of cardiac, glucose, lipid and nutritional disorders involving APs. Patients <18 years were classified as pediatric population. Disproportionality analyses relied on the Information Component (IC): the positivity of the lower end of its 95 % confidence interval was required to suspect a signal. We yielded 4,672 pediatric reports. In disproportionality analysis, nutritional disorders were leading in youths (IC 3.9 [3.9-4.0]). Among healthcare professionals' reports, stronger signals were detected in youths than in adults. Children had the greatest signal with nutritional disorders (IC 4.7 [4.6-4.8]). In adolescents, aripiprazole was ascribed to non-alcoholic steatohepatitis (NASH). Our findings, based on real-world data, support the hypothesis of a greater propensity for nutritional disorders in youths, despite limitations of pharmacovigilance studies. We suggest specific safety profiles, such as aripiprazole and NASH. Pending more answers from population-based studies, a careful anamnesis should seek for risk factors before AP initiation. A cautious monitoring is warranted to allow earlier identification of side effects.
Collapse
Affiliation(s)
- Diane Merino
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice, CHU-Lenval, Nice, France; Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital CHU de Nice, Nice, France; Université Côte d'Azur, CoBTeK, Nice, France
| | - Alexandre O Gérard
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital CHU de Nice, Nice, France; Université Côte d'Azur, Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, Nice, France
| | - Alexandre Destere
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital CHU de Nice, Nice, France; Université Côte d'Azur, Inria, CNRS, Laboratoire J.A. Dieudonné, Maasai team, Nice, France
| | - Haitam Saidessalam
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital CHU de Nice, Nice, France
| | - Florence Askenazy
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice, CHU-Lenval, Nice, France; Université Côte d'Azur, CoBTeK, Nice, France
| | - François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Faculty of Medicine, Toulouse University Hospital, Toulouse, France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance Center of Nice, University Hospital CHU de Nice, Nice, France
| | - Susanne Thümmler
- University Department of Child and Adolescent Psychiatry, Children's Hospitals of Nice, CHU-Lenval, Nice, France; Université Côte d'Azur, CoBTeK, Nice, France.
| |
Collapse
|
2
|
Tabata K, Son S, Miyata J, Toriumi K, Miyashita M, Suzuki K, Itokawa M, Takahashi H, Murai T, Arai M. Association of homocysteine with white matter dysconnectivity in schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:39. [PMID: 38509166 PMCID: PMC10954654 DOI: 10.1038/s41537-024-00458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Several studies have shown white matter (WM) dysconnectivity in people with schizophrenia (SZ). However, the underlying mechanism remains unclear. We investigated the relationship between plasma homocysteine (Hcy) levels and WM microstructure in people with SZ using diffusion tensor imaging (DTI). Fifty-three people with SZ and 83 healthy controls (HC) were included in this retrospective observational study. Tract-Based Spatial Statistics (TBSS) were used to evaluate group differences in WM microstructure. A significant negative correlation between plasma Hcy levels and WM microstructural disruption was noted in the SZ group (Spearman's ρ = -.330, P = 0.016) but not in the HC group (Spearman's ρ = .041, P = 0.712). These results suggest that increased Hcy may be associated with WM dysconnectivity in SZ, and the interaction between Hcy and WM dysconnectivity could be a potential mechanism of the pathophysiology of SZ. Further, longitudinal studies are required to investigate whether high Hcy levels subsequently cause WM microstructural disruption in people with SZ.
Collapse
Grants
- 19K17061 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 18H02749 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 18H05130 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 20H05064 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 23H04979 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 21H02849 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 21H05173 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- 23H02844 Ministry of Education, Culture, Sports, Science and Technology (MEXT)
- JP18dm0307008 Japan Agency for Medical Research and Development (AMED)
- JP21uk1024002 Japan Agency for Medical Research and Development (AMED)
- JPMJCR22P3 MEXT | JST | Core Research for Evolutional Science and Technology (CREST)
- The Novartis Pharma Research Grant; SENSHIN Medical Research Foundation; SUZUKEN Memorial Foundation; the Takeda Science Foundation.
- the Brain/MINDS Beyond program (23dm0307008) from the Japan Agency for Medical Research
Collapse
Affiliation(s)
- Koichi Tabata
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuraku Son
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuya Toriumi
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mitsuhiro Miyashita
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kazuhiro Suzuki
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masanari Itokawa
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Center for Brain Integration Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Makoto Arai
- Schizophrenia Research Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| |
Collapse
|
3
|
Curtis J, Teasdale SB, Morell R, Wadhwa P, Watkins A, Lederman O, O'Donnell C, Fibbins H, Ward PB. Implementation of a lifestyle and life-skills intervention to prevent weight-gain and cardiometabolic abnormalities in young people with first-episode psychosis as part of routine care: The Keeping the Body in Mind program. Early Interv Psychiatry 2024. [PMID: 38334187 DOI: 10.1111/eip.13508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/28/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES In 2013, a cluster-controlled pilot study found the 12-week Keeping the Body in Mind (KBIM) lifestyle and life skills intervention was able to prevent weight gain in a small sample of youth experiencing first-episode psychosis (FEP) with fewer than 4 weeks of antipsychotic exposure. This study aims to evaluate the effectiveness of KBIM as routine care on anthropometry and metabolic biochemistry in a larger sample of youth with FEP across three community mental health services. METHOD This retrospective chart audit was conducted on youth with FEP, prescribed a therapeutic dose of antipsychotic medication, and who engaged with KBIM between 2015 and 2019. Primary outcomes were weight and waist circumference. Secondary outcomes were blood pressure, blood glucose, and blood lipids. Outcomes were collected in at baseline and at 12 weeks. Data on program engagement were obtained from the participant's medical file. RESULTS One-hundred and eighty-two people met inclusion criteria, and up to 134 people had baseline and 12-week data on one or more outcome. Mean number of sessions attended was 11.1 (SD = 7.3). Increases in weight and waist circumference were limited to 1.5 kg (SD = 5.3, t(133) = 3.2, p = .002) and 0.7 cm (SD = 5.8, t(109) = 1.2, p = .23) respectively. Eighty-one percent of participants did not experience clinically significant weight gain (>7% of baseline weight). There were no significant changes in blood pressure or metabolic biochemistry. CONCLUSION The prevention of substantial gains in weight and waist circumference observed in the initial pilot study was maintained with implementation of KBIM as part of routine clinical care for youth with FEP.
Collapse
Affiliation(s)
- Jackie Curtis
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Mindgardens Neuroscience Network, Sydney, New South Wales, Australia
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia
| | - Scott B Teasdale
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Mindgardens Neuroscience Network, Sydney, New South Wales, Australia
| | - Rachel Morell
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Mindgardens Neuroscience Network, Sydney, New South Wales, Australia
| | - Prarthna Wadhwa
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia
| | - Andrew Watkins
- Mindgardens Neuroscience Network, Sydney, New South Wales, Australia
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Oscar Lederman
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia
- School of Health Sciences, UNSW Sydney, Kensington, New South Wales, Australia
| | | | - Hamish Fibbins
- Mindgardens Neuroscience Network, Sydney, New South Wales, Australia
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia
| | - Philip B Ward
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Schizophrenia Research Unit, South Western Sydney Local Health District and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| |
Collapse
|
4
|
ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S258-S281. [PMID: 38078582 PMCID: PMC10725814 DOI: 10.2337/dc24-s014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
5
|
Psychiatric Disorders and Obesity in Childhood and Adolescence-A Systematic Review of Cross-Sectional Studies. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020285. [PMID: 36832413 PMCID: PMC9955505 DOI: 10.3390/children10020285] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
Obesity and psychiatric disorders have high prevalence and are both considered major health problems. Within the last decades, the rates of obesity have risen over 6%, while the prevalence of psychiatric disorders is over 12% for children and adolescents. The aim of this study was to systematically review the evidence regarding the relation of obesity and psychiatric disorders in childhood and adolescence. This review, based on the PRISMA guidelines, included cross-sectional studies published within the last decade, pertaining to the relation between psychiatric disorders and obesity in children and adolescents up to the age of 19 years. Studies on eating disorders were excluded. A total of 14 studies of 23,442 children and adolescents that investigated the relation of obesity with anxiety, mood disorders, and psychosis were included in this systematic review. Nine of the included studies reported a significant relationship between the psychiatric disorder under investigation and obesity. Understanding the nexus between obesity and psychiatric disorders in children and adolescents is of great importance, given the alarming increase in both conditions in youth. Such findings could facilitate the development and implementation of targeted interventions.
