1
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Besag FMC, Vasey MJ, Salim I, Hollis C. Tardive Dyskinesia with Antipsychotic Medication in Children and Adolescents: A Systematic Literature Review. Drug Saf 2024:10.1007/s40264-024-01446-0. [PMID: 38862692 DOI: 10.1007/s40264-024-01446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Tardive dyskinesia (TD) is a persisting, and potentially irreversible, movement disorder associated with treatment with dopamine receptor antagonists. Few data are available on the risk of TD in children and adolescents treated with antipsychotic medication. OBJECTIVE To review the literature on incidence, risk factors, and treatment options for antipsychotic-associated TD in children and adolescents (aged < 18 years). METHODS Relevant articles were identified through a systematic search of Embase and Medline performed in January 2024. Methodological quality was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute Critical Appraisal tools. RESULTS Thirteen studies were identified. The reported TD point prevalence was 5-20%, with higher rates in studies involving typical antipsychotics. Lower estimates (around 1%) emerged from analyses of clinical database data suggesting underdiagnosis in clinical practice. Risk factors included treatment with typical antipsychotics, higher doses, longer duration of exposure, older age, female gender, higher baseline Abnormal Involuntary Movements Scale (AIMS) scores, intellectual impairment, and perinatal complications. CONCLUSION Although relatively few cases have been reported in children and adolescents, TD remains a risk in this population. Individuals receiving antipsychotics should be monitored carefully for the emergence of abnormal movements. Other than dose reduction, discontinuation, or switch to a lower-risk antipsychotic, few interventions have demonstrated efficacy. The strongest evidence for pharmacological treatment is for VMAT-2 inhibitors (valbenazine and deutetrabenazine), but these drugs are not licensed for use in children. To reduce risk, antipsychotics should be prescribed only if necessary, at the minimum effective dose and for the minimum necessary duration.
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Affiliation(s)
- Frank M C Besag
- East London NHS Foundation Trust, 9 Rush Court, Bedford, MK40 3JT, UK.
- University College London, London, UK.
- King's College London, London, UK.
| | - Michael J Vasey
- East London NHS Foundation Trust, 9 Rush Court, Bedford, MK40 3JT, UK
| | - Iffah Salim
- East London NHS Foundation Trust, Newham, London, UK
| | - Chris Hollis
- Institute of Mental Health, School of Medicine, NIHR MindTech HealthTech Research Centre, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
- Institute of Mental Health, NIHR Nottingham Biomedical Research Centre, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
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2
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Hauptman AJ, Augustine EF, Brown HB. The Psychiatric Care of Children and Young Adults With Neurodegenerative Diseases. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00060-1. [PMID: 38340894 DOI: 10.1016/j.jaac.2024.02.001] [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] [Received: 05/18/2023] [Revised: 11/14/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Pediatric neurodegenerative disorders (PNDs), such as juvenile neuronal ceroid lipofuscinosis (CLN3 disease, also called Batten disease) and juvenile Huntington disease, are devastating conditions that result in progressive neurological dysfunction and profound medical comorbidities leading to early mortality in children and young adults.1 There are more than 70 PNDs, with a combined estimated prevalence of ∼0.1 in 1,000 live births.2,3 Individuals with PNDs commonly experience complex neuropsychiatric manifestations such as neurocognitive symptoms (dementia), irritability, aggression and self-injury, mood disorders, sensory alterations, and psychosis. Symptoms are dynamic, changing with illness progression, and evolve over time. Effects on patients and families can be devastating, and caregiver burden is enormous.4 We are a group of colleagues with backgrounds in pediatric neuropsychiatry, pediatric neuropalliative care, and pediatric neurology who care for patients together in specialized clinics.
