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Hauryski S, Potts A, Swigart A, Babinski D, Waschbusch DA, Forrest LN. Characterizing psychopharmacological prescribing practices in a large cohort of adolescents with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2024; 11:17. [PMID: 39103898 DOI: 10.1186/s40479-024-00262-3] [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: 02/01/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Psychiatric medications are not efficacious for treating borderline personality disorder (BPD), yet many patients with BPD are prescribed multiple psychiatric medications. This study aimed to (1) characterize psychiatric medication prescribing practices in adolescents with BPD and (2) assess whether demographic features are associated with prescribing practices. METHOD This sample was N = 2950 pediatric patients with BPD (ages 10-19) across the U.S. Data came from the NeuroBlu database, which includes data from 30 U.S. healthcare systems and hundreds of hospitals. Poisson regressions and chi-squared tests determined whether gender, race, and ethnicity were associated with (1) number of unique psychiatric medications prescribed and (2) number of unique medication classes prescribed. RESULTS Roughly two-thirds (64.85%) of youth were prescribed any medications. Of these youth, 79.40% were prescribed ≥ 2 unique medications and 72.66% were prescribed ≥ 2 unique medications classes. The mean number of unique medications was 3.50 (SD = 2.50). The mean number of unique medication classes was 2.35 (SD = 1.15). The most commonly prescribed medication classes were antidepressants and antipsychotics, which were often prescribed in combination. Poisson regressions showed that boys were prescribed more unique medications (M = 3.67) than girls (M = 3.47). Non-Latinx youth were prescribed significantly more unique medications (M = 44.12) than Latinx youth (M = 3.60, p = .01). CONCLUSIONS Results characterize psychiatric medication prescribing practices in youth with BPD. Prescribing practices vary by demographics, such that boys and non-Latinx youth are prescribed more medications than girls and Latinx youth, respectively. These demographic differences suggest that prescribers may treat BPD differently based on patient demographic characteristics.
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Affiliation(s)
- Sarah Hauryski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Alexandra Potts
- Department of Psychiatry, Medical University of South Carolina, Charleston, USA
| | - Alison Swigart
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Dara Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Lauren N Forrest
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA.
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Büber A, Gavcar EG, Başay Ö, Ünlü G, Kabukçu Başay B, Şenol H. Prevalence and Factors Affecting the Use of Antipsychotics and Antipsychotic Polypharmacy in a Child and Adolescent Psychiatry Inpatient Service. J Child Adolesc Psychopharmacol 2023; 33:69-75. [PMID: 36944095 DOI: 10.1089/cap.2022.0065] [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] [Indexed: 03/23/2023]
Abstract
Objective: We aimed to examine the antipsychotics used by patients hospitalized in the child and youth inpatient service providing tertiary care to investigate whether there is a difference between admission and discharge, polypharmacy, which antipsychotics are used, and which psychotropics are used concomitant with antipsychotics. Methods: Research data were collected retrospectively from all children and adolescents hospitalized in a child and adolescent psychiatry inpatient service in a university hospital in a 4-year period (2015-2019). The sociodemographic and clinical characteristics of the patients, the antipsychotics they used at admission and discharge, the other psychotropics concomitantly used with antipsychotics, and the side effects associated with antipsychotics during hospitalization were collected from the files of the 363 patients. Results: Patients on antipsychotics increased 12.1% from hospitalization to discharge. Antipsychotic polypharmacy increased from 16.2% at admission to 30.7% at discharge. Logistic regression analysis was performed to investigate the factors affecting antipsychotic and antipsychotic polypharmacy. Self-harm, aggression/violence, and extended hospitalization were factors associated with increased antipsychotic use. Psychotic symptoms, psychotic disorder, and extended hospitalization were factors associated with an increase in antipsychotic polypharmacy. Conclusions: Understanding the factors that may cause antipsychotic use and polypharmacy in inpatient services in children and adolescents may prevent unnecessary drug use and long-term side effects that may occur due to these drugs.
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Affiliation(s)
- Ahmet Büber
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Erdal Görkem Gavcar
- Department of Child and Adolescent Psychiatry, Kırıkkale Yüksek Ihtisas Hospital, Kırıkkale, Türkiye
| | - Ömer Başay
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Gülşen Ünlü
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Bürge Kabukçu Başay
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Türkiye
| | - Hande Şenol
- Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli, Türkiye
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Oh S, Byeon SJ, Chung SJ. Characteristics of adverse reactions among antipsychotic drugs using the Korean Adverse Event Reporting System database from 2010 to 2019. J Psychopharmacol 2022; 36:1041-1050. [PMID: 35695641 DOI: 10.1177/02698811221104055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Retrospective studies using spontaneous reporting system databases have provided a great understanding of adverse drug reactions (ADRs) in the real world, complementing the data obtained from randomized controlled trials. However, there have been few reports on large-scale epidemiological studies on the adverse effects of antipsychotics in Asia. AIM This study aimed to investigate the characteristics of antipsychotic ADRs using a nationwide pharmacovigilance database. METHODS Data were collected from the Korea Adverse Event Reporting System database between 2010 and 2019. The study subjects were selected using the International Classification of Disease codes for diseases related to psychosis and Electronic Data Interchange codes for amisulpride, aripiprazole, clozapine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone. The causality assessment of "possible," "probable," or "certain" by the World Health Organization-Uppsala Monitoring Center System causality category was selected. All data were descriptively analyzed. RESULTS In total, 5067 adverse events associated with antipsychotic drugs were reported. The antipsychotics that commonly resulted in ADRs were quetiapine (47.7%), olanzapine (11.3%), and clozapine (10.7%). Serious ADRs were most commonly observed with clozapine. Gastrointestinal and central nervous system problems occurred within a month when ADRs were classified according to the time of onset. In contrast, metabolic and bone marrow-related symptoms occurred after long-term use. Sedation and nausea were the most common ADRs in children and adolescents, whereas constipation and dizziness were common in adults and the elderly. CONCLUSIONS This study extends our knowledge of antipsychotic ADRs in the Asian population.
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Affiliation(s)
- Sanghoon Oh
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Sun-Ju Byeon
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Soo Jie Chung
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
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Severe hyperprolactinemia during lurasidone treatment in a 16-year old girl with schizophrenia – a case report. Scand J Child Adolesc Psychiatr Psychol 2022; 10:87-88. [PMID: 35903553 PMCID: PMC9284940 DOI: 10.2478/sjcapp-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Increase of serum prolactin is a common adverse effect to antipsychotic medication, potentially leading to galactorrhea, menstrual cycle disturbances or sexual adverse effects. Lurasidone is commonly associated with a low risk of prolactin change. Objective To describe a case of severe hyperprolactinemia in a 16-year old female with schizophrenia. Method Case report. Results We saw a severe and sustained prolactin increase during treatment with lurasidone. Conclusions Although lurasidone is usually considered not to increase prolactin, some patients may experience this adverse effect. As related subjective consequences may be falsely attributed to the disease or as direct effects of the antipsycotic agent, serum prolactin measurements should be made prior to and during antipsychotic treatment regardless of medication choice.