Collapse
|
6
|
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S230-S253. [PMID: 36507640 PMCID: PMC9810473 DOI: 10.2337/dc23-s014] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
7
|
Claridy MD, Perez NP, Czepiel KS, Acholonu NO, Stanford FC. Association Between Weight Promoting Medication Use and Weight Status Among Children and Adolescents in the United States. Acad Pediatr 2023; 23:102-108. [PMID: 35533966 PMCID: PMC10042467 DOI: 10.1016/j.acap.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 04/15/2022] [Accepted: 04/30/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The objectives of this study were to 1) examine the prevalence of prescription medication use overall and 2) examine the association between weight promoting medication (WPM) use by therapeutic class and weight status among a nationally representative sample of the children and adolescents in the United States. This study also further investigated antidepressant medication use among this population. METHODS This cross-sectional study used data from the National Health and Nutrition Examination Survey from 2013 to 2018. Children and adolescents ages 2 to 19 years were included in this study. RESULTS Of the 68,057,468 derived participants (34,507,154 [50.7%] male; 33,564,059 [49.3%] aged 2-10 years; 34,905,058 [51.3%] non-Hispanic White), 14,895,618 (22.2%) used a prescription medication in the prior 30 days, 21.7% (3,235,323) of which were considered weight promoting. There was no significant difference between weight status and WPM use for overall prescription medication use. Nevertheless, for overall antidepressant medication use, those with obesity were less likely to be prescribed antidepressant WPM when compared to those with normal weight (adjusted odds ratios 0.4; 95% confidence interval 0.2-0.7). CONCLUSIONS These findings suggest that although there was no significant association between WPM use and weight status overall when examining the association by therapeutic class, most children with obesity were not using antidepressant WPM. This is reassuring and potentially an active attempt at avoiding the use of medications that have an exacerbating effect on weight gain. When choosing antidepressant medications, providers, parents, and patients consider the WPM effects and appropriately choose a medication best suited to the child's health status.
Collapse
Affiliation(s)
- Mechelle D Claridy
- Department of Epidemiology and Biostatistics, University of Georgia (MD Claridy), Athens, Ga
| | - Numa P Perez
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School (NP Perez), Boston, Mass
| | - Kathryn S Czepiel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford School of Medicine (KS Czepiel), Stanford, Calif
| | - Nonyerem O Acholonu
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School (NO Acholonu), Boston, Mass
| | - Fatima Cody Stanford
- Department of Medicine, Neuroendocrine Unit, Department of Pediatrics, Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School (FC Stanford), Boston, Mass.
| |
Collapse
|
8
|
Guber KM, Cortes ND, Duan L. Risk of Obesity Among Children Prescribed Atypical Antipsychotics for Six Months or More. J Child Adolesc Psychopharmacol 2022; 32:52-60. [PMID: 34283934 DOI: 10.1089/cap.2021.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: The study investigates the risk of obesity for young children prescribed an atypical antipsychotic (AAP) for 6 months or more. AAPs are associated with risk of obesity. They are used in children for a variety of psychiatric conditions and are often prescribed off-label. Long-term risk of obesity in this age group is unknown as most studies are short-term investigations and generally combine younger children with adolescents and adults. Methods: A retrospective cohort of children, 10 years old or younger, prescribed either an AAP or selective serotonin reuptake inhibitor (SSRI) for 6 months or more were followed for up to 9.5 years. The primary endpoint was the body-mass index (BMI) reaching the 95th percentile. Results: One thousand six hundred fifty-five patients met inclusion criteria. One thousand one hundred eighteen patients were prescribed an AAP and 537 were prescribed an SSRI: 1152 (74.5%) patients were male and mean (standard deviation) age was 7.9 [1.90] years at study entry. Median follow-up was 3.58 years for the AAP cohort and 3.28 years for the SSRI cohort (p = 0.02). After adjusting for baseline demographic variables, BMI, and other concomitantly prescribed medications, children prescribed AAPs for 6 months or longer were twice as likely to become obese compared with children prescribed SSRIs (adjusted hazard ratio [HR] 2.06 [95% confidence interval; CI 1.60-2.66], p < 0.0001). Further stratification by AAP revealed that the obesity risk for patients prescribed aripiprazole was 34% greater than for those prescribed risperidone (adjusted HR 1.34 [95% CI 1.01-1.78], p = 0.0033). Conclusions: The risk of obesity for young children prescribed an AAP for 6 months or more is approximately double that of children prescribed an SSRI. The risk of obesity is greater with aripiprazole than risperidone in the first year. Prescribers should consider the risk of obesity when prescribing AAPs and consider alternative treatment modalities in this vulnerable patient population.
Collapse
Affiliation(s)
- Kevin Meis Guber
- San Bernardino County Department of Psychiatry, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Fontana, California, USA
| | - Natasha Dasig Cortes
- San Bernardino County Department of Psychiatry, Southern California Permanente Medical Group, Kaiser Permanente Southern California, Fontana, California, USA
| | - Lewei Duan
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| |
Collapse
|
9
|
Pozzi M, Ferrentino RI, Scrinzi G, Scavone C, Capuano A, Radice S, Nobile M, Formisano P, Clementi E, Bravaccio C, Carnovale C, Pisano S. Weight and body mass index increase in children and adolescents exposed to antipsychotic drugs in non-interventional settings: a meta-analysis and meta-regression. Eur Child Adolesc Psychiatry 2022; 31:21-37. [PMID: 32617775 DOI: 10.1007/s00787-020-01582-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/22/2020] [Indexed: 12/28/2022]
Abstract
Antipsychotics increase weight, BMI and waist size, particularly in pediatric patients. Switching antipsychotics is common practice, thus defining the risk for each antipsychotic in real-life settings can be important for clinical guidance. We conducted a meta-analysis on antipsychotic-related changes in body measures in pediatric observational studies. Of 934 publications found on PubMed, we analyzed 38, including nine treatment arms: no treatment, mixed antipsychotic treatment, first-generation antipsychotics, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone. Changes in weight, BMI, BMI-Z and waist size were meta-analyzed according to the duration of clinical observations: 6, 12, > 12 months. Meta-regressions probed influencing factors. Weight in Kg was increased at 6, 12, > 12 months by olanzapine [+ 10.91, + 10.7, data not available (n/a)], mixed antipsychotic treatment (n/a, + 9.42, + 12.59), quetiapine (+ 5.84, n/a, n/a) and risperidone (+ 4.47, + 6.01, + 9.51) and without treatment (n/a, + 2.3, n/a). BMI was increased at 6, 12, > 12 months by olanzapine (+ 3.47, + 3.42, n/a), clozapine (n/a, + 3, n/a) mixed antipsychotic treatment (+ 3.37, + 2.95, + 3.32), risperidone (+ 2, + 2.13, + 2.16), quetiapine (+ 1.5, + 1.82, n/a), aripiprazole (n/a, + 1.7, + 2.1) and without treatment (n/a, + 0.75, n/a). BMI-Z was increased at 6, 12, > 12 months by olanzapine (+ 0.94, + 0.98, + 0.89), clozapine (n/a, + 0.8, n/a), risperidone (+ 0.62, + 0.61, + 0.48), quetiapine (+ 0.57, + 0.54, n/a), mixed antipsychotic treatment (+ 0.51, + 0.94, + 0.44), without treatment (n/a, + 0.37, n/a) and aripiprazole (no gain, + 0.31, n/a). Waist size in cm was increased at 6, 12 months by risperidone (+ 8.8, + 11.5), mixed antipsychotics treatment (+ 9.1, + 10.2) and quetiapine (+ 6.9, + 9.1). Overall, olanzapine and clozapine displayed maximum risk, followed by risperidone, quetiapine and aripiprazole (more risky at longer terms); ziprasidone was associated with no gains. No time-based trends emerged, suggesting a drug-specific risk magnitude. Meta-regressions evidenced variable roles for persistence in therapy and follow-up length, increased risk for drug-naïve patients, and a ceiling effect determined by higher baseline BMI/BMI-Z values.