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Affiliation(s)
- Aaron J Hauptman
- Kennedy Krieger Institute, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Erika F Augustine
- Kennedy Krieger Institute, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heather B Brown
- Kennedy Krieger Institute, Baltimore, Maryland; Johns Hopkins University School of Medicine, Baltimore, Maryland
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3
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Lundberg M, Andersson P, Lundberg J, Desai Boström AE. Challenges and opportunities in the diagnosis and treatment of early-onset psychosis: a case series from the youth affective disorders clinic in Stockholm, Sweden. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:5. [PMID: 38172588 PMCID: PMC10851694 DOI: 10.1038/s41537-023-00427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
Early-onset psychosis is linked to adverse long-term outcomes, recurrent disease course, and prolonged periods of untreated illness; thus highlighting the urgency of improving early identification and intervention. This paper discusses three cases where initial emphasis on psychosocial treatments led to diagnostic and therapeutic delays: (1) a 15-year-old misdiagnosed with emotionally unstable personality disorder and autism, who improved on bipolar medication and antipsychotics; (2) another 15-year-old misdiagnosed with autism, who stabilized on lithium and antipsychotics, subsequently allowing for gender dysphoria evaluation; (3) a 9-year-old autistic boy incorrectly treated for ADHD, who recovered with appropriate antipsychotic treatment. These cases illuminate the vital importance of adhering to a diagnostic hierarchy, prioritizing diagnostic utility, and conducting longitudinal evaluations to facilitate early targeted treatment of psychotic symptoms in early-onset psychosis. Adherence to such strategies can minimize delays in managing early-onset psychosis and improve long-term prognoses.
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Affiliation(s)
- Mathias Lundberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- The Affective Disorders Clinic, Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Andersson
- Department of Clinical Neuroscience/Psychology, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Johan Lundberg
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Adrian E Desai Boström
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.
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4
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Frau R, Melis M. Sex-specific susceptibility to psychotic-like states provoked by prenatal THC exposure: Reversal by pregnenolone. J Neuroendocrinol 2023; 35:e13240. [PMID: 36810840 DOI: 10.1111/jne.13240] [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: 08/01/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
Sociocultural attitudes towards cannabis legalization contribute to the common misconception that it is a relatively safe drug and its use during pregnancy poses no risk to the fetus. However, longitudinal studies demonstrate that maternal cannabis exposure results in adverse outcomes in the offspring, with a heightened risk for developing psychopathology. One of the most reported psychiatric outcomes is the proneness to psychotic-like experiences during childhood. How exposure to cannabis during gestation increases psychosis susceptibility in children and adolescents remains elusive. Preclinical research has indicated that in utero exposure to the major psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), deranges brain developmental trajectories towards vulnerable psychotic-like endophenotypes later in life. Here, we present how prenatal THC exposure (PCE) deregulates mesolimbic dopamine development predisposing the offspring to schizophrenia-relevant phenotypes, exclusively when exposed to environmental challenges, such as stress or THC. Detrimental effects of PCE are sex-specific because female offspring do not display psychotic-like outcomes upon exposure to these challenges. Moreover, we present how pregnenolone, a neurosteroid that showed beneficial properties on the effects elicited by cannabis intoxication, normalizes mesolimbic dopamine function and rescues psychotic-like phenotypes. We, therefore, suggest this neurosteroid as a safe "disease-modifying" aid to prevent the onset of psychoses in vulnerable individuals. Our findings corroborate clinical evidence and highlight the relevance of early diagnostic screening and preventative strategies for young individuals at risk for mental diseases, such as male PCE offspring.
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Affiliation(s)
- Roberto Frau
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato, Italy
- The Guy Everett Laboratory for Neuroscience, University of Cagliari, Cagliari, Italy
| | - Miriam Melis
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Monserrato, Italy
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5
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Lopez-Morinigo JD, Leucht S, Arango C. Pharmacological Treatment of Early-Onset Schizophrenia: A Critical Review, Evidence-Based Clinical Guidance and Unmet Needs. PHARMACOPSYCHIATRY 2022; 55:233-245. [PMID: 35777418 PMCID: PMC9458343 DOI: 10.1055/a-1854-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Early-onset schizophrenia (EOS) – onset before age 18 – is linked
with great disease burden and disability. Decision-making for EOS
pharmacological treatment may be challenging due to conflicting information from
evidence and guidelines and unidentified care needs may remain unmet. We searched for systematic reviews, meta-analyses and umbrella reviews of EOS
pharmacological treatment published in PubMed over the past 10 years and
selected five clinical guidelines from Europe, North-America and Australia.