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Lan NTP, Tam NT, Bach NX, Thien LC. Psychotropic Drugs Prescription and Use among Children with Mental Disorders at a Tertiary Hospital in Vietnam. Hosp Pharm 2022; 57:336-344. [PMID: 35615478 PMCID: PMC9125123 DOI: 10.1177/00185787211032357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Background: Awareness of psychotropic medication and its adverse drug reactions (ADRs) can promote safe and rational use of medications, particularly in children and adolescents with mental problems. This study examined the prescription of psychotropic drugs and actual drug-drug interaction (DDI) and ADR for children with mental disorders under 18 years of age in a tertiary hospital in Vietnam. Methods: A cross-sectional descriptive study was performed on 257 psychiatric inpatients under 18 years of age at the National Mental Health Institute-Bach Mai Hospital in 2017. Information about the course of treatment included prescribed medications, drug interactions, side effects, drug combination, and modifications to the regimen was collected. Results: 14.8% and 59.5% of patients received a single-drug regimen and a 2-drug combination regimen upon admission, respectively. The most used regimen was antipsychotics + tranquilizers, accounting for 38.1%. Haloperidol was the most commonly prescribed drug (40.5%). Most patients were given the recommended dosage of the drug (>90%). There were 20.6% of patients having drug interactions with the largest proportion of the combination of diazepam and olanzapine (62.3%). ADRs of psychotropic drugs were detected in 46.3% of patients, with the highest rate of ADRs from antipsychotic drugs. Antipsychotics had the highest rate of replacement (91.3%), mostly replaced from a first-generation antipsychotic (FGA) to a second-generation antipsychotic (SGA). Conclusion: The appointment of psychotropic drugs to patients under 18 years of age has to comply with the recommendations, and carefully balance the benefits and risks of ADRs as well as the risk of DDI in case of the drug combination.
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Elsayed OH, Pahwa M, El-Mallakh RS. Pharmacologic Treatment and Management of Bipolar Disorder in Adolescents. Expert Opin Pharmacother 2022; 23:1165-1179. [PMID: 35621334 DOI: 10.1080/14656566.2022.2083954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The importance of the appropriate therapeutic interventions in children and adolescents with bipolar disorder (BD) cannot be overstated since treatment choices and their consequences may have effects into adulthood. AREAS COVERED Randomized clinical trials (RCTs) investigating treatment of mania, bipolar depression, and maintenance in adolescents with BD are reviewed. When RCTs are not available or are inadequate, naturalistic data or open studies are also reviewed. EXPERT OPINION Efficacy and safety of pharmaceutical agents in adolescents with BD appear to mirror adults with BD. Lithium/mood stabilizers are preferred first line agents over antipsychotic medications, but the latter are second line agents particularly in bipolar depression. When lithium is used, serum levels approaching 1.0 mEq/L are reasonable since younger people appear to require/tolerate higher levels. Among the antipsychotics, quetiapine appeared to be minimally better than risperidone while risperidone was associated with greater adverse events. Antipsychotics with antidepressant activity in adults, also appear to have antidepressant effects in youths. Use of antidepressants in bipolar depression is generally not recommended although it may be reasonable in specific clinical situations. The similarities between adolescent and adult outcomes suggest that it is reasonable to utilize adult data to aid with clinical decision making in adolescents with BD, especially when pediatric-specific data are unavailable.
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Affiliation(s)
- Omar H Elsayed
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Kentucky USA
| | - Mehak Pahwa
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Kentucky USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville, Kentucky USA
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Jacob P, Shere S, Kommu JVS. The use of first-generation long-acting injectable antipsychotics in children and adolescents-A retrospective audit from India. Asian J Psychiatr 2021; 61:102663. [PMID: 33971577 DOI: 10.1016/j.ajp.2021.102663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/11/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES There is a dearth of knowledge regarding the usage of first-generation long-acting injectable (LAI) antipsychotics in children and adolescents, despite their off-label use, in low and middle-income countries (LAMIC). METHODS Case records of subjects less than 18 years of age who received any first-generation LAI antipsychotics in the last 10 years(between 2010-19) were reviewed. Details documented for the study from the records included ICD-10 diagnoses, clinical profile, indication for use, medication details, severity of illness, improvement, and global functioning. RESULTS Forty-five subjects (55.3 % male) received first-generation LAI antipsychotics during the study period. All subjects were diagnosed to have serious mental illnesses, with Schizophrenia (52.6 %) and Bipolar Affective Disorder (31.6 %) being the most common diagnoses. At baseline, according to Clinical Global Impressions-Severity (CGI-S) scale, a majority (94.7 %) were severely or markedly ill. Fluphenazine decanoate (60.5 %), flupenthixol decanoate (34.2 %), and zuclopenthixol decanoate (18.4 %) were the first- generation LAI antipsychotics used. Nearly half the subjects (47.4 %) experienced at least one acute adverse event. The most common acute adverse events noted included tremors, rigidity, sialorrhea, and bradykinesia. 31/34 subjects showed improvement at follow-up. CONCLUSIONS The profile of patients for whom first-generation LAI antipsychotics were used included children and adolescents who had severe mental illnesses and were considerably ill. Acute adverse events were common. Short and- long-term follow-up studies are needed to evaluate the efficacy and safety of first-generation LAI antipsychotics in children and adolescents, especially in low and middle-income countries, given that they are reasonably priced and efficacious for severe mental illnesses.
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Affiliation(s)
- Preeti Jacob
- Dept of Child & Adolescent Psychiatry, NIMHANS, Bangalore, India
| | - Siddhesh Shere
- Dept of Psychiatry, Seth GSMC & KEM Hospital, Mumbai, India.