Collapse
Affiliation(s)
- Marco Pozzi
- Scientific Institute IRCCS E. Medea, 23892, Bosisio Parini, LC, Italy
| | | | - Giulia Scrinzi
- Department of Child and Adolescent Psychiatry and Psychotherapy, Bolzano, Italy
| | - Cristina Scavone
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Capuano
- Section of Pharmacology "L. Donatelli", Department of Experimental Medicine, Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Fatebenefratelli-Sacco Hospital, "Luigi Sacco" University Hospital, Università Di Milano, Via GB Grassi 74, 20157, Milan, Italy
| | - Maria Nobile
- Scientific Institute IRCCS E. Medea, 23892, Bosisio Parini, LC, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Fatebenefratelli-Sacco Hospital, "Luigi Sacco" University Hospital, Università Di Milano, Via GB Grassi 74, 20157, Milan, Italy
| | - Carmela Bravaccio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, Fatebenefratelli-Sacco Hospital, "Luigi Sacco" University Hospital, Università Di Milano, Via GB Grassi 74, 20157, Milan, Italy.
| | - Simone Pisano
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Department of Neuroscience, AORN Santobono-Pausilipon, Naples, Italy
| |
Collapse
|
10
|
Garcia-Rizo C, Cabrera B, Bioque M, Mezquida G, Lobo A, Gonzalez-Pinto A, Diaz-Caneja CM, Corripio I, Vieta E, Baeza I, Garcia-Portilla MP, Gutierrez-Fraile M, Rodriguez-Jimenez R, Garriga M, Fernandez-Egea E, Bernardo M. The effect of early life events on glucose levels in first-episode psychosis. Front Endocrinol (Lausanne) 2022; 13:983792. [PMID: 36545332 PMCID: PMC9762519 DOI: 10.3389/fendo.2022.983792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022] Open
Abstract
First episode of psychosis (FEP) patients display a wide variety of metabolic disturbances at onset, which might underlie these patients' increased morbidity and early mortality. Glycemic abnormalities have been previously related to pharmacological agents; however, recent research highlights the impact of early life events. Birth weight (BW), an indirect marker of the fetal environment, has been related to glucose abnormalities in the general population over time. We aim to evaluate if BW correlates with glucose values in a sample of FEP patients treated with different antipsychotics. Two hundred and thirty-six patients were included and evaluated for clinical and metabolic variables at baseline and at 2, 6, 12, and 24 months of follow-up. Pearson correlations and linear mixed model analysis were conducted to analyze the data. Antipsychotic treatment was grouped due to its metabolic risk profile. In our sample of FEP patients, BW was negatively correlated with glucose values at 24 months of follow-up [r=-0.167, p=0.037]. BW showed a trend towards significance in the association with glucose values over the 24-month period (F=3.22; p=0.073) despite other confounders such as age, time, sex, body mass index, antipsychotic type, and chlorpromazine dosage. This finding suggests that BW is involved in the evolution of glucose values over time in a cohort of patients with an FEP, independently of the type of pharmacological agent used in treatment. Our results highlight the importance of early life events in the later metabolic outcome of patients.
Collapse
Affiliation(s)
- Clemente Garcia-Rizo
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- *Correspondence: Clemente Garcia-Rizo,
| | - Bibiana Cabrera
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana Gonzalez-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Hospital Universitario de Alava, Servicio de Psiquiatría, BIOARABA, University of the Basque Country, Vitoria, Spain
| | - Covadonga M. Diaz-Caneja
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Maria Paz Garcia-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, University of Oviedo, Oviedo, Spain. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Miguel Gutierrez-Fraile
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, University of the Basque Country (UPV/EHU), Vitoria, Spain
- Neurosciences Department, Araba University Hospital, University of the Basque Country (UPV/EHU), Vitoria, Spain
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigacion Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Marina Garriga
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon, United Kingdom
| | - Miguel Bernardo
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | |
Collapse
|
11
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
12
|
Yi W, Sylvester E, Lian J, Deng C. Kidney plays an important role in ketogenesis induced by risperidone and voluntary exercise in juvenile female rats. Psychiatry Res 2021; 305:114196. [PMID: 34488011 DOI: 10.1016/j.psychres.2021.114196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/16/2021] [Accepted: 08/28/2021] [Indexed: 11/27/2022]
Abstract
The positive role of ketone bodies in the treatment for mental disorders has been demonstrated. Ketogenesis can be triggered by not only exercise and diet but also metabolic disorders. This study aimed to explore the role of risperidone and exercise in ketogenesis. Thirty-two juvenile female Sprague Dawley rats were randomly assigned into four groups: Vehicle-Sedentary, Risperidone (0.9 mg/kg; b.i.d)-Sedentary, Vehicle-Exercise (three hours daily access to running wheels) and Risperidone-Exercise groups for four weeks. Exercise-intervention significantly ameliorated the risperidone-induced increase in white adipose mass, fasting plasma triglyceride and insulin levels. Compared to the vehicle-exercise group, the risperidone-exercise group had significantly higher plasma β-hydroxybutyrate (β-HB) level, which had a positive correlation with plasma non-esterified fatty acid levels. Risperidone-treatment upregulated expression of ketogenic key enzyme, mitochondrial 3-hydroxy-3-methyl-glutaryl-CoA synthase 2 (HMGCS2) in the kidney rather than liver. Exercise-intervention significantly enhanced renal carnitine palmitoyltransferase1A (CPT1A) expression. These results suggested that the kidney plays an important role in ketogenesis associated with risperidone and exercise. Therefore, it is important to monitor the levels of plasma ketone bodies while exercise intervention is utilized to prevent risperidone-induced metabolic disorders in young people.
Collapse
Affiliation(s)
- Weijie Yi
- Department of Nutrition and Food Hygiene, School of Public Health and Management, Binzhou Medical University, Yantai, Shandong 264003, China; Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia
| | - Emma Sylvester
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia
| | - Jiamei Lian
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia
| | - Chao Deng
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; School of Medicine and Molecular Horizons, University of Wollongong, Wollongong, NSW, Australia.
| |
Collapse
|
13
|
Wilson C, Nichles A, Zmicerevska N, Carpenter JS, Song YJC, McHugh C, Hamilton B, Hockey S, Scott EM, Hickie IB. Effect of an online healthy lifestyle psychoeducation programme to improve cardiometabolic outcomes and affective symptoms in youth receiving mental health care: study protocol for a pilot clinical trial. BMJ Open 2021; 11:e044977. [PMID: 34187819 PMCID: PMC8245471 DOI: 10.1136/bmjopen-2020-044977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Worsened cardiometabolic profiles in youth with mental ill health have been associated with a number of modifiable lifestyle risk factors. It is becoming increasingly evident that clinical interventions need to be multimodal in focus to improve mental health symptoms and the physical health symptoms in this already at-risk cohort. METHODS AND ANALYSIS This 12-week pilot clinical trial examines the efficacy, feasibility and acceptability of an adjunctive online psychoeducation programme for improving cardiometabolic risk parameters and affective symptoms in a transdiagnostic sample of at least 44 young people aged 16-25 years presenting for mental healthcare for mood and/or psychotic syndromes (including anxiety, depression, bipolar disorder and psychosis). Individuals will be invited to participate in a pilot clinical trial for a structured online psychoeducation programme incorporating nutritional, physical activity, sleep-wake and healthy lifestyle information, delivered fortnightly over six online modules. Participants will undergo a series of assessments including: (1) self-report and clinician administered assessments determining mental health symptomatology; (2) fasting blood tests to assess cardiometabolic markers (fasting insulin, fasting glucose and blood lipids); (3) anthropometric assessments (height, weight, waist circumference and blood pressure); and (4) sleep-wake behaviours and circadian rhythm assessments. Changes in scores for all cardiometabolic and affective measures will be assessed via paired samples t-tests, and correlations between change scores will be assessed via Pearson's or Spearman's correlations. Feasibility will be assessed via completion rates, and the acceptability of the programme will be assessed via programme satisfaction measures. ETHICS AND DISSEMINATION This pilot clinical trial has been approved by the Sydney Local Health District Research Ethics and Governance Office (X20-0228 & 2020/ETH01201). The results of this pilot clinical trial will be disseminated into the scientific and broader community through peer-reviewed journals, conference presentations, social media and university websites. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12620000772943, Date 28 August 2020.