Based on predefined outcomes, we critically compared the evidence supporting
EOS-approved drugs in Europe and/or North-America with guidelines
recommendations. We also evaluated the coverage of these outcomes to identify
unmet needs. One systematic review, nine meta-analyses and two umbrella reviews (k=203
trials, N=81,289 participants, including duplicated samples across
selected articles) were retrieved. Evidence supported the efficacy of
aripiprazole, clozapine, haloperidol, lurasidone, molindone, olanzapine,
quetiapine, risperidone and paliperidone in EOS, all of which obtained approval
for EOS either in Europe and/or in North-America. Cognition, functioning
and quality of life, suicidal behaviour and mortality and services utilisation
and cost-effectiveness were poorly covered/uncovered. Among the antipsychotics approved for EOS, aripiprazole, lurasidone, molindone,
risperidone, paliperidone and quetiapine emerged as efficacious and comparably
safe options. Olanzapine is known for a high risk of weight gain and haloperidol
for extrapyramidal side-effects. Treatment-resistant patients should be offered
clozapine. Future long-term trials looking at cognition, functioning, quality of
life, suicidal behaviour, mortality, services utilisation and cost-effectiveness
are warranted. Closer multi-agency collaboration may bridge the gap between
evidence, guidelines and approved drugs.
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Ismaninger Straße 22, Munich, Germany
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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6
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de Castro REV, Rodríguez-Rubio M, de Magalhães-Barbosa MC, Prata-Barbosa A, Holbrook J, Kamat P, Stormorken A. A review of key strategies to address the shortage of analgesics and sedatives in pediatric intensive care. Front Pediatr 2022; 10:895541. [PMID: 36110118 PMCID: PMC9468272 DOI: 10.3389/fped.2022.895541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/21/2022] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Targeted analgosedation is a challenge in critically ill children, and this challenge becomes even more significant with drug shortages. OBSERVATIONS Published guidelines inform the provision of analgosedation in critically ill children. This review provides insights into general approaches using these guidelines during drug shortages in Pediatric Intensive Care Units as well as strategies to optimize both pharmacological and non-pharmacological approaches in these situations. CONCLUSIONS AND RELEVANCE Considering that drug shortages are a recurrent worldwide problem, this review may guide managing these drugs in critically ill children in situations of scarcity, such as in pandemics or disasters.
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Affiliation(s)
- Roberta Esteves Vieira de Castro
- Pediatric Intensive Care Unit, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.,Department of Pediatrics, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.,Department of Pediatrics, Souza Marques School of Medicine, Rio de Janeiro, RJ, Brazil
| | - Miguel Rodríguez-Rubio
- Pediatric Intensive Care Department, Hospital Universitario La Paz, Madrid, Spain.,Department of Pediatrics, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Jaimee Holbrook
- Department of Pediatrics, University of Chicago Medicine, Chicago, IL, United States
| | - Pradip Kamat
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Anne Stormorken
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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7
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Mori Y, Takeuchi H, Tsutsumi Y. Current perspectives on the epidemiology and burden of tardive dyskinesia: a focused review of the clinical situation in Japan. Ther Adv Psychopharmacol 2022; 12:20451253221139608. [PMID: 36601351 PMCID: PMC9806439 DOI: 10.1177/20451253221139608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/28/2022] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Tardive dyskinesia (TD) is a movement disorder that can develop with the use of dopamine receptor-blocking agents and is most commonly caused by antipsychotics. The use of antipsychotics is expanding, which may lead to an increased number of patients experiencing TD. To summarise the current knowledge of the epidemiology and risk factors for TD in Japan, we reviewed articles related to the current state of knowledge around TD identified through a PubMed search, and held a roundtable discussion of experts in Japan on 9 September 2021 to form the basis of the opinion presented within this review. The true prevalence of TD among patients treated with antipsychotics is not well characterised; it is reported to be between 15% and 50% globally and between 6.5% and 7.7% in Japan. Potential barriers to timely treatment of TD include the stigma surrounding mental health issues and the lack of data regarding TD in Asian patients. This review summarises the current knowledge of the epidemiology, challenges to TD diagnosis and risk factors for TD in Japan. Recent strategies for symptom monitoring and early diagnosis, as well as consensus recommendations are included. Achieving a high level of awareness of TD among physicians who treat patients with psychiatric disorders is of great importance and physicians should ensure that patients with psychiatric disorders receiving antipsychotics are proactively monitored for signs of TD. PLAIN LANGUAGE SUMMARY Plain Language Summary (In Japanese). VISUAL SUMMARY Visual Summary (In Japanese).