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Wiedeman AM, Panagiotopoulos C, Devlin AM. Treatment-related weight gain and metabolic complications in children with mental health disorders: potential role for lifestyle interventions. Appl Physiol Nutr Metab 2020; 46:193-204. [PMID: 33226841 DOI: 10.1139/apnm-2020-0259] [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] [Indexed: 12/27/2022]
Abstract
Over 1 million Canadian children are estimated to have a mental health disorder, which are commonly treated with medications, such as second-generation antipsychotics (SGAs). Estimates suggest that SGA prescriptions to children are increasing in Canada. Although these medications are important and lifesaving components of psychiatric treatment, they are not without side effects. For some children, SGA treatment is associated with adverse metabolic complications including rapid weight gain, dyslipidemia, elevated blood pressure, and risk for type 2 diabetes. It is not clear why these complications develop, but it is assumed that SGAs stimulate appetite and food intake, and reduce resting energy expenditure leading to weight gain and that the metabolic complications occur secondary to the weight gain. Understanding the mechanisms underlying these complications is key to being able to identify children at risk and prevent and optimize treatment. In this narrative review, we provide an overview of the literature pertaining to the weight gain and metabolic complications in children treated with SGAs, highlighting the scope of the problem and the current limited research on how diet and physical activity can be used to prevent or lessen the severity of the metabolic complications and improve the long-term health trajectories of SGA-treated children. Novelty: Children are increasingly being treated with second-generation antipsychotics for mental health disorders. Dietary and physical activity assessments are not commonly considered in clinical settings. Randomized controlled trials of lifestyle interventions are needed to determine the effectiveness of mitigating the cardiometabolic complications in second-generation antipsychotic-treated children.
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Affiliation(s)
- Alejandra M Wiedeman
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.,Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Constadina Panagiotopoulos
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.,Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Angela M Devlin
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.,Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
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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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Simvastatin improves olanzapine-induced dyslipidemia in rats through inhibiting hepatic mTOR signaling pathway. Acta Pharmacol Sin 2019; 40:1049-1057. [PMID: 30728467 DOI: 10.1038/s41401-019-0212-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/07/2019] [Indexed: 12/14/2022] Open
Abstract
Second-generation antipsychotic drug (SGA)-induced metabolic abnormalities, such as dyslipidemia, are a major clinical problem for antipsychotic therapy. Accumulated evidences have shown the efficacy of statins in reducing SGA-induced dyslipidemia, but the underlying mechanisms are unclear. In this study, we explored whether mTOR signaling was involved in olanzapine (OLZ)-induced dyslipidemia as well as the lipid-lowering effects of cotreatment of simvastatin (Sim) in rats. Model rats received OLZ (1.0 mg/kg, t.i.d.) for 7 weeks; from the third week a group of model rats were cotreatment of Sim (3.0 mg/kg, t.i.d.) for 5 weeks. We found that OLZ treatment significantly increased the plasma triglyceride (TG) and total cholesterol (TC) levels, and promoted lipid accumulation in the liver, whereas cotreatment of Sim reversed OLZ-induced dyslipidemia. Hepatic mTORC1 and p-mTORC1 expression was accelerated in the OLZ treatment group, with upregulation of mRNA expression of sterol regulatory element-binding protein 1c (SREBP1c) and its target genes, whereas these alterations were ameliorated by Sim cotreatment. In HepG2 cells, rapamycin (a mTOR inhibitor) significantly reduced the OLZ-stimulated hepatocellular lipid contents and weakened the ability of Sim to lower lipids via a mechanism associated with the upregulation of SREBP1c-mediated de novo lipogenesis. Our data suggest that OLZ induces lipid accumulation in both plasma and liver, and Sim ameliorates OLZ-induced lipid metabolic dysfunction through its effects on mTOR signaling via reducing SREBP1c activation and the downregulation of gene expression involved in lipogenesis. These data provide a new insight into the prevention of metabolic side effects induced by antipsychotic drugs.
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Khan S, Down J, Aouira N, Bor W, Haywood A, Littlewood R, Heussler H, McDermott B. Current pharmacotherapy options for conduct disorders in adolescents and children. Expert Opin Pharmacother 2019; 20:571-583. [PMID: 30702354 DOI: 10.1080/14656566.2018.1561862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Conduct disorder (CD) is a common mental health disorder of childhood and adolescence. CD's complexity, with its heterogenous clinical manifestations and overlapping comorbidities makes the application of evidence-based management approaches challenging. This article aims to combine a systematic review of the available literature, with a consensus opinion from both child and adolescent psychiatrists and developmental pediatricians on the clinical and pharmacological management of children and adolescents with conduct disorder (CD). AREAS COVERED The authors review the CD population and provide a systematic review and meta-analysis of the effectiveness and safety of pharmacotherapies using preferred reporting items for systematic review and meta-analysis (PRISMA) and strength of evidence recommendation taxonomy (SORT) guidelines. The authors then provide an expert clinical opinion for the use of different pharmacotherapies to address aggressive and disruptive behavior in children. EXPERT OPINION Atypical antipsychotics (e.g. risperidone) demonstrate evidence for efficacy in CD. Other pharmacotherapies (e.g. mood stabilizers, anticonvulsants, psychostimulants and selective norepinephrine reuptake inhibitors) have a low level of evidence for CD alone, however, can sometimes be effective in managing the symptoms of CD when other psychiatric disorders are also present.
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Affiliation(s)
- Sohil Khan
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia.,b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,c Manipal College of Pharmaceutical Sciences , Manipal University , Manipal , India
| | - John Down
- d Children's Health Queensland Hospital and Health Service , Lady Cilento Children's Hospital , South Brisbane , Australia
| | - Nisreen Aouira
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia
| | - William Bor
- b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,e Child and Youth Mental Health Service , Children's Health Queensland Hospital and Health Service , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia
| | - Alison Haywood
- a School of Pharmacy and Pharmacology, Quality Use of Medicines Network, Menzies Health Institute , Griffith University , Gold Coast , Australia.,b Mater Research Institute , The University of Queensland , South Brisbane , Australia
| | - Robyn Littlewood
- e Child and Youth Mental Health Service , Children's Health Queensland Hospital and Health Service , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia.,g School of Human Movement and Nutrition Sciences , The University of Queensland , South Brisbane , Australia
| | - Helen Heussler
- b Mater Research Institute , The University of Queensland , South Brisbane , Australia.,d Children's Health Queensland Hospital and Health Service , Lady Cilento Children's Hospital , South Brisbane , Australia.,f Centre for Children's Health Research , Children's Health Queensland Hospital and Health Services , South Brisbane , Australia
| | - Brett McDermott
- h Townsville Clinical School, College of Medicine and Dentistry , James Cook University , Townsville , Australia
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Pan B, Lian J, Deng C. Chronic antipsychotic treatment differentially modulates protein kinase A- and glycogen synthase kinase 3 beta-dependent signaling pathways, N-methyl-D-aspartate receptor and γ-aminobutyric acid A receptors in nucleus accumbens of juvenile rats. J Psychopharmacol 2018; 32:1252-1263. [PMID: 30136620 DOI: 10.1177/0269881118788822] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Antipsychotics are developed to treat mental disorders in adults; however, the prescription (mostly "off-label") of antipsychotics for children/adolescents has been constantly increasing over years. The influences of antipsychotics on juveniles requires investigation to validate their clinic use. Antipsychotics mainly exert their effects via several receptors and signaling pathways. AIMS This study examined the effects of aripiprazole, olanzapine, and risperidone on selected signaling pathways, N-methyl-D-aspartate, and γ-aminobutyric acid A receptors in juveniles. METHODS Rats were orally administered aripiprazole (1 mg/kg), olanzapine (1 mg/kg), risperidone (0.3 mg/kg), or vehicle three times/day from postnatal day 23 (±1 day) for three weeks. The effects of antipsychotics in the nucleus accumbens and caudate putamen were measured by Western blots. RESULTS In the nucleus accumbens, all three drugs differentially increased N-methyl-D-aspartate and γ-aminobutyric acid A receptor expression. Additionally, all three antipsychotics differentially elevated the phosphorylation of glycogen synthase kinase 3 beta, β-catenin, and cAMP-responsive element-binding protein 1. In the caudate putamen, olanzapine increased β-catenin phosphorylation; and aripiprazole and olanzapine elevated γ-aminobutyric acid A receptor levels. Correlation analysis indicated that antipsychotics might modulate N-methyl-D-aspartate receptors via glycogen synthase kinase 3 beta-β-catenin signaling and/or cAMP-responsive element-binding protein 1 activation. CONCLUSIONS These findings suggest that antipsychotics can affect protein kinase A- and glycogen synthase kinase 3 beta-dependent signaling pathways in juveniles; and their modulation on N-methyl-D-aspartate and γ-aminobutyric acid A receptors is probably through glycogen synthase kinase 3 beta-β-catenin signaling and/or cAMP-responsive element-binding protein 1 activation.