Collapse
Affiliation(s)
- Chloe Wilson
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Alissa Nichles
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Natalia Zmicerevska
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Joanne Sarah Carpenter
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Catherine McHugh
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Blake Hamilton
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Samuel Hockey
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Elizabeth M Scott
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| |
Collapse
|
14
|
Libowitz MR, Nurmi EL. The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children. Front Psychiatry 2021; 12:623681. [PMID: 33776816 PMCID: PMC7994286 DOI: 10.3389/fpsyt.2021.623681] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/17/2021] [Indexed: 12/13/2022] Open
Abstract
Antipsychotic medications are critical to child and adolescent psychiatry, from the stabilization of psychotic disorders like schizophrenia, bipolar disorder, and psychotic depression to behavioral treatment of autism spectrum disorder, tic disorders, and pediatric aggression. While effective, these medications carry serious risk of adverse events-most commonly, weight gain and cardiometabolic abnormalities. Negative metabolic consequences affect up to 60% of patients and present a major obstacle to long-term treatment. Since antipsychotics are often chronically prescribed beginning in childhood, cardiometabolic risk accumulates. An increased susceptibility to antipsychotic-induced weight gain (AIWG) has been repeatedly documented in children, particularly rapid weight gain. Associated cardiometabolic abnormalities include central obesity, insulin resistance, dyslipidemia, and systemic inflammation. Lifestyle interventions and medications such as metformin have been proposed to reduce risk but remain limited in efficacy. Furthermore, antipsychotic medications touted to be weight-neutral in adults can cause substantial weight gain in children. A better understanding of the biological underpinnings of AIWG could inform targeted and potentially more fruitful treatments; however, little is known about the underlying mechanism. As yet, modest genetic studies have nominated a few risk genes that explain only a small percentage of the risk. Recent investigations have begun to explore novel potential mechanisms of AIWG, including a role for gut microbiota and microbial metabolites. This article reviews the problem of AIWG and AP metabolic side effects in pediatric populations, proposed mechanisms underlying this serious side effect, and strategies to mitigate adverse impact. We suggest future directions for research efforts that may advance the field and lead to improved clinical interventions.
Collapse
Affiliation(s)
| | - Erika L. Nurmi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
15
|
Onishi Y, Mikami K, Kimoto K, Watanabe N, Takahashi Y, Akama F, Yamamoto K, Matsumoto H. Second-Generation Antipsychotic Drugs for Children and Adolescents. J NIPPON MED SCH 2021; 88:10-16. [PMID: 32999174 DOI: 10.1272/jnms.jnms.2021_88-108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The effectiveness and safety of antipsychotics have not been fully established in children and adolescents. Many antipsychotics approved for use in adults are prescribed off-label to children and adolescents. We investigated the effectiveness and tolerability of antipsychotics for children and adolescents with schizophrenia and bipolar disorder. A literature review of the empirical evidence regarding the use of antipsychotics, particularly second-generation antipsychotics, in children and adolescents showed that these drugs were safe and effective for this population. Antipsychotics were similarly effective for treatment of schizophrenia and bipolar disorder in children and adolescents. When prescribing antipsychotics to this population, clinicians should consider adverse events and the discontinuation rate in treated patients. However, the current evidence shows a lack of consensus regarding the use of antipsychotics in children and adolescents.
Collapse
Affiliation(s)
- Yuichi Onishi
- Department of Psychiatry, Tokai University School of Medicine
| | | | - Keitaro Kimoto
- Department of Psychiatry, Tokai University School of Medicine
| | | | - Yuki Takahashi
- Department of Psychiatry, Tokai University School of Medicine
| | - Fumiaki Akama
- Department of Psychiatry, Tokai University School of Medicine
| | - Kenji Yamamoto
- Department of Psychiatry, Tokai University School of Medicine
| | - Hideo Matsumoto
- Department of Psychiatry, Tokai University School of Medicine
| |
Collapse
|
16
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
17
|
Savic Hitt TA, Katz LEL. Pediatric Type 2 Diabetes: Not a Mini Version of Adult Type 2 Diabetes. Endocrinol Metab Clin North Am 2020; 49:679-693. [PMID: 33153674 PMCID: PMC7772966 DOI: 10.1016/j.ecl.2020.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pediatric type 2 diabetes mellitus (T2DM) is increasing in incidence, with risk factors including obesity, puberty, family history of T2DM in a first-degree or second-degree relative, history of small-for-gestational-age at birth, child of a gestational diabetes pregnancy, minority racial group, and lower socioeconomic status. The pathophysiology of T2DM consists of insulin resistance and progression to pancreatic beta-cell failure, which is more rapid in pediatric T2DM compared with adult T2DM. Treatment options are limited. Treatment failure and nonadherence rates are high in pediatric T2DM; therefore, early diagnosis and treatment and new pharmacologic options and/or effective behavioral interventions are needed.
Collapse
Affiliation(s)
- Talia Alyssa Savic Hitt
- Division of Endocrinology & Diabetes, Department of Pediatrics, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Buerger Building -12th Floor, Philadelphia, PA 19104, USA.
| | - Lorraine E Levitt Katz
- Division of Endocrinology & Diabetes, Department of Pediatrics, Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, Buerger Building -12th Floor, Philadelphia, PA 19104, USA
| |
Collapse
|
18
|
Razavi BM, Abazari AR, Rameshrad M, Hosseinzadeh H. Carnosic acid prevented olanzapine-induced metabolic disorders through AMPK activation. Mol Biol Rep 2020; 47:7583-7592. [PMID: 32929650 DOI: 10.1007/s11033-020-05825-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
Olanzapine, an atypical antipsychotic medication, has been associated with weight gain and metabolic toxicity, especially in long term usage. Carnosic acid (CA), a major constituent of rosemary extract, has been shown to improve metabolic abnormalities. In this experiment, the effect of CA on olanzapine-induced obesity and metabolic toxicity has been evaluated. Female Wistar rats were divided into six groups. (1) control; (2) olanzapine (5 mg/kg/day, IP); (3, 4 and 5) olanzapine (5 mg/kg/day, IP) plus CA (5, 10 and 20 mg/kg/day, gavage) and (6) CA (20 mg/kg/day, gavage). Bodyweight and food intake were measured during the study. After 14 days, mean systolic blood pressure (MSBP), glycemia, serum lipid profile, the serum concentration of leptin, insulin, AMPK, P-AMPK, and P-ACC liver protein levels were evaluated. The mean weight in the group received olanzapine increased by 4.8 g at the end of the study. The average food intake was increased by olanzapine. Olanzapine increased triglyceride, fasting blood glucose (FBG), and leptin levels. It increased MSBP and down-regulated P-AMPK/AMPK ratio and P-ACC protein levels. CA (three doses) decreased body weight gain and reduced average food intake at 10 and 20 mg/kg. CA especially at the highest dose decreased the changes in lipid profile, FBG, leptin level, and MSBP. P-AMPK/AMPK and P-ACC protein levels were increased by carnosic acid. In conclusion, the activation of AMPK by CA can be proposed as a key mechanism against olanzapine-induced metabolic toxicity where the activation of AMPK increases fat consumption and regulates glucose hemostasis in the liver.
