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Raffin M, Bonnot O, Giannitelli M, Xavier J, Bodeau N, Bibrac B, Leban M, Fautrel B, Menard ML, Consoli A, Cohen D. Hormonal Risk Factors for Osteoporosis: Different Profile Among Antipsychotics. J Child Adolesc Psychopharmacol 2018; 28:719-726. [PMID: 30421978 DOI: 10.1089/cap.2017.0158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: Osteoporosis is a major risk factor for fracture and treatment is mainly preventive. Patients with severe psychiatric condition and treated with antipsychotics are at risk for vitamin D deficiency and iatrogenic hyperprolactinemia, two serious risk factors of osteoporosis. We aim to determine whether all antipsychotics are similar regarding the risk of osteoporosis in young patients. Methods: From January 2009 to March 2015, we determined the vitamin D blood level (VDBL) among 484 inpatients and from January 2012 to March 2015, we determined the prolactin blood level (PBL) among 205 inpatients. We systematically recorded well-documented risk factors (e.g., age, gender, ethnic origin, body mass index, or season) and suspected risk factors (e.g., disease type or antipsychotic treatment). Results: Up to 89% of the inpatients had a VDBL under the recommended threshold. Up to 60% of the inpatients had hyperprolactinemia. The multivariate model found a significant effect on VDBL for seasonality (higher VDBL in summer), ethnicity (lower VDBL in Black individuals), and treatment exposure. The multivariate model found a significant effect on PBL for gender and treatment exposure. In both models, aripiprazole had a safer profile compared with other antipsychotics. Conclusion: Because adolescence is a period of bone construction and a critical window of opportunity for maximizing bone mass, we recommend vitamin D supplementation in young patients with severe mental condition. It could be interesting to reconsider to regularly monitor PBL among youth patients treated with antipsychotic, with the exception of aripiprazole.
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Affiliation(s)
- Marie Raffin
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, University Hospital Pitié-Salpêtrière, Paris, France.,Groupe de Recherche Clinique n°15 (PSYDEV), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, UPMC Univ Paris 06, Paris, France
| | - Olivier Bonnot
- Department of Child and Adolescent Psychiatry, Nantes University Hospital, Nantes, France
| | - Marianna Giannitelli
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, University Hospital Pitié-Salpêtrière, Paris, France.,Groupe de Recherche Clinique n°15 (PSYDEV), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, UPMC Univ Paris 06, Paris, France
| | - Jean Xavier
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, University Hospital Pitié-Salpêtrière, Paris, France.,Groupe de Recherche Clinique n°15 (PSYDEV), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, UPMC Univ Paris 06, Paris, France.,CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, UPMC, Paris, France
| | - Nicolas Bodeau
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, University Hospital Pitié-Salpêtrière, Paris, France
| | - Barbara Bibrac
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, University Hospital Pitié-Salpêtrière, Paris, France
| | - Monique Leban
- Pierre Louis Institute for Epidemiology and Public Health, Assistance Publique-Hôpitaux de Paris, UPMC-GRC 08, Paris, France
| | - Bruno Fautrel
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, University Hospital Pitié-Salpêtrière, Paris, France
| | - Marie-Line Menard
- Department of Child and Adolescent Psychiatry, Nice Children's Hospitals CHU-Lenval, Nice, France
| | - Angele Consoli
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, University Hospital Pitié-Salpêtrière, Paris, France.,Groupe de Recherche Clinique n°15 (PSYDEV), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, UPMC Univ Paris 06, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Assistance Publique-Hôpitaux de Paris, University Hospital Pitié-Salpêtrière, Paris, France.,Groupe de Recherche Clinique n°15 (PSYDEV), Assistance Publique-Hôpitaux de Paris, Sorbonne Université, UPMC Univ Paris 06, Paris, France.,CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, UPMC, Paris, France