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Affiliation(s)
- Bo Pan
- 1 The Key Laboratory of Syndrome Differentiation and Treatment of Gastric Cancer of the State Administration of Traditional Chinese Medicine, Yangzhou University Medical College, Yangzhou, China.,4 School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Jiamei Lian
- 3 Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,4 School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Chao Deng
- 3 Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia.,4 School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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Hayes D, Kyriakopoulos M. Dilemmas in the treatment of early-onset first-episode psychosis. Ther Adv Psychopharmacol 2018; 8:231-239. [PMID: 30065814 PMCID: PMC6058451 DOI: 10.1177/2045125318765725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/26/2018] [Indexed: 12/20/2022] Open
Abstract
Early-onset first-episode psychosis (EOP) is a severe mental disorder that can pose a number of challenges to clinicians, young people and their families. Its assessment and differentiation from other neurodevelopmental and mental health conditions may at times be difficult, its treatment may not always lead to optimal outcomes and can be associated with significant side effects, and its long-term course and prognosis seem to be less favourable compared with the adult-onset disorder. In this paper, we discuss some dilemmas associated with the evaluation and management of EOP and propose approaches that can be used in the clinical decision-making process. A detailed and well-informed assessment of psychotic symptoms and comorbidities, a systematic approach to treatment with minimum possible medication doses and close monitoring of its effectiveness and adverse effects, and multidimensional interventions taking into consideration risks and expectations associated with EOP, are paramount in the achievement of the most favourable outcomes for affected children and young people.
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Affiliation(s)
- Daniel Hayes
- National and Specialist Bethlem Adolescent Unit, Bethlem Royal Hospital, Child and Adolescent Mental Health Clinical Academic Group, South London and the Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and the Maudsley NHS Foundation Trust, London, UK
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Safety and efficacy of lithium in children and adolescents: A systematic review in bipolar illness. Eur Psychiatry 2018; 54:85-97. [DOI: 10.1016/j.eurpsy.2018.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 01/04/2023] Open
Abstract
AbstractIntroduction:Many clinicians are reluctant to use traditional mood-stabilizing agents, especially lithium, in children and adolescents. This review examined the evidence for lithium’s safety and efficacy in this population.Methods:A systematic review was conducted on the use of lithium in children and adolescents with bipolar disorder (BD). Relevant papers published through June 30th 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library.Results:30 articles met inclusion criteria, including 12 randomized controlled trials (RCTs). Findings from RCTs demonstrate efficacy for acute mania in up to 50% of patients, and evidence of long-term maintenance efficacy. Lithium was generally safe, at least in the short term, with most common side effects being gastrointestinal, polyuria, or headache. Only a minority of patients experienced hypothyroidism. No cases of acute kidney injury or chronic kidney disease were reported.Conclusions:Though the available literature is mostly short-term, there is evidence that lithium monotherapy is reasonably safe and effective in children and adolescents, specifically for acute mania and for prevention of mood episodes.
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De Santis M, Huang XF, Deng C. Early antipsychotic treatment in juvenile rats elicits long-term alterations to the adult serotonin receptors. Neuropsychiatr Dis Treat 2018; 14:1569-1583. [PMID: 29950841 PMCID: PMC6011877 DOI: 10.2147/ndt.s158545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Antipsychotic drug (APD) prescription/use in children has increased significantly worldwide, despite limited insight into potential long-term effects of treatment on adult brain functioning. While initial long-term studies have uncovered alterations to behaviors following early APD treatment, further investigations into potential changes to receptor density levels of related neurotransmitter (NT) systems are required. METHODS The current investigation utilized an animal model for early APD treatment with aripiprazole, olanzapine, and risperidone in male and female juvenile rats to investigate potential long-term changes to the adult serotonin (5-HT) NT system. Levels of 5-HT1A, 5-HT2A, and 5-HT2C receptors were measured in the prefrontal cortex (PFC), caudate putamen (CPu), nucleus accumbens (NAc), and hippocampus via Western Blot and receptor autoradiography. RESULTS In the male cohort, long-term changes to 5-HT2A and 5-HT2C receptors were found mostly across hippocampal and cortical brain regions following early aripiprazole and olanzapine treatment, while early risperidone treatment changed 5-HT1A receptor levels in the NAc and PFC. Lesser effects were uncovered in the female cohort with aripiprazole, olanzapine and risperidone to alter 5-HT1A and 5-HT2A receptors in NAc and hippocampal brain regions, respectively. CONCLUSION The results of this study suggest that early treatment of various APDs in juvenile rats may cause gender and brain regional specific changes in 5-HT2A and 5-HT2C receptors in the adult brain.