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Affiliation(s)
- Yasuhiro Mori
- Department of Psychiatry, Aichi Medical University, 1-1 Yazako-karimata, Nagakute 480-1195, Aichi, Japan
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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8
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Albers C, Nair N, Shankar R. Antipsychotics in Inpatient Children and Adolescents with Seclusion and Restraint: A Preliminary Exploratory Retrospective Chart Review. J Child Adolesc Psychopharmacol 2021; 31:358-363. [PMID: 34143681 DOI: 10.1089/cap.2020.0055] [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] [Indexed: 11/12/2022]
Abstract
Objective: This study is a retrospective review of patients 5-17 years of age experiencing seclusion and/or restraint (S&R) in a pediatric psychiatric inpatient setting and an exploratory analysis of antipsychotic use on S&R duration. We examined whether administration of antipsychotics would possibly decrease the time spent in S&R. Methods: Reports of patients who underwent S&R in an acute care inpatient child and adolescent psychiatric unit from 2012 to 2014 were reviewed. Demographic information related to age, gender, and race as well as information on diagnosis, current medications (including antipsychotics) were obtained. Independent samples t-tests were used to determine whether there were differences in how much time patients spent in S&R based on whether they were administered antipsychotics or not. Odds ratios (ORs) of being administered antipsychotics during S&R were computed for factors such as gender, race, and diagnosis group. Results: Ninety-six patients (68 males, age range 5-17 years) were involved in 232 S&R events that occurred between 2012 and 2014. Results indicate that patients who were administered antipsychotics during S&R still spent significantly more time in S&R compared with those who were given medications other than antipsychotics (e.g., Benadryl) (t = 3.161; p = 0.002) and those who were not administered any medication (t = 3.54; p = 0.001). Binary logistic regression showed that female patients were at more than two times (OR(adjusted) = 2.86; 95% confidence interval = 1.234-6.655) higher risk of being administered antipsychotics while in S&R compared with their male counterparts within this particular sample. Conclusions: The results of our study indicate that, contrary to our hypothesis, antipsychotic administration did not appear to reduce the time spent in S&R compared with groups that were administered medications other than antipsychotics and those that were not administered any medication during S&R. We also found an increased risk of antipsychotic administration in female patients compared with male patients in S&R events, indicating the need for larger studies examining these effects in greater detail.
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Affiliation(s)
- Cecilia Albers
- Department of Psychiatry, University of Missouri, Columbia, Missouri, USA
| | - Neetu Nair
- Department of Psychiatry, University of Missouri, Columbia, Missouri, USA
| | - Ravi Shankar
- Department of Psychiatry, University of Missouri, Columbia, Missouri, USA
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Brown JT, Campo-Soria C, Bishop JR. Current strategies for predicting side effects from second generation antipsychotics in youth. Expert Opin Drug Metab Toxicol 2021; 17:655-664. [PMID: 33896324 DOI: 10.1080/17425255.2021.1922668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Antipsychotic medications are used to treat a number of conditions in children and adolescents. While side effect profiles from second generation antipsychotics (SGAs) may differ from older antipsychotics, they do not come without risk. Knowing which children may be at higher risk for specific outcomes is important clinical information for prescribers. Common side effects and toxicities of SGAs in children include movement disorders, weight gain, and hormonal changes. There are also rare, but potentially dangerous adverse events including neuroleptic malignant syndrome, hypersensitivity and suicidal ideation.Areas covered: This review will summarize and comment on clinical, pharmacological, and genetic factors having evidence as predictors of SGA-associated side effects and toxicities in children.Expert opinion: Observations across studies note that older children and those that do not respond early in treatment may be more at risk for movement disorders, while younger, antipsychotic naive children are at increased risk for weight gain. Relatively fewer studies have looked at pharmacogenetic relationships, although variations in pharmacokinetic and pharmacodynamic genes hold promise to advance drug dosing or selection strategies. Future efforts to assimilate multiple clinical, pharmacological, and genetic factors to facilitate predictive analytics and clinical decision support for prescribers will advance precision care to patients.