Collapse
Affiliation(s)
- Bibi Marjan Razavi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Reza Abazari
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Rameshrad
- Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Hossein Hosseinzadeh
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. .,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
19
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
20
|
Alvarez-Herrera S, Escamilla R, Medina-Contreras O, Saracco R, Flores Y, Hurtado-Alvarado G, Maldonado-García JL, Becerril-Villanueva E, Pérez-Sánchez G, Pavón L. Immunoendocrine Peripheral Effects Induced by Atypical Antipsychotics. Front Endocrinol (Lausanne) 2020; 11:195. [PMID: 32373066 PMCID: PMC7186385 DOI: 10.3389/fendo.2020.00195] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/18/2020] [Indexed: 12/15/2022] Open
Abstract
Atypical antipsychotics (AAP) or second-generation antipsychotics are the clinical option for schizophrenia treatment during acute psychoses, but they are also indicated for maintenance during lifetime, even though they are being used for other psychiatric conditions in clinical practice such as affective disorders and autism spectrum disorder, among others. These drugs are differentiated from typical antipsychotics based on their clinical profile and are a better choice because they cause fewer side effects regarding extrapyramidal symptoms (EPS). Even though they provide clear therapeutic benefits, AAP induce peripheral effects that trigger phenotypic, functional, and systemic changes outside the Central Nervous System (CNS). Metabolic disease is frequently associated with AAP and significantly impacts the patient's quality of life. However, other peripheral changes of clinical relevance are present during AAP treatment, such as alterations in the immune and endocrine systems as well as the intestinal microbiome. These less studied alterations also have a significant impact in the patient's health status. This manuscript aims to revise the peripheral immunological, endocrine, and intestinal microbiome changes induced by AAP consumption recommended in the clinical guidelines for schizophrenia and other psychiatric disorders.
Collapse
Affiliation(s)
- Samantha Alvarez-Herrera
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Raúl Escamilla
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Oscar Medina-Contreras
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Ricardo Saracco
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Yvonne Flores
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Gabriela Hurtado-Alvarado
- Area of Neurosciences, Department of Biology of Reproduction, CBS, Universidad Autonoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - José Luis Maldonado-García
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Enrique Becerril-Villanueva
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Gilberto Pérez-Sánchez
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Lenin Pavón
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
- *Correspondence: Lenin Pavón
| |
Collapse
|
21
|
Incidence of adverse events in antipsychotic-naïve children and adolescents treated with antipsychotic drugs: Results of a multicenter naturalistic study (ETAPE). Eur Neuropsychopharmacol 2019; 29:1397-1407. [PMID: 31699516 DOI: 10.1016/j.euroneuro.2019.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 01/07/2023]
Abstract
The main objective of ETAPE study was to determine the incidence of adverse events (AEs) potentially related to antipsychotic (AP) during a 12-months observational study of naturalistic treatment. ETAPE is a naturalistic prospective multicenter study conducted between April 2013 and May 2016. 200 patients were included. The mean age was 12 ± 3 years, with 73.6% being males. Patients presented a significant clinical improvement over time. At baseline, 92% of patients received a second generation AP, 74% AP monotherapy and 79.5% off-label AP prescriptions. Clinical diagnoses were heterogeneous including psychosis, anxiety, mood and neurodevelopmental disorders. The overall AE incidence rate was 11.52 AEs per person-years. Among AEs potentially attributable to AP, 15.4% were neuromotor, 14.8% gastroenterological, 12.2% metabolic and 11.8% general symptoms. Weight and body mass index increased significantly. More than half of AE appeared during the first 3 months, but onset of AE was noted all over follow-up. The presence of AEs was stable over time. ETAPE study highlights a high incidence rate of AE in children treated with AP. A careful and continuous clinical and biological monitoring is required to adapt treatment decisions based on benefice-risk-analysis. Moreover, additional research is warranted, also in regard of high proportion of off-label prescriptions.
Collapse
|
22
|
Alonso-Pedrero L, Bes-Rastrollo M, Marti A. Effects of antidepressant and antipsychotic use on weight gain: A systematic review. Obes Rev 2019; 20:1680-1690. [PMID: 31524318 DOI: 10.1111/obr.12934] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/19/2022]
Abstract
Weight gain is an adverse effect of antidepressants and antipsychotics. This side effect can lead to numerous comorbidities and reduces life expectancy. The use of these drugs is increasing worldwide, and the weight gain produced by them represents a common clinical challenge. The goal of this systematic review was to evaluate the potential association of antidepressant and antipsychotic therapy with body weight gain in cohort studies. A search of cohort studies investigating the association between weight gain and the use of antidepressants and antipsychotics in individuals was conducted through the PubMed database from 1 January 2008 to 31 January 2019 following the PRISMA statement. We found 27 independent eligible cohort studies that included children (2-18 years old) and adult (18-103 years old) subjects. Most of the included studies showed a 5% weight gain in individuals using antidepressant therapy. However, Quetiapine, Haloperidol, Trifluoperazine, Risperidone, Aripiprazole, Olanzapine, and Clozapine increased body weight ≥7% from baseline, which is considered a clinically significant result. Weight loss was found in individuals treated with Bupropion. Further cohort studies with higher sample sizes and longer durations of treatment are needed to confirm our observations.
Collapse
Affiliation(s)
- Lucia Alonso-Pedrero
- Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Maira Bes-Rastrollo
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Amelia Marti
- Department of Nutrition, Food Science and Physiology, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
23
|
Singh R, Bansal Y, Sodhi RK, Saroj P, Medhi B, Kuhad A. Modeling of antipsychotic-induced metabolic alterations in mice: An experimental approach precluding psychosis as a predisposing factor. Toxicol Appl Pharmacol 2019; 378:114643. [DOI: 10.1016/j.taap.2019.114643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 02/06/2023]
|
24
|
The effects of antipsychotic medications on microbiome and weight gain in children and adolescents. BMC Med 2019; 17:112. [PMID: 31215494 PMCID: PMC6582584 DOI: 10.1186/s12916-019-1346-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed as treatment for psychotic disorders in adults, as well as in children and adolescents with behavioral problems. However, in many cases, second-generation antipsychotics have unwanted side effects, such as weight gain, potentially further increasing risk for morbidities including obesity, diabetes, and cardiovascular disease. While various mechanisms for this weight gain have been proposed, including effects on metabolic hormone signaling, recent evidence points to the importance of the gut microbiome in this process. The microbial communities residing within the gut are affected by second-generation antipsychotics and can confer weight gain. MAIN TEXT This review summarizes recent findings and presents data linking second-generation antipsychotics, gut microbiota alterations and weight gain. The review focuses on children and adolescent populations, which have not previously received much attention, but are of great interest because they may be most vulnerable to gut microbiome changes and may carry long-term metabolic effects into adulthood. CONCLUSIONS We present correlations between second-generation antipsychotics, gut microbiota alterations and weight gain, and suggest some mechanisms that may link them. A better understanding of the underlying mechanisms may lead to the design of improved treatments for psychotic disorders with fewer harmful side effects.