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Affiliation(s)
- Michael De Santis
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Xu-Feng Huang
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Chao Deng
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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Fortea A, Ilzarbe D, Espinosa L, Solerdelcoll M, de Castro C, Oriolo G, Sugranyes G, Baeza I. Long-Acting Injectable Atypical Antipsychotic Use in Adolescents: An Observational Study. J Child Adolesc Psychopharmacol 2018; 28:252-257. [PMID: 29381388 DOI: 10.1089/cap.2017.0096] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Although second generation long-acting injectable antipsychotics (SG-LAIAs) have been approved and are widely used in adults, there is limited evidence for the use of long-acting formulations in children and adolescents. Thus, we systematically describe the off-label use of SG-LAIAs in clinical practice in adolescent inpatients. METHODS All individuals admitted to our Children and Adolescent Inpatient Psychiatry Unit receiving treatment with SG-LAIAs between January 2013 and June 2016 were reviewed. A retrospective analysis of medical records was conducted. Clinical diagnoses were established using DSM-5 criteria. RESULTS Thirty individuals (53.3% female) out of a total of 1,148 admitted patients (2.6%) were identified. The mean age was 16.3 (SD = 1.3; range: 12.5-17.9).The main diagnoses were psychosis (70%) and disruptive behavior disorders (DBDs) (30%), although comorbidity was frequent (96.6%), especially drug use (55.2%, mostly cannabis). SG-LAIAs used were aripiprazole (40%), risperidone (36.7%), and paliperidone palmitate (23.3%), and the main reasons were a history of low compliance (90%) and/or poor insight (73.3%). A mean improvement of 31.7 (SD = 8.7) between admission and discharge was registered in the Children's Global Assessment Scale (CGAS); no differences were observed between different SG-LAIAs. Although they were generally well tolerated, 23.3% of patients reported mild short-term side effects, which were more frequent with risperidone than with aripiprazole (p = .014). CONCLUSIONS Our clinical experience suggests that SG-LAIAs may be a safe treatment option during adolescence in inpatients with psychotic disorders, as well as with DBD. No differences were found in CGAS improvement scores between the three SGA-LAIAs used, although patients on risperidone reported more side effects than those on aripiprazole. Further research is needed so as to evaluate safety and effectiveness of SG-LAIAs in this population.
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Affiliation(s)
- Adriana Fortea
- 1 Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona , Barcelona, Spain
| | - Daniel Ilzarbe
- 2 Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College of London , London, United Kingdom
| | - Laura Espinosa
- 1 Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona , Barcelona, Spain
| | - Mireia Solerdelcoll
- 1 Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona , Barcelona, Spain
| | - Clara de Castro
- 3 Centro de Salud Mental Infanto-Juvenil, Hospital Sant Joan de Déu , Cornellá de Llobregat, Barcelona, Spain
| | - Giovanni Oriolo
- 1 Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic de Barcelona , Barcelona, Spain
| | - Gisela Sugranyes
- 4 Department of Child and Adolescent Psychiatry, Institute of Neuroscience, Hospital Clínic de Barcelona , Barcelona, Spain .,5 Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (CERCA-IDIBAPS) , Barcelona, Spain .,6 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) , Barcelona, Spain
| | - Inmaculada Baeza
- 4 Department of Child and Adolescent Psychiatry, Institute of Neuroscience, Hospital Clínic de Barcelona , Barcelona, Spain .,5 Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (CERCA-IDIBAPS) , Barcelona, Spain .,6 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) , Barcelona, Spain
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Abbas S, Ihle P, Adler JB, Engel S, Günster C, Linder R, Lehmkuhl G, Schübert I. Psychopharmacological Prescriptions in Children and Adolescents in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 113:396-403. [PMID: 27374377 DOI: 10.3238/arztebl.2016.0396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/18/2016] [Accepted: 02/18/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND In view of the well-known increase in prescriptions of stimulants for children and adolescents over the last 20 years, it is important to study trends in the prevalence and incidence of the use of other psychotropic drugs by this age group as well, to enable an early response to potential problems in the current care situation. METHODS We used nationwide data from German statutory health insurance funds (Allgemeine Ortskrankenkasse [AOK], all insurees; Techniker Kranken - kasse [TK], a 50% randomized sample) concerning all insurees aged 0-17 years (5.0 million people in 2012) to study trends in the prevalence and incidence of psychotropic medication use as well as initially prescribing medical specialties over the period 2004-2012, both for the overall group of psychotropic drugs and for selected subgroups of drugs. RESULTS From 2004 to 2012, the prevalence of psychotropic drug prescriptions (not including herbal and homeopathic substances) for children and adolescents rose from 19.6 to 27.1 per 1000 individuals. Marked rises were seen for stimulants (10.5 to 19.1 per 1000) and antipsychotic drugs (2.3 to 3.1 per 1000), while the prevalence of antidepressant prescriptions remained constant at about 2 per 1000. The rates of new prescriptions from 2006 to 2012 were generally constant or decreasing; for the overall group of (non-herbal, nonhomeopathic) psychotropic drugs, the rate of new prescriptions fell from 9.9 to 8.7 per 1000. There was a trend toward the issuance of new prescriptions by medical specialists, rather than by family physicians and pediatricians. CONCLUSION The observed increased prevalence of psychotropic drug use among children and adolescents appears to be due not to an increased rate of initial prescriptions for these drugs, but rather to a rise in the number of patients who, once having received such drugs, were given further prescriptions for them in the years that followed.
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Affiliation(s)
- Sascha Abbas
- PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Scientific Institute of the AOK (WIdO, Wissenschaftliches Institut der AOK), Berlin, Scientific Institute of the TK for Benefit and Efficiency in Health Care (WINEG, Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen), Hamburg
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Bose-Brill S, Xing J, Barnette DJ, Hanks C. Pharmacogenomic testing: aiding in the management of psychotropic therapy for adolescents with autism spectrum disorders. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2017; 10:247-252. [PMID: 29026329 PMCID: PMC5626389 DOI: 10.2147/pgpm.s130247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adolescents with autism have higher rates of anxiety than the general adolescent population. They often struggle to express psychological symptoms verbally where their symptoms may manifest as withdrawal and agitation. Adolescent patients with autism have higher rates of polypharmacy and high-risk psychiatric medication use (eg, atypical antipsychotics) than other patients with psychiatric illness. Primary care pediatricians are at the front lines of psychiatric management for patients with autism. Yet, they have inadequate access to pediatric psychiatry for complex medication management. Pharmacogenomic testing can provide personalized drug metabolism profiles for a majority of psychotropic medications. Primary care based pharmacogenomic testing for adolescents with autism on one or more psychiatric medications may help individualize and optimize complex medication regimens, while promoting drug safety.