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Affiliation(s)
- Jacob T Brown
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, USA
| | - Claudia Campo-Soria
- Department of Psychiatry, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Minneapolis, MN, USA
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10
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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.
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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
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Jeon SM, Park S, Kwon S, Kwon JW. Association Between Antipsychotic Treatment and Neurological Adverse Events in Pediatric Patients: A Population-Based Cohort Study in Korea. Front Psychiatry 2021; 12:668704. [PMID: 34122182 PMCID: PMC8187563 DOI: 10.3389/fpsyt.2021.668704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Potential adverse effects might be caused by increasing the number of antipsychotic prescriptions. However, the empirical evidence regarding pediatric psychiatric patients is insufficient. Therefore, we explored the antipsychotic-induced adverse effects focusing on the neurological system. Method: Using the medical information of pediatric patients retrieved from the claims data of Health Insurance Review and Assessment in Korea, we identified those psychiatric patients who were started on antipsychotic treatment at age 2-18 years between 2010 and 2018 (n = 10,969). In this study, movement disorders and seizures were considered as major neurological adverse events. The extended Cox model with time-varying covariates was applied to explore the association between antipsychotic medication and adverse events. Findings: Total 1,894 and 1,267 cases of movement disorders and seizures occurred in 32,046 and 33,280 person-years, respectively. The hazard risks of neurological adverse events were 3-8 times higher in the exposed to antipsychotics period than in the non-exposure period. Among the exposure periods, the most dangerous period was within 30 days of cumulative exposure. High doses or polypharmacy of antipsychotics was associated with increased risks of neurological adverse events. Among individual antipsychotics, haloperidol showed the highest risk of developing movement disorders among the examined agents. Quetiapine showed a lower risk of developing movement disorders but a higher risk of developing seizures than risperidone. Conclusion: These findings suggest that antipsychotics should be used with caution in pediatric patients, especially regarding initial exposure, high dose, and polypharmacy.
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Affiliation(s)
- Soo Min Jeon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Susan Park
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
| | - Soonhak Kwon
- Department of Pediatric Neurology, Kyung-pook National University Children's Hospital, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea
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12
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Béchard L, Corbeil O, Malenfant E, Lehoux C, Stip E, Roy MA, Demers MF. Une approche de la psychopharmacologie des premiers épisodes psychotiques axée sur le rétablissement. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088180ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Kakko K, Pihlakoski L, Keskinen P, Salmelin R, Puura K. Current follow-up practices often fail to detect metabolic and neurological adverse reactions in children treated with second-generation antipsychotics. Acta Paediatr 2020; 109:342-348. [PMID: 31359492 DOI: 10.1111/apa.14951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/10/2019] [Accepted: 07/24/2019] [Indexed: 11/30/2022]
Abstract
AIM This study examined the use and adverse reactions of second-generation antipsychotics (SGAs), alone or combined with other psychotropic medication, to identify areas for standardising prescribing and monitoring practices. METHODS We conducted a retrospective study at Tampere University Hospital, Finland, involving 128 patients (81% boys) who were under 13 years old at SGA initiation and had SGA treatment between October 2013 and October 2014. RESULTS The median age at baseline was 9.4 years. Weight gain was reported as an adverse reaction in 33%, but an increase in standardised body mass index, adjusted for age and sex (BMI z-score), was detected in 75% of patients with sufficient data. The statistically significant median changes during the study were an increase of 0.46 in BMI z-score, a reduction of 0.25 mmol/L in fasting plasma high-density lipoprotein and an increase of 0.28 mmol/L in triglyceride values. The weight gain was most apparent in patients treated with just an SGA or SGA plus melatonin. Patients treated with an SGA plus medication for attention deficit hyperactivity disorder were less likely to gain weight. CONCLUSION SGA-induced metabolic disturbances remained partly unrecognised in children under 13 years of age and more systematic monitoring is needed.