Collapse
|
25
|
Xu R, Huang F, Zhang S, Lv Y, Liu Q. Thyroid function, body mass index, and metabolic risk markers in euthyroid adults: a cohort study. BMC Endocr Disord 2019; 19:58. [PMID: 31174521 PMCID: PMC6555987 DOI: 10.1186/s12902-019-0383-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 05/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In recent years, the relationship between thyroid stimulating hormone (TSH) and obesity has been widely discussed. However, it is unclear how thyroid hormone concentrations relate to body weight and its impact on metabolic risk markers. This study aimed to assess how thyroid function is linked to underweight, overweight, or obesity, and metabolic risk markers in adults. METHODS A total of 16,975 subjects, aged 18-80 years, who attended the Health Management Center of Tongji Hospital, Wuhan, China were enrolled in this study. Anthropometric and laboratory data were collected and analyzed. RESULTS Serum free triiodothyronine (fT3) and fT3/free thyroxine (fT4) ratio (fT3/fT4) were positively associated with body mass index (BMI) (P < 0.001), while there was a negative relationship between fT4 and BMI (P < 0.001) according to multivariable regression analysis adjusted for age and sex. Associations between thyroid hormone concentrations and markers of blood pressure, and lipid and glucose metabolism were identified after adjustment for age, sex, and BMI, with TSH being negatively associated with fasting blood glucose (FBG). fT3 was positively associated with systolic blood pressure and low-density lipoprotein-cholesterol, while fT4 was positively associated with diastolic blood pressure, FBG, and high-density lipoprotein-cholesterol (HDL-C), and negatively associated with hemoglobin A1c (HbA1c) and triglyceride. Finally, fT3/fT4 was positively associated with HbA1c and triglyceride, and negatively associated with HDL-C. CONCLUSIONS Overweight or obese participants had a high serum concentration of fT3, high fT3/fT4 ratio, and a low concentration of fT4. Underweight participants had high concentrations of fT4 and low concentrations of fT3. Thus, relationships between thyroid hormones and metabolic risk markers were identified which suggest that thyroid function might be one factor that influences body weight and the co-morbidities of obesity.
Collapse
Affiliation(s)
- Ranran Xu
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Hankou, Wuhan, 430030 People’s Republic of China
| | - Fei Huang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Hankou, Wuhan, 430030 People’s Republic of China
| | - Shijie Zhang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Hankou, Wuhan, 430030 People’s Republic of China
| | - Yongman Lv
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Hankou, Wuhan, 430030 People’s Republic of China
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Hankou, Wuhan, 430030 People’s Republic of China
| | - Qingquan Liu
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Hankou, Wuhan, 430030 People’s Republic of China
| |
Collapse
|
26
|
Pozzi M, Pisano S, Marano G, Carnovale C, Bravaccio C, Rafaniello C, Capuano A, Rossi F, Rizzo R, Bernardini R, Nobile M, Molteni M, Clementi E, Biganzoli E, Radice S. Weight-Change Trajectories of Pediatric Outpatients Treated with Risperidone or Aripiprazole in a Naturalistic Setting. J Child Adolesc Psychopharmacol 2019; 29:133-140. [PMID: 30452281 DOI: 10.1089/cap.2018.0092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Second-generation antipsychotics (SGAs) increase appetite and weight, leading toward a metabolic syndrome. Risperidone and aripiprazole, the most widely used pediatric SGAs, have been studied predominantly in short-term clinical trials, where risperidone leads to a rapid weight increase and aripiprazole to a slower one, while long-term effects are not yet elucidated. Factors that may influence weight gain are likewise not clarified, although baseline weight, previous SGA exposure, pubertal status, and type of SGA have been suggested as moderators. We analyzed weight gain induced by risperidone and aripiprazole in a sample of pediatric outpatients enrolled into a 2-year observational study. METHODS We assessed at several time points their body mass index (BMI)-Z scores (age and sex-corrected and referred to national norms). We used hierarchical mixed-effects modeling to design BMI-Z trajectories and observed the effects of several variables on determining them. RESULTS The study group comprised of 127 patients, predominantly males (79%), of 12.6 years on average, treated with risperidone (81%) and aripiprazole (19%) for disruptive behavioral symptoms in patients with and without neurodevelopmental disorders. Overall, BMI-Z was 1.2 at first and 1.4 at last visit (no significant change). We could design four weight-change trajectories, determined by the factors: drug (risperidone/aripiprazole) and age status (children/adolescent). Additional factors not retained in the model but possibly explanatory include the previous duration of SGA treatment and a progressive patient-selection effect due to dropouts in this observational study. Risperidone treatment was associated with trends of BMI-Z increase in children and decrease in adolescents. Aripiprazole treatment was associated with significant BMI-Z increase, higher in children than in adolescents. Results are probably due to longer previous drug exposure in adolescents. CONCLUSIONS Children were at risk of weight gain more than adolescents, for both risperidone and, of note, aripiprazole. Adolescents and patients with long previous drug exposure tend to reach stable BMI-Z, although in the range between excessive weight and obesity.
Collapse
Affiliation(s)
- Marco Pozzi
- 1 Scientific Institute IRCCS Eugenio Medea , Lecco, Italy
| | - Simone Pisano
- 2 Department of Neurosciences, AORN Santobono-Pausilipon , Naples, Italy
| | - Giuseppe Marano
- 3 Department of Clinical Sciences and Community Health, Università degli Studi di Milano , Milan, Italy
| | - Carla Carnovale
- 4 Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan, Italy
| | - Carmela Bravaccio
- 5 Department of Medical Translational Sciences, Università "Federico II ," Napoli, Italy
| | - Concetta Rafaniello
- 6 Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli," University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Annalisa Capuano
- 6 Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli," University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Francesco Rossi
- 6 Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli," University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Renata Rizzo
- 7 Child and Adolescent Neuropsychiatry, Department of Medical and Paediatric Sciences, School of Medicine, University of Catania , Catania, Italy
| | - Renato Bernardini
- 8 Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine, University of Catania , Catania, Italy
| | - Maria Nobile
- 1 Scientific Institute IRCCS Eugenio Medea , Lecco, Italy
| | | | - Emilio Clementi
- 1 Scientific Institute IRCCS Eugenio Medea , Lecco, Italy .,4 Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan, Italy
| | - Elia Biganzoli
- 3 Department of Clinical Sciences and Community Health, Università degli Studi di Milano , Milan, Italy .,9 Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro," Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumori , Milan, Italy
| | - Sonia Radice
- 4 Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan, Italy
| |
Collapse
|
27
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
28
|
A prospective study of adverse effects of antipsychotics in adolescents with schizophrenia during a 6-month follow-up. Int Clin Psychopharmacol 2019; 34:33-36. [PMID: 29958237 DOI: 10.1097/yic.0000000000000232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is a paucity of follow-up studies of neurological, endocrine, and metabolic adverse effects of antipsychotics in adolescents from low-income and middle-income countries, who have a higher prevalence of obesity and overweight, and could present increased morbidity. A Mexican sample of 86 adolescents with schizophrenia was examined during a 6-month follow-up using the Simpson-Angus, abnormal involuntary movement and Barnes Akathisia rating scales, in addition to a side effects score sheet and other laboratory measures. Binary logistic regression models were used to identify specific variables as predictors of weight gain. Sleep difficulties, restlessness, drowsiness, changes in thyroid hormones, and a linear increase in weight gain were observed. A baseline positive and negative syndrome scale score greater than 97 predicted a 5 kg increase at month 3 (odds ratio: 4.52, 95% confidence interval: 1.5-13.2). The absence of a plateau in weight gain in the present study across the 6-month treatment period and its relationship with illness severity suggests that even longer follow-up time should be examined in future studies in these patient populations.
Collapse
|
29
|
Singh R, Bansal Y, Medhi B, Kuhad A. Antipsychotics-induced metabolic alterations: Recounting the mechanistic insights, therapeutic targets and pharmacological alternatives. Eur J Pharmacol 2018; 844:231-240. [PMID: 30529195 DOI: 10.1016/j.ejphar.2018.12.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/02/2018] [Accepted: 12/05/2018] [Indexed: 12/14/2022]
Abstract
Atypical antipsychotics (AAPs) are the drug of choice in the management of mental illnesses by virtue of their advantage over typical antipsychotics i.e. least tendency of producing extrapyramidal motor symptoms (EPS) or pseudoparkinsonism. Despite the clinical efficacy, AAPs produces troublesome adverse effects, particularly hyperphagia, hyperglycemia, dyslipidemia weight gain, diabetes mellitus, insulin resistance and QT prolongation which further develops metabolic and cardiac complications with subsequent reduction in life expectancy, poor patient compliance, and sudden death. AAPs-induced weight gain and metabolic alterations are increasing at an alarming rate and became an utmost matter of concern for psychopharmacotherapy. Diverse underlying mechanisms have been explored such as the interaction of AAPs with neurotransmitter receptors, alteration in food reward anticipation behavior, altered expressions of hypothalamic orexigenic and anorexigenic neuropeptides, histamine H1 receptor-mediated hypothalamic AMP-activated protein kinase (AMPK) activation, increased blood leptin, ghrelin, pro-inflammatory cytokines. Antipsychotics induced imbalance in energy homeostasis, reduction in energy expenditure which is linked to altered expression of uncoupling proteins (UCP-1) in brown adipose tissue and reduced hypothalamic orexin expressions are emerging insights. In addition, alteration in gut-microbiota and subsequent inflammation, dyslipidemia, obesity, and diabetes after AAPs treatment are also associated with weight gain and metabolic alterations. Oral hypoglycemics and lipid-lowering drugs are mainly prescribed in the clinical management of weight gain associated with AAPs while many other pharmacological and nonpharmacological interventions also have been explored in different clinical and preclinical studies. In this review, we critically discuss the current scenario, mechanistic insights, biomarkers, and therapeutic alternatives for metabolic alterations associated with antipsychotics.