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Affiliation(s)
- Seuli Bose-Brill
- Internal Medicine and Pediatrics at Grandview, Wexner Medical Center
| | - Jinming Xing
- Department of Practice and Science, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Debra J Barnette
- Internal Medicine and Pediatrics at Grandview, Wexner Medical Center.,Department of Practice and Science, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Christopher Hanks
- Internal Medicine and Pediatrics at Grandview, Wexner Medical Center
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Dikeç G, Arabaci LB, Uzunoglu GB, Mizrak SD. An Investigation of Cardiovascular Risks in a Group of Children and Adolescents Who Use Atypical Antipsychotics. Issues Ment Health Nurs 2017; 38:872-880. [PMID: 28872927 DOI: 10.1080/01612840.2017.1355946] [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: 10/18/2022]
Abstract
This study was conducted to identify the metabolic parameters and body measurements associated with cardiovascular risks in a group of children and adolescents who as part of inpatient treatment received atypical antipsychotics at a psychiatric hospital in Turkey. Body mass indexes (BMIs), waist circumferences (WCs), diastolic blood pressures (DBPs), systolic blood pressures (SBPs) and heart rates (HRs) of the patients were evaluated during hospitalization and at discharge. A statistically significant difference was found among the mean BMIs, WCs, DBPs and HRs of the patients at the stages of their hospitalization and discharge (p < 0.05). On the basis of the study findings, it is recommended that mental health nurses evaluate these risk factors in children and adolescents and provide education on this subject to the patients and their families.
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Affiliation(s)
- Gül Dikeç
- a Faculty of Heath Sciences, Department of Nursing , Istinye University , Istanbul , Turkey
| | - Leyla Baysan Arabaci
- b Faculty of Health Sciences, Department of Psychiatric Nursing , Izmir Katip Çelebi University , Izmir , Turkey
| | - Gülçin Bölük Uzunoglu
- c Manisa Psychiatric and Neurological Hospital , Child and Adolescent Psychiatry Clinic , Manisa , Turkey
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20
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Prevalence and Risk Factors of Prolonged Corrected QT Interval Among Children and Adolescents Treated With Antipsychotic Medications: A Long-Term Follow-Up in a Real-World Population. J Clin Psychopharmacol 2017; 37:78-83. [PMID: 27930499 DOI: 10.1097/jcp.0000000000000639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to describe the prevalence of corrected QT (QTc) interval disorders and the possible predisposing factors in children and adolescents treated with antipsychotic (AP) medications in a real-world population with a long-term follow-up. METHODS Data were obtained from the SafEty of NeurolepTics in Infancy and Adolescence (SENTIA) registry (https://sentia.es). The SENTIA includes patients younger than 18 years who are currently taking or initiating treatment with AP medications and have agreed to participate in the registry. The SENTIA's follow-up includes an electrocardiogram (ECG) assessment before starting treatment and at 1, 3, and 6 months after treatment initiation or after any changes in the patient's AP medication treatment. Thereafter, all participants undergo an ECG every 6 months. A QTc interval more than 450 milliseconds, increases in QTc interval of 60 milliseconds or more, or QTc dispersion more than 100 milliseconds were considered abnormal. RESULTS Since January 1, 2011, 101 patients have been enrolled in SENTIA and have had at least 1 ECG assessment. The mean age at inclusion was 11.5 years; 75% of the patients were men. The mean follow-up time was 20.0 ± 15.1 months. The most frequently prescribed AP medications were risperidone (52.2%) and aripiprazole (45.5%). Seven patients (6.9%) had abnormal changes in QTc. No patient had a QTc interval more than 500 milliseconds. All patients were asymptomatic. The QTc changes were observed at different times of exposure, with a range of 1 to 39 months after beginning AP treatment. Concomitant use of attention deficit and hyperactivity disorder drugs seemed a possible factor associated with QTc disorders. CONCLUSIONS Patients should undergo a baseline ECG assessment before starting AP medication treatment, particularly patients with concomitant use of attention deficit and hyperactivity disorder drugs or a family/personal history of heart disease.
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Lytle S, McVoy M, Sajatovic M. Long-Acting Injectable Antipsychotics in Children and Adolescents. J Child Adolesc Psychopharmacol 2017; 27:2-9. [PMID: 28112539 DOI: 10.1089/cap.2016.0055] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE While a number of articles have reviewed the use of long-acting injectable antipsychotics (LAIs) in first-episode psychosis, there has been extremely limited focus on LAIs in children and adolescents. This review of the literature evaluated use of LAIs in children and youth under the age of 18. METHODS We conducted a comprehensive search of the PubMed, PsychINFO, CINAHL, and EMBASE databases using keywords related to LAIs, children, and psychiatric conditions, including schizophrenia, bipolar disorder, and schizoaffective disorder. Reports were included if they were in English, conducted between 1971 and 2015, and reported on use of LAIs in individuals less than the age of 18. RESULTS The search identified seven reports including one open-label trial, three case reports, and three case series. No controlled trials were found. Sample sizes ranged from 1 to 19 with a total of 36 individuals in all cases combined. Mean sample age was 12.1 ± 2.2 in the open-label trial and calculated to be 14.9 ± 1.5 in the remainder of the reports. Most patients (80.6%) were boys. Primary diagnoses included bipolar I disorder (n = 18; 50%), schizophrenia (n = 7; 19.4%), and bipolar spectrum disorders (n = 6; 16.6%). The LAIs used were risperidone long-acting injection (n = 24; 66.7%), paliperidone palmitate (n = 8; 22.2%), fluphenazine decanoate (n = 1; 2.8%), aripiprazole extended-release injectable (n = 1; 2.8%), zuclopenthixol decanoate (n = 1; 2.8%), and olanzapine extended release (n = 1; 2.8%). Most cases reported clinical improvement and the majority of individuals (n = 14; 82.4%) were reported to tolerate the medication well. The most common side effects were weight gain (mean 5.7 ± 4.1 kg in the open-label trial), tremor (n = 2; 5.6%), and oculogyric crisis (n = 2; 5.6%). CONCLUSIONS This literature review suggests that LAI use in youth with serious mental illness may improve clinical outcomes and adherence. Side effects of LAIs among youth appear are similar to oral preparations. However, there is a paucity of data despite issues with nonadherence in youth and the fact that they have much to lose and much to gain. Existing reports have substantial methodological limitations, and research is needed to guide the use of LAIs in children and adolescents.