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Affiliation(s)
- Kirsi Kakko
- Department of Child Psychiatry Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Leena Pihlakoski
- Department of Child Psychiatry Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Päivi Keskinen
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Center for Child Health Research Tampere University Tampere Finland
| | - Raili Salmelin
- Department of Child Psychiatry Tampere University Hospital Tampere Finland
- Faculty of Social Sciences/Health Sciences Tampere University Tampere Finland
| | - Kaija Puura
- Department of Child Psychiatry Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
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14
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Niemann N, Jankovic J. Juvenile parkinsonism: Differential diagnosis, genetics, and treatment. Parkinsonism Relat Disord 2019; 67:74-89. [DOI: 10.1016/j.parkreldis.2019.06.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/24/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022]
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Treatment of Tardive Dyskinesia: A General Overview with Focus on the Vesicular Monoamine Transporter 2 Inhibitors. Drugs 2019; 78:525-541. [PMID: 29484607 DOI: 10.1007/s40265-018-0874-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tardive dyskinesia (TD) encompasses the spectrum of iatrogenic hyperkinetic movement disorders following exposure to dopamine receptor-blocking agents (DRBAs). Despite the advent of atypical or second- and third-generation antipsychotics with a presumably lower risk of complications, TD remains a persistent and challenging problem. Prevention is the first step in mitigating the risk of TD, but early recognition, gradual withdrawal of offending medications, and appropriate treatment are also critical. As TD is often a persistent and troublesome disorder, specific antidyskinetic therapies are often needed for symptomatic relief. The vesicular monoamine transporter 2 (VMAT2) inhibitors, which include tetrabenazine, deutetrabenazine, and valbenazine, are considered the treatment of choice for most patients with TD. Deutetrabenazine-a deuterated version of tetrabenazine-and valbenazine, the purified parent product of one of the main tetrabenazine metabolites, are novel VMAT2 inhibitors and the only drugs to receive approval from the US FDA for the treatment of TD. VMAT2 inhibitors deplete presynaptic dopamine and reduce involuntary movements in many hyperkinetic movement disorders, particularly TD, Huntington disease, and Tourette syndrome. The active metabolites of the VMAT2 inhibitors have high affinity for VMAT2 and minimal off-target binding. Compared with tetrabenazine, deutetrabenazine and valbenazine have pharmacokinetic advantages that translate into less frequent dosing and better tolerability. However, no head-to-head studies have compared the various VMAT2 inhibitors. One of the major advantages of VMAT2 inhibitors over DRBAs, which are still being used by some clinicians in the treatment of some hyperkinetic disorders, including TD, is that they are not associated with the development of TD. We also briefly discuss other treatment options for TD, including amantadine, clonazepam, Gingko biloba, zolpidem, botulinum toxin, and deep brain stimulation. Treatment of TD and other drug-induced movement disorders must be individualized and based on the severity, phenomenology, potential side effects, and other factors discussed in this review.
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16
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Kakko K, Bjelogrlic-Laakso N, Pihlakoski L, Lehtimäki K, Järventausta K. Tardive Dyskinesia Should Not Be Overlooked. J Child Adolesc Psychopharmacol 2019; 29:72-74. [PMID: 30388034 DOI: 10.1089/cap.2018.0084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kirsi Kakko
- 1 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,2 Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland
| | | | - Leena Pihlakoski
- 2 Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Kai Lehtimäki
- 4 Department of Neurosciences, Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Kaija Järventausta
- 1 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,5 Department of Psychiatry, Tampere University Hospital, Tampere, Finland
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17
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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.