Collapse
Affiliation(s)
- Raghunath Singh
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study (UGC-CAS), Panjab University, Chandigarh 160014, India
| | - Yashika Bansal
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study (UGC-CAS), Panjab University, Chandigarh 160014, India
| | - Bikash Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Anurag Kuhad
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study (UGC-CAS), Panjab University, Chandigarh 160014, India.
| |
Collapse
|
30
|
Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association. Diabetes Care 2018; 41:2648-2668. [PMID: 30425094 PMCID: PMC7732108 DOI: 10.2337/dci18-0052] [Citation(s) in RCA: 196] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, PA
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Fida Bacha
- Children's Nutrition Research Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Margaret Grey
- Yale School of Nursing, New Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | - Neil H White
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Philip Zeitler
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO
| |
Collapse
|
31
|
Baeza I, de la Serna E, Calvo-Escalona R, Merchán-Naranjo J, Rodríguez-Latorre P, Martínez-Cantarero MC, Andrés P, Alda JA, Muñoz-Samons D, Ilzarbe D, Arango C, Castro-Fornieles J. One-Year Prospective Study of Liver Function Tests in Children and Adolescents on Second-Generation Antipsychotics: Is There a Link with Metabolic Syndrome? J Child Adolesc Psychopharmacol 2018; 28:463-473. [PMID: 29975563 DOI: 10.1089/cap.2017.0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To analyze liver function tests (LFT), weight, metabolic syndrome (MetS) and at risk of meeting MetS criteria (AR-MetS) in children and adolescents on antipsychotics (AP) during a year-long follow-up. METHODS Two hundred sixteen patients, AP naïve or quasi-naïve (<30 days on AP), were included. Total bilirubin, the enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), weight and other parameters of MetS were measured at baseline, and at 3, 6 and 12 months, while patients remained on the same AP. RESULTS At baseline, patients (mean age: 14.1 ± 3.1 years; 60.2% male) were on risperidone (N = 143), olanzapine (N = 37), or quetiapine (N = 36), although the sample decreased over time to 67 patients at 12 months (risperidone N = 46, olanzapine N = 10, and quetiapine N = 11). Around 3% of patients had ALT/AST levels that were at least twice the upper limit of normal (ULN) at 3 and 6 months; whereas roughly 19% of patients had ALP levels that were at least twice the ULN in at least one assessment after baseline, but had no clinical symptoms. From baseline to 6 months, significant increases were observed in ALT levels in the whole sample (p = 0.005), whereas ALP increased only in patients on risperidone. Patients showed significant weight gain, and more individuals met criteria for MetS and AR-MetS over time (from baseline: 2.8% and 8.3%, to 1 year: 10.5% and 23.9%, respectively). There was a trend-level group effect in global ALT across time (p = 0.076). Patients with MetS showed higher ALT concentrations (28.9 [18.4-39.4] U/L) than AR-MetS (20.4 [8.5-32.2] U/L), and no-AR-MetS (19.2 [8.4-29.9] U/L). CONCLUSIONS Less than 3% of children and adolescents on AP during 1-year follow-up showed an increase in ALT or AST levels in one or more of the assessments, and none of these increases was of clinical significance. Patients with MetS and AR-MetS increased during this period, and the possible role of ALT levels to monitor these patients deserves further study.
Collapse
Affiliation(s)
- Inmaculada Baeza
- 1 Department of Child and Adolescent Psychiatry and Psychology, SGR-881, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdi ques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona , Barcelona, Spain .,2 Department of Medicine, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona , Barcelona, Spain
| | - Elena de la Serna
- 1 Department of Child and Adolescent Psychiatry and Psychology, SGR-881, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdi ques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona , Barcelona, Spain .,2 Department of Medicine, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona , Barcelona, Spain
| | - Rosa Calvo-Escalona
- 1 Department of Child and Adolescent Psychiatry and Psychology, SGR-881, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdi ques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona , Barcelona, Spain .,2 Department of Medicine, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona , Barcelona, Spain
| | - Jessica Merchán-Naranjo
- 3 Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón , School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Pamela Rodríguez-Latorre
- 3 Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón , School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | | | - Patricia Andrés
- 4 Child and Adolescent Psychiatry Department, Hospital Infantil Universitario Niño Jesús , Madrid, Spain
| | - José Angel Alda
- 5 Child and Adolescent Psychiatry Department, Hospital Sant Joan de Déu , CIBERSAM, Barcelona, Spain
| | - Daniel Muñoz-Samons
- 5 Child and Adolescent Psychiatry Department, Hospital Sant Joan de Déu , CIBERSAM, Barcelona, Spain
| | - Daniel Ilzarbe
- 6 Department of Child and Adolescent Psychiatry, Institute of Psychiatry , Psychology and Neuroscience, King's College London, London, United Kingdom .,7 Faculty of Medicine, Universitat de Barcelona , Barcelona, Spain
| | - Celso Arango
- 3 Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón , School of Medicine, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Josefina Castro-Fornieles
- 1 Department of Child and Adolescent Psychiatry and Psychology, SGR-881, Institut Clinic of Neurosciences, Institut d'Investigacions Biomèdi ques August Pi Sunyer (IDIBAPS), Hospital Clínic Universitari of Barcelona , Barcelona, Spain .,2 Department of Medicine, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), University of Barcelona , Barcelona, Spain
| |
Collapse
|
32
|
Pisano S, Coppola G, Catone G, Carotenuto M, Iuliano R, D'Esposito V, Cabaro S, Miraglia Del Giudice E, Bravaccio C, Formisano P. Differences in Metabolic Factors Between Antipsychotic-Induced Weight Gain and Non-pharmacological Obesity in Youths. Clin Drug Investig 2018; 38:457-462. [PMID: 29435908 DOI: 10.1007/s40261-018-0627-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Youth exposed to antipsychotics may experience several metabolic consequences that often limit the effectiveness of this class of drugs. OBJECTIVES The aim of this study was to compare several metabolic markers between subjects who experienced antipsychotic-induced weight gain and untreated obese patients. METHODS Nineteen non-diabetic youth (mean age 159 months, mean body mass index z-score 1.81) experiencing antipsychotic-induced weight gain and an age-, sex-, and body mass index-matched group of non-diabetic obese patients with no record of treatment (n = 19, mean age 147 months, mean body mass index z-score 2) were compared for a wide range of metabolic factors using a Bioplex Multiplex system. RESULTS C-peptide, glucose-dependent insulinotropic polypeptide, and adipsin were significantly higher in the antipsychotic-induced weight gain group, whereas visfatin was significantly higher in the untreated obese patients. When age, sex, pubertal status, and body mass index were controlled, C-peptide, glucose-dependent insulinotropic polypeptide, and visfatin remained significant, whereas adipsin fell slightly below the threshold of statistical significance. No other statistically significant difference emerged. CONCLUSIONS Antipsychotic-induced weight gain and untreated obesity showed some similarities, confirming that levels of some hormones, such as leptin and ghrelin, are related to body mass index rather than to antipsychotic exposure. Some differences were also noted; for example, the antipsychotic-induced weight gain group displayed higher C-peptide, glucose-dependent insulinotropic polypeptide, and adipsin, which may reflect β-cell stress and may suggest susceptibility to insulin resistance and lower visfatin, possibly indicating a lower inflammatory status.