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Petron-Bardou C, Bardot V. Iatrogénie des psychotropes chez l’enfant et l’adolescent. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Les psychotropes ayant obtenu une autorisation de mise sur le marché chez l’enfant et l’adolescent sont essentiellement des anciennes molécules aux indications limitées. En effet, les études sur la iatrogénie des psychotropes en population pédiatrique restent peu nombreuses et les résultats d’études en population adulte ne sont pas toujours extrapolables chez l’enfant.Le métabolisme de l’enfant et de l’adolescent étant différent, la pharmacocinétique des molécules utilisées différerait entraînant une moins bonne tolérance. Les effets indésirables sont ainsi plus fréquents qu’en population adulte notamment le syndrome métabolique et les troubles endocriniens comme l’hyperprolactinémie secondaire à la prise d’antipsychotiques.Les effets indésirables les plus fréquemment observés lors de la prescription d’antipsychotiques regroupent la sédation, la prise de poids, les dyskinésies tardives et l’hyperprolactinémie. Cette iatrogénie peut majorer à long terme les risques de maladie cardiovasculaires ou d’ostéoporose. Les auteurs proposent un ajustement de ces traitements et une surveillance spécifique pour une meilleure prévention des risques ultérieurs.La prescription d’antidépresseurs repose sur une évaluation du ratio bénéfice-risque lorsque la psychothérapie seule (thérapeutique de première intention) est jugée inefficace. Le principal risque iatrogène rapporté est alors la faible augmentation du risque de passage à l’acte suicidaire. L’usage des anxiolytiques, notamment des benzodiazépines doit être limité dans cette population face aux risques d’accoutumance, d’effet désinhibiteur et de troubles mnésiques associés.La prescription de psychotropes chez l’enfant ou l’adolescent s’inscrit donc dans une prise en charge globale. L’information du patient et de ses parents est essentielle. Une surveillance somatique et psychiatrique étroite permettra une prise en charge précoce de tout effet iatrogène, garantissant ainsi une meilleure adhésion à long terme et la prévention d’effets iatrogènes à révélation ultérieure. La monothérapie doit être privilégiée et sa pertinence régulièrement questionnée.
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Adverse effects of second-generation antipsychotics in children and adolescents: a Bayesian meta-analysis. J Clin Psychopharmacol 2012; 32:309-16. [PMID: 22544019 DOI: 10.1097/jcp.0b013e3182549259] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In adults, second-generation antipsychotics (SGAs) have a low frequency of extrapyramidal syndrome (EPS) and a moderate frequency of metabolic adverse effects. Here we aimed to assess short-term adverse effects of SGAs in children and adolescents. We searched for relevant studies in MEDLINE and EMBASE (1996-2010), Food and Drug Administration and European Medicines Agency clinical trial registries, and reference lists of review articles. We found 41 were short-term (3-12 weeks) controlled studies that evaluated SGA adverse effects in youths. Using Bayesian meta-analysis, we analyzed odds ratios (ORs) or mean average effects. Numbers of arms (subjects) in the 41 trials were aripiprazole, 10 (n = 671); olanzapine, 14 (n = 413); quetiapine, 10 (n = 446); risperidone, 25 (n = 1040); ziprasidone, 4 (n = 228); clozapine, 5 (n = 79); and placebo/untreated, 23 (n = 1138), totaling 93 arms (4015 patients). Clozapine was assessed only for weight gain and somnolence. Compared with placebo, significant treatment-related increases were observed for weight gain with olanzapine (mean ± SD = 3.99 ± 0.42 kg; 95% credible interval, 3.17-4.84 kg), clozapine (2.38 ± 1.13 kg; 95% credible