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Rouby P, Marioni G, Lopez C. La confusion mentale en oncologie pédiatrique : réflexion à partir d’un cas. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Abstract
OBJECTIVE To examine the diagnoses, demographics, and prevalence of psychotherapy use among children and adolescents prescribed antipsychotics by psychiatric providers in a community setting. METHODS Medical records from 1127 children aged 0 to 17 years who were prescribed antipsychotics in 2014-2015 at Pine Rest Christian Mental Health Services (PRCMHS) outpatient network were analyzed. Antipsychotics, diagnosis codes, demographics, and number of psychotherapy sessions during this time frame were analyzed using χ and logistic regression analyses. RESULTS During this year, 50.8% of the patients attended psychotherapy, and 35.6% attended 5 or more sessions of psychotherapy. The most prevalent primary diagnosis was bipolar disorder (37.1%), followed by attention-deficit/hyperactivity disorder (19.7%). Females being treated with antipsychotics were significantly more likely to attend psychotherapy than their male peers (55.7% vs. 47.9%, P=0.01). In the fully adjusted models, patients with diagnoses of bipolar disorder or disorders first diagnosed in infancy, childhood, or adolescence were less than half as likely to attend psychotherapy as patients with depressive disorders, with adjusted odds ratios of 0.41 and 0.42, respectively. CONCLUSIONS Approximately half of the child and adolescent patients prescribed antipsychotics in this community sample did not attend psychotherapy, and 39% of the patients did not have a diagnosis of bipolar disorder, psychotic disorder, or autistic disorder.
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20
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Blasco-Fontecilla H. Clinical utility of pharmacogenetic testing in children and adolescents with severe mental disorders. J Neural Transm (Vienna) 2018; 126:101-107. [PMID: 29626260 PMCID: PMC6373261 DOI: 10.1007/s00702-018-1882-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/02/2018] [Indexed: 12/03/2022]
Abstract
This is a retrospective cohort study of 20 children and adolescents to evaluate the clinical utility of a pharmacogenetic decision support tool. Twenty children and adolescents underwent pharmacogenetic testing between June 2014 and May 2017. All children and adolescents were evaluated at Puerta de Hierro University Hospital-Majadahonda (Madrid, Spain). We report the proportion of patients achieving clinical improvement, amelioration of side effects, and changes in number of drugs. Data normality was assessed with the Shapiro–Wilk test, and changes of pre- and post-pharmacogenetic testing were analyzed with the Wilcoxon test for paired samples. A two-sided p value threshold of 0.05 was considered for significance. Pharmacogenetic testing helped to improve the clinical outcome as measured by the Clinical Global Impressions (CGI) Scale in virtually all children (95%; 19 out of 20 children). The CGI improvement (CGI-I) was 2 (0.79) (range 1–4), 2.1 (0.56) (range 1–3), and 1.9 (0.99) (range 1–4) in foster and non-foster care children, respectively. Pharmacogenetic testing also helped to reduce the number of children using polypharmacy (from 65 to 45%), the mean number of drugs per children (from 3.3 to 2.4 drugs, p = 0.017), and self-reported relevant side effects (p = 0.006). Pharmacogenetic testing helped to improve the clinical outcome, and to reduce polypharmacy and the number of drugs used in children and adolescents with severe mental disorders. More evidence using robust (i.e., clinical trials) independent studies is required to properly determine the clinical utility and cost-effectiveness of pharmacogenetic testing tools in children and adolescents with mental disorders.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Segovia de Arana Health Research Institute (IDIPHISA)-Puerta de Hierro University Hospital, Avenida Manuel de Falla s/n, Majadahonda, Madrid, Spain.
- Autonoma University, Madrid, Spain.
- Biomedical Research Centre in Mental Health Net (CIBERSAM), Madrid, Spain.