Collapse
Affiliation(s)
- Simone Pisano
- Department of Medicine and Surgery, Clinic of Child and Adolescent Neuropsychiatry, S. Giovanni di Dio and Ruggi d'Aragona Hospital, University of Salerno, Via S. Allende, Baronissi, 84081, Salerno, SA, Italy.
| | - Giangennaro Coppola
- Department of Medicine and Surgery, Clinic of Child and Adolescent Neuropsychiatry, S. Giovanni di Dio and Ruggi d'Aragona Hospital, University of Salerno, Via S. Allende, Baronissi, 84081, Salerno, SA, Italy
| | - Gennaro Catone
- Faculty of Educational Science, Suor Orsola Benicasa University, Naples, Italy
| | - Marco Carotenuto
- Department of Mental and Physical Health and Preventive Medicine, University of Campania, Naples, Italy
| | | | - Vittoria D'Esposito
- Department of Translational Medicine, Federico II University of Naples and URT "Genomics of Diabetes" of the Institute of Experimental Endocrinology and Oncology, National Council of Research (CNR), Naples, Italy
| | - Serena Cabaro
- Department of Translational Medicine, Federico II University of Naples and URT "Genomics of Diabetes" of the Institute of Experimental Endocrinology and Oncology, National Council of Research (CNR), Naples, Italy
| | | | - Carmela Bravaccio
- Department of Translational Medicine, Federico II University of Naples, Naples, Italy
| | - Pietro Formisano
- Department of Translational Medicine, Federico II University of Naples, Naples, Italy
| |
Collapse
|
33
|
Nicol GE, Yingling MD, Flavin KS, Schweiger JA, Patterson BW, Schechtman KB, Newcomer JW. Metabolic Effects of Antipsychotics on Adiposity and Insulin Sensitivity in Youths: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75:788-796. [PMID: 29898210 PMCID: PMC6143095 DOI: 10.1001/jamapsychiatry.2018.1088] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Antipsychotic medications are commonly used to treat nonpsychotic disruptive behavioral disorders in youths. OBJECTIVE To characterize the metabolic effects of first exposure to antipsychotics in youths using criterion standard assessments of body composition and insulin sensitivity. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial recruited antipsychotic-naive youths aged 6 to 18 years in the St Louis, Missouri, metropolitan area who were diagnosed with 1 or more psychiatric disorders and clinically significant aggression and in whom antipsychotic treatment was considered. Participants were enrolled from June 12, 2006, through November 10, 2010. Enrolled participants were randomized (1:1:1) to 1 of 3 antipsychotics commonly used in children with disruptive behavioral disorders and evaluated for 12 weeks. Data were analyzed from January 17, 2011, through August 9, 2017. INTERVENTIONS Twelve weeks of treatment with oral aripiprazole (n = 49), olanzapine (n = 46), or risperidone (n = 49). MAIN OUTCOMES AND MEASURES Primary outcomes included percentage total body fat measured by dual-energy x-ray absorptiometry (DXA) and insulin sensitivity in muscle measured via hyperinsulinemic clamps with stable isotopically labeled tracers. Secondary outcomes included abdominal adiposity measured by magnetic resonance imaging (MRI) and adipose and hepatic tissue insulin sensitivity measured via clamps with tracers. RESULTS The intention-to-treat sample included 144 participants (98 males [68.1%]; mean [SD] age, 11.3 [2.8] years); 74 (51.4%) were African American, and 43 (29.9%) were overweight or obese at baseline. For the primary outcomes, from baseline to week 12, DXA percentage total body fat increased by 1.18% for risperidone, 4.12% for olanzapine, and 1.66% for aripiprazole and was significantly greater for olanzapine than risperidone or aripiprazole (time by treatment interaction P < .001). From baseline to week 12, insulin-stimulated change in glucose rate of disappearance increased by 2.30% for risperidone and decreased by 29.34% for olanzapine and 30.26% for aripiprazole, with no significant difference across medications (time by treatment interaction, P < .07). This primary measure of insulin sensitivity decreased significantly during 12 weeks in the pooled study sample (effect of time, F = 17.38; P < .001). For the secondary outcomes from baseline to week 12, MRI measured abdominal fat increased, with subcutaneous fat increase significantly greater for olanzapine than risperdone or aripiprazole (time by treatment, P = .003). Behavioral improvements occurred with all treatments. CONCLUSIONS AND RELEVANCE Adverse changes in adiposity and insulin sensitivity were observed during 12 weeks of antipsychotic treatment in youths, with the greatest fat increases on olanzapine. Such changes, likely attributable to treatment, may be associated with risk for premature cardiometabolic morbidity and mortality. The results inform risk-benefit considerations for antipsychotic use in youths. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00205699.
Collapse
Affiliation(s)
- Ginger E. Nicol
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael D. Yingling
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Karen S. Flavin
- Department of Internal Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Julia A. Schweiger
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Bruce W. Patterson
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Kenneth B. Schechtman
- Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri,Department of Biostatistics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John W. Newcomer
- Department of Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| |
Collapse
|
34
|
Xia L, Li WZ, Liu HZ, Hao R, Zhang XY. Olanzapine Versus Risperidone in Children and Adolescents with Psychosis: A Meta-Analysis of Randomized Controlled Trials. J Child Adolesc Psychopharmacol 2018; 28:244-251. [PMID: 29356569 PMCID: PMC5952347 DOI: 10.1089/cap.2017.0120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of olanzapine and risperidone in children and adolescents (aged ≤18 years) with psychosis by conducting a meta-analysis of randomized controlled trials (RCTs). METHODS Several English and Chinese databases were searched for studies published before February 8th, 2017. Two independent investigators screened the studies according to prespecified criteria and extracted the data. Review Manager 5.3 was used to conduct the data synthesis. RESULTS Eight RCTs involving 457 participants (225 participants in the olanzapine group and 232 participants in the risperidone group) were included. No significant differences were observed in the mean scores on the Positive and Negative Syndrome Scale/Brief Psychiatric Rating Scale (standard mean difference [SMD] = -0.06, 95% confidence intervals [CI] = [-0.31, 0.19], p = 0.63), the positive symptom scores (SMD = -0.09, 95% CI = [-0.32, 0.15], p = 0.48), or the negative symptom scores (SMD = -0.11 95% CI = [-0.34, 0.13], p = 0.38) between the two groups. Regarding adverse effects, the mean increases in weight (MD = 2.90, 95% CI = [1.41, 4.39], p = 0.0001), body mass index (MD = 0.90, 95% CI = [0.42, 1.38], p = 0.0003), and incidence of hypersomnia (risk ratios [RR] = 1.98, 95% CI = [1.15, 3.43], p = 0.01) were higher in the olanzapine group, while the incidence of insomnia (RR = 0.31, 95% CI = [0.11, 0.85], p = 0.02), prolactin elevation (RR = 0.11, 95% CI = [0.01, 0.85], p = 0.03), myotonia (RR = 0.12, 95% CI = [0.03, 0.49], p = 0.003), tremor (RR = 0.22, 95% CI = [0.08, 0.63], p = 0.005), and akathisia (RR = 0.27, 95% CI = [0.12, 0.57], p = 0.0007) was higher in the risperidone group. CONCLUSIONS There is no significant difference in efficacy between olanzapine and risperidone for the treatment of children and adolescents with psychosis, but the side effect profiles of these two medications differ. High-quality RCTs are needed before recommending clinical treatment in children and adolescents.
Collapse
Affiliation(s)
- Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Wen-Zheng Li
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Huan-Zhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Rui Hao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Xiang-Yang Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China.,Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
35
|
Prescribing Trends of Atypical Antipsychotic Drugs in an Outpatient Unit of a Child and Adolescent Clinic in Turkey. Clin Neuropharmacol 2018; 41:23-27. [DOI: 10.1097/wnf.0000000000000263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|