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Affiliation(s)
- Sarah Lytle
- Department of Psychiatry, University Hospitals Cleveland Medical Center , Cleveland, Ohio
| | - Molly McVoy
- Department of Psychiatry, University Hospitals Cleveland Medical Center , Cleveland, Ohio
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center , Cleveland, Ohio
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De Santis M, Lian J, Huang XF, Deng C. Early Antipsychotic Treatment in Juvenile Rats Elicits Long-Term Alterations to the Dopamine Neurotransmitter System. Int J Mol Sci 2016; 17:E1944. [PMID: 27879654 PMCID: PMC5133938 DOI: 10.3390/ijms17111944] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 10/31/2016] [Accepted: 11/10/2016] [Indexed: 12/16/2022] Open
Abstract
Prescription of antipsychotic drugs (APDs) to children has substantially increased in recent years. Whilst current investigations into potential long-term effects have uncovered some alterations to adult behaviours, further investigations into potential changes to neurotransmitter systems are required. The current study investigated potential long-term changes to the adult dopamine (DA) system following aripiprazole, olanzapine and risperidone treatment in female and male juvenile rats. Levels of tyrosine hydroxylase (TH), phosphorylated-TH (p-TH), dopamine active transporter (DAT), and D₁ and D₂ receptors were measured via Western blot and/or receptor autoradiography. Aripiprazole decreased TH and D₁ receptor levels in the ventral tegmental area (VTA) and p-TH levels in the prefrontal cortex (PFC) of females, whilst TH levels decreased in the PFC of males. Olanzapine decreased PFC p-TH levels and increased D₂ receptor expression in the PFC and nucleus accumbens (NAc) in females only. Additionally, risperidone treatment increased D₁ receptor levels in the hippocampus of females, whilst, in males, p-TH levels increased in the PFC and hippocampus, D₁ receptor expression decreased in the NAc, and DAT levels decreased in the caudate putamen (CPu), and elevated in the VTA. These results suggest that early treatment with various APDs can cause different long-term alterations in the adult brain, across both treatment groups and genders.
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Affiliation(s)
- Michael De Santis
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia.
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Jiamei Lian
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia.
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Xu-Feng Huang
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Chao Deng
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia.
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
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Hambly JL, Khan S, McDermott B, Bor W, Haywood A. Pharmacotherapy of conduct disorder: Challenges, options and future directions. J Psychopharmacol 2016; 30:967-75. [PMID: 27436231 DOI: 10.1177/0269881116658985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED There is a critical need for evaluation of the pharmacotherapies used in conduct disorder (CD), due to the high incidence of off-label prescribing. The aim of this review was to identify concerns associated with the safety, efficacy and impact on quality of life (QOL) that pharmacotherapy has in children and adolescents with CD. A systematic review was undertaken using pre-defined search criteria and four databases, including reference searches. We assessed these studies using the Strength of Recommendation Taxonomy, Grading of Recommendations Assessment, Development and Evaluation, and Review Manager Risk of Bias (RevMan®) tools. There were 12 randomised controlled trials that met our inclusion criteria. STUDIES INCLUDED antipsychotics, atomoxetine, lithium, clonidine, divalproex sodium and psychostimulants. The antipsychotics demonstrated efficacy, but were associated with adverse effects. Other agents demonstrated mixed responses, highlighting the lack of clinical significance and increased incidence of adverse effects. The management of related adverse effects was addressed to assist with clinical gaps. Overall, there is limited evidence regarding the role of pharmacotherapy in CD. More research is needed that takes into account the heterogeneity of CD and analysis of pharmacotherapy in pure CD.
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Affiliation(s)
- Jessica L Hambly
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Sohil Khan
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia Manipal College of Pharmaceutical Sciences, Manipal University, Manipal, India
| | - Brett McDermott
- Townsville Clinical School, College of Medicine and Dentistry, James Cook University, Queensland, QLD, Australia
| | - William Bor
- Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia Child and Youth Mental Health Service, Centre for Children's Health Research, Queensland Health, Brisbane, QLD, Australia
| | - Alison Haywood
- School of Pharmacy, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia
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Moe AAK, Scott JG, Burne TH, Eyles DW. Neural changes induced by antipsychotic administration in adolescence: A review of studies in laboratory rodents. J Psychopharmacol 2016; 30:771-94. [PMID: 27413140 DOI: 10.1177/0269881116654776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Adolescence is characterized by major remodelling processes in the brain. Use of antipsychotic drugs (APDs) in adolescents has increased dramatically in the last 20 years; however, our understanding of the neurobiological consequences of APD treatment on the adolescent brain has not kept the same pace and significant concerns have been raised. In this review, we examined currently available preclinical studies of the effects of APDs on the adolescent brain. In animal models of neuropsychiatric disorders, adolescent APD treatment appears to be protective against selected structural, behavioural and neurochemical phenotypes. In "neurodevelopmentally normal" adolescent animals, a range of short- and long-term alterations in behaviour and neurochemistry have been reported. In particular, the adolescent brain appears to be sensitive to long-term locomotor/reward effects of chronic atypical APDs in contrast with the outcomes in adults. Long-lasting changes in dopaminergic, glutamatergic and gamma-amino butyric acid-ergic systems induced by adolescent APD administration have been observed in the nucleus accumbens. A detailed examination of other potential target regions such as striatum, prefrontal cortex and ventral tegmental area is still required. Through identification of specific neural pathways targeted by adolescent APD treatment, future studies will expand the current knowledge on long-term neural outcomes which are of translational value.
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Affiliation(s)
- Aung Aung Kywe Moe
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
| | - James G Scott
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia Discipline of Psychiatry, School of Medicine, The University of Queensland Centre for Clinical Research, Herston, QLD, Australia Metro North Mental Health Service, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Thomas Hj Burne
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Darryl W Eyles
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia Queensland Centre for Mental Health Research, Wacol, QLD, Australia
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Pope S, Zaraa SG. Efficacy of Long-Acting Injectable Antipsychotics in Adolescents. J Child Adolesc Psychopharmacol 2016; 26:391-4. [PMID: 27028966 DOI: 10.1089/cap.2015.0091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The number of long-acting injectable antipsychotics (LAIA) has increased in recent years. The safety and efficacy of that treatment are not established in children. This study aims to address this gap of information by studying such treatments in a case series. METHODS This retrospective chart review of patients identified by the investigators at an academic acute inpatient psychiatric unit included all patients from the past 24 months who required new initial treatment with LAIA. This study included a case series of the nine patients along with Clinical Global Impression-Severity (CGI-S) scores from admission and discharge and Clinical Global Impression-Improvement (CGI-I) scores. Other observations included the presentation of primary psychiatric diagnosis, psychiatric and medical comorbidities, age, sex, previous and LAIA psychiatric medications, reasoning for LAIA treatment, adverse events, CGI-S and CGI-I scores, and outpatient resources utilized to continue treatment. RESULTS The case series included two females and seven males within the ages of 14-17 years. Of those patients, five were treated with paliperidone palmitate, one treated with risperidone, one treated with fluphenazine, and one treated with aripiprazole. Primary psychiatric diagnosis of the patients in the case series included five with schizophrenia, one with schizoaffective disorder, one with bipolar affective disorder-type I, one with bipolar affective disorder-not otherwise specified, and one with mood disorder-not otherwise specified. In all nine cases, noncompliance was a consideration in treatment with LAIA. Frequent running away and severity of illness were also considerations in one case each. All of the patients required community resources with injectable services. CONCLUSION This study describes initiation of treatment with LAIA in 14-17-year olds in an acute inpatient psychiatric unit with serious mental illness. This study also demonstrates the need for outpatient community resources with the ability to provide long-acting injectable medication. Limitations of this study include a small patient population, other factors changing CGI-S and CGI-I scores beyond the medication, and the nature of the study as a retrospective chart review. This study did not compare medications between each other. Maintenance dosing and long-term safety were beyond the scope of this study. Future directives for safety studies, open-label trials, and randomized double-blinded control trails in the pediatric population would be needed.