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21
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Pitzer M, Engelmann G, Stammschulte T. [Tardive movement disorders with antipsychotics – a case of aripirazole-induced tardive dystonia and review of the literature]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 45:325-334. [PMID: 28682214 DOI: 10.1024/1422-4917/a000460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Extrapyramidal adverse events (EPS) occur less frequently with second-generation antipsychotics (SGAs) than with first-generation antipsychotics (FGAs). Tardive dyskinesia (TD), but not tardive dystonia (TDt), also seems to occur less often in adults. TD was found to occur less frequently in children and adolescents treated with FGAs than in adults. No data are available on TDt, and the data pertaining to SGAs are limited and conflicting. SGAs differ in their profile of adverse events. Aripiprazole is less frequently associated with adverse metabolic or cardiac events, but more often with EPS, at least in children and adolescents. To date, there are several case reports of TD or TDt with aripiprazole in adults. Symptomatology, differential diagnosis, pathophysiology, prevalence, and therapy of TDt are presented here based on a case report of TDt during aripiprazole therapy in a 13-year-old girl. During medication with SGAs, the occurrence of EPS, including tardive movement disorders, should be considered and regularly monitored.
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Affiliation(s)
- Martina Pitzer
- 1 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Städtisches Klinikum Karlsruhe
- 2 Arzneimittelkommission der Deutschen Ärzteschaft (AkdÄ), Berlin
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Bellonci C, Baker M, Huefner JC, Hilt RJ. Deprescribing and Its Application to Child Psychiatry. ACTA ACUST UNITED AC 2016. [DOI: 10.1521/capn.2016.21.6.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Megan Baker
- Stanford Child and Adolescent Psychiatry, Fellow
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23
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Pisano S, Catone G, Veltri S, Lanzara V, Pozzi M, Clementi E, Iuliano R, Riccio MP, Radice S, Molteni M, Capuano A, Gritti A, Coppola G, Milone A, Bravaccio C, Masi G. Update on the safety of second generation antipsychotics in youths: a call for collaboration among paediatricians and child psychiatrists. Ital J Pediatr 2016; 42:51. [PMID: 27209326 PMCID: PMC4875613 DOI: 10.1186/s13052-016-0259-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/04/2016] [Indexed: 02/08/2023] Open
Abstract
During the past decade, a substantial increase in the use of second generation antipsychotics (SGAs) has occurred for a number of juvenile psychiatric disorders, often as off-label prescriptions. Although they were thought to be safer than older, first generation antipsychotics, mainly due to a lower risk of neurological adverse reactions, recent studies have raised significant concerns regarding their safety regarding metabolic, endocrinological and cardiovascular side effects. Aim of this paper is to update with a narrative review, the latest findings on safety of SGAs in youths. Results suggest that different SGAs may present different safety profiles. Metabolic adverse events are the most frequent and troublesome, with increasing evidences of heightened risk for type II diabetes mellitus. Results are discussed with specific emphasis on possible strategies of an active monitoring, which could enable both paediatricians and child psychiatrists to a possible prevention, early detection, and a timely management of such effects.
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Affiliation(s)
- Simone Pisano
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, 80131, Naples, Italy
| | - Gennaro Catone
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, 80131, Naples, Italy
| | - Stefania Veltri
- Child Neurology and Psychiatry Unit, Center for Rare Diseases, Department of Pediatrics, Catholic University, Rome, Italy
| | - Valentina Lanzara
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, 80131, Naples, Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, 20157, Milan, Italy
| | | | - Maria Pia Riccio
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, 80131, Naples, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L Sacco, L. Sacco University Hospital, Università di Milano, 20157, Milan, Italy
- Faculty of Education Science, University Suor Orsola Benincasa of Naples, Naples, Italy
| | - Massimo Molteni
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, 80131, Naples, Italy
| | - Antonella Gritti
- Child Neuropsychiatry, Faculty of Education, Suor Orsola Benincasa University, Naples, Italy
| | - Giangennaro Coppola
- Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, S. Giovanni di Dio and Ruggi d'Aragona Hospital, University of Salerno, Fisciano, Italy
| | - Annarita Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - Carmela Bravaccio
- Department of Translational Medical Sciences, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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