interval, 0.19-4.62 kg), risperidone (2.02 ± 0.32 kg; 95% credible interval, 1.39-2.66 kg), quetiapine (1.74 ± 0.38 kg; 95% credible interval, 0.99-2.5 kg), and aripiprazole (0.89 ± 0.32 kg; 95% credible interval, 0.26-1.51 kg); glucose levels with risperidone (3.7 ± 1.36 mg/dL; 95% credible interval, 1.08-6.42 mg/dL) and olanzapine (2.09 ± 1.08 mg/dL; 95% credible interval, 0.13-4.32 mg/dL); cholesterol levels with quetiapine (10.77 ± 2.14 mg/dL; 95% credible interval, 6.6-14.95 mg/dL) and olanzapine (4.46 ± 1.65 mg/dL; 95% credible interval, 1.24-7.73 mg/dL); triglyceride levels with olanzapine (20.18 ± 5.26 mg/dL; 95% credible interval, 9.85-30.53 mg/dL) and quetiapine (19.5 ± 3.92 mg/dL; 95% credible interval, 11.84-27.17 mg/dL); hyperprolactinemia with risperidone (OR, 38.63; 95% credible interval, 8.62-125.6), olanzapine (OR, 15.6; 95% credible interval, 4.39-41.1), and ziprasidone (OR, 9.35; 95% credible interval, 1.24-37.03); and EPS with ziprasidone (OR, 20.56; 95% credible interval, 3.53-68.94), olanzapine (OR, 6.36; 95% credible interval, 2.43-13.84), aripiprazole (OR, 3.79; 95% credible interval, 2.17-6.17), and risperidone (OR, 3.71; 95% credible interval, 2.18-6.02). All SGAs increased the risk of somnolence/sedation. We conclude that short-term metabolic effects and EPS are frequent in children treated with SGAs. Second-generation antipsychotics have distinct profiles of secondary effects, which should be considered in making treatment decisions.
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Bonnot O, Inaoui R, Raffin-Viard M, Bodeau N, Coussieu C, Cohen D. Children and adolescents with severe mental illness need vitamin D supplementation regardless of disease or treatment. J Child Adolesc Psychopharmacol 2011; 21:157-61. [PMID: 21486172 DOI: 10.1089/cap.2010.0079] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND To protect against osteoporosis, keeping the vitamin D blood level (25[OH]D; VDBL) above 30 ng/mL is recommended. It is established that regular intake of vitamin D, calcium intake, and physical exercise contribute to maximizing bone mineral mass during childhood and adolescence. Recent articles suggest that patients with schizophrenia treated with antipsychotics have low VDBL and may have a higher risk of hip fractures in their later years than the general population. OBJECTIVES To evaluate whether adolescent psychiatric inpatient VDBL is lower than the 30-ng/mL optimal threshold and to document low-VDBL risk factors. METHOD We determined the VDBL of all consecutive inpatients from three adolescents units in 2009 (N = 136). Univariate analyses explored the influence on VDBL of (1) well-documented risk factors (e.g., age, gender, ethnic origin, body mass index, or season) and (2) suspected risk factors (e.g., disease type or antipsychotic treatment). RESULTS All but six patients had a VDBL <30 ng/mL (mean [ ± SD]: 15.9 [ ± 8.4] ng/mL). VDBL was significantly lower for all patients during the first quarter of the year compared to the other three (all p < 0.01). VDBL was also lower for blacks/North Africans 12.8 (±7.0) than for Caucasians/Europeans 17.2 (±8.5): t = 2.62, p = 0.009. We found no differences between patients regarding disease category (K = 3.75, p = 0.154) or antipsychotic treatment (t = 0.127, df = 124, p = 0.89). CONCLUSION VDBL in an adolescent population with severe mental illness is lower than current recommendations of optimal level for bone health regardless of treatment or disease type. Because adolescence is a period of bone construction and could represent a critical window of opportunity for maximizing bone mass, especially among patients with severe mental illness, we recommend vitamin D supplementation.
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Affiliation(s)
- Olivier Bonnot
- Child and Adolescent Department and Reference Center for Rare Disease with Psychiatric Expression, Groupe Hospitalier Pitié Salpétriere, Assistance Publique Hopitaux de Paris, Paris, France.
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