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Affiliation(s)
- Stephanie Pope
- Division of Child & Adolescent Psychiatry, Department of Psychiatry, University Hospitals Case Medical Center , Cleveland, Ohio
| | - Solomon G Zaraa
- Division of Child & Adolescent Psychiatry, Department of Psychiatry, University Hospitals Case Medical Center , Cleveland, Ohio
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De Santis M, Lian J, Huang XF, Deng C. Early antipsychotic treatment in childhood/adolescent period has long-term effects on depressive-like, anxiety-like and locomotor behaviours in adult rats. J Psychopharmacol 2016; 30:204-14. [PMID: 26577063 DOI: 10.1177/0269881115616383] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Childhood/adolescent antipsychotic drug (APD) use is exponentially increasing worldwide, despite limited knowledge of the long-term effects of early APD treatment. Whilst investigations have found that early treatment has resulted in some alterations to dopamine and serotonin neurotransmission systems (essential to APD efficacy), there have only been limited studies into potential long-term behavioural changes. This study, using an animal model for childhood/adolescent APD treatment, investigated the long-term effects of aripiprazole, olanzapine and risperidone on adult behaviours of male and female rats. Open-field/holeboard, elevated plus maze (EPM), social interaction and forced swim (FS) tests were then conducted in adult rats. Our results indicated that in the male cohort, early risperidone and olanzapine treatment elicited long-term hyper-locomotor effects (open-field/holeboard and FS tests), whilst a decrease in depressive-like behaviour (in FS test) was observed in response to olanzapine treatment. Furthermore, anxiolytic-like behaviours were found following testing in the open-field/holeboard and EPM in response to all three drug treatments. Effects in the female cohort, however, were to a far lesser extent, with behavioural attributes indicative of an increased depressive-like behaviour and hypo-locomotor activity exhibited in the FS test following early risperidone and olanzapine treatment. These results suggest that various APDs have different long-term effects on the behaviours of adult rats.
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Affiliation(s)
- Michael De Santis
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Jiamei Lian
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Xu-Feng Huang
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Chao Deng
- Antipsychotic Research Laboratory, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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Cook TB, Reeves GM, Teufel J, Postolache TT. Persistence of racial disparities in prescription of first-generation antipsychotics in the USA. Pharmacoepidemiol Drug Saf 2015; 24:1197-206. [PMID: 26132170 DOI: 10.1002/pds.3819] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/21/2015] [Accepted: 05/27/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to estimate the prevalence of first-generation antipsychotics (FGA) prescribed for treatment of psychiatric and neurological conditions and use of benztropine to reduce extrapyramidal side effects (EPS) by patient race/ethnicity in a nationally representative sample of adult outpatient visits. METHODS The study sample included all outpatient visits (N = 8154) among patients aged 18-69 years where a prescription for one or more antipsychotics was recorded across 6 years of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2005-2010). Use of FGA was compared by race/ethnicity using multiple logistic regression models accounting for patient and clinical characteristics stratified by neighborhood poverty rate. Frequency of EPS was determined by use of benztropine to reduce or prevent EPS. RESULTS Black patients were significantly more likely than White patients to use FGA (odds ratio = 1.48, p = 0.040) accounting for psychiatric and neurological diagnoses, treatment setting, metabolic factors, neighborhood poverty, and payer source. Black patients were more than twice as likely as White patients to receive higher-potency FGA (haloperidol or fluphenazine), particularly in higher-poverty areas (odds ratio = 2.50, p < 0.001). Use of FGA, higher among Black than White patients, was positively associated with use of benztropine to reduce EPS. CONCLUSIONS Racial disparities in the pharmacological treatment of severe mental disorders persist 30 years after the introduction of second-generation antipsychotics. The relatively high frequency of FGA of use among Black patients compared with White patients despite more Food and Drug Administration-approved indications and lower EPS risk for second-generation antipsychotics requires additional research.
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Affiliation(s)
- Thomas B Cook
- Department of Public Health, Mercyhurst Institute of Public Health, Mercyhurst University, Erie, PA, USA
| | - Gloria M Reeves
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James Teufel
- Department of Public Health, Mercyhurst Institute of Public Health, Mercyhurst University, Erie, PA, USA
| | - Teodor T Postolache
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.,Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Rocky Mountain MIRECC, Denver, CO, USA
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Devlin AM, Panagiotopoulos C. Metabolic side effects and pharmacogenetics of second-generation antipsychotics in children. Pharmacogenomics 2015; 16:981-96. [DOI: 10.2217/pgs.15.55] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Second-generation antipsychotics (SGAs) are increasingly being used to treat children for a range of mental health conditions, for example, anxiety disorder, attention deficit hyperactivity disorder and bipolar disorder. SGA treatment is associated with weight gain and cardiometabolic side effects such as dyslipidemia, insulin resistance and elevated blood pressure, in some, but not all children. This review provides an overview of the potential role of pharmacogenomics in predisposing a child to unhealthy weight gain and cardiometabolic side effects with SGA treatment. Specifically, the review includes a synopsis of the evidence for cardiometabolic side effects in SGA-treated children, illustrating the extent and depth of the problem; summarizes the potential long-term consequences of developing cardiometabolic risk during childhood and highlights genetic variants that may be useful in predicting cardiometabolic side effects in SGA-treated children.
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Affiliation(s)
- Angela M Devlin
- Department of Pediatrics, University of British Columbia, Child & Family Research Institute, 272–950 West 28th Avenue, Vancouver, V5Z 4H4, Canada
| | - Constadina Panagiotopoulos
- Department of Pediatrics, University of British Columbia, Child & Family Research Institute, 272–950 West 28th Avenue, Vancouver, V5Z 4H4, Canada
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