Update on the safety of second generation antipsychotics in youths: a call for collaboration among paediatricians and child psychiatrists.

Simone Pisano,Massimo Molteni,Raffaella Iuliano,Annalisa Capuano,Valentina Lanzara,Maria Pia Riccio,Marco Pozzi,Carmela Bravaccio,Stefania Veltri,Gennaro Catone,Antonella Gritti,Annarita Milone,Gabriele Masi,Giangennaro Coppola,Emilio Clementi,Sonia Radice

doi:10.1186/s13052-016-0259-2

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.

Highlights

During the past decade, a substantial increase has occurred in the use of second generation antipsychotics (SGAs) for a number of psychiatric disorders in paediatric patients [1, 2]; the phenomenon is worldwide, its magnitude varies a lot among countries
Second generation antipsychotics block D2 dopamine receptors, to first generation antipsychotics (FGAs), but with lower receptor occupancy. They block serotonin receptors in the cortico-limbic pathways. They were thought to be safer than FGAs (e.g. Haloperidol), mainly due to a better neurological profile [10, 11], recent studies have raised significant concerns regarding their adverse events related to the metabolic syndrome [12,13,14]
Adverse events from therapeutically-intentioned use of antipsychotics still cause thousands of child and adolescents’ emergency department visits annually in the U.S, with significantly higher risk compared to other psychotropic medications, such as stimulants or antidepressants [22]

Summary

Introduction

A substantial increase has occurred in the use of second generation antipsychotics (SGAs) for a number of psychiatric disorders in paediatric patients [1, 2]; the phenomenon is worldwide, its magnitude varies a lot among countries. Adverse events from therapeutically-intentioned use of antipsychotics still cause thousands of child and adolescents’ emergency department visits annually in the U.S, with significantly higher risk compared to other psychotropic medications, such as stimulants or antidepressants [22] Despite these concerns, inconsistent monitoring patterns are reported for children assuming SGAs. Rodday et al [19] found that two thirds of clinicians report a careful assessment of patient history, height and weight, blood pressure, fasting plasma lipids and glucose, but only 23 % report a regular monitoring of waist circumference, and only 12 % monitor cardiac functioning with an electrocardiogram. This is consistent with a study by Connolly et al, according to which insufficient rates of metabolic screening tests are performed, mainly blood glucose level [21]

Results

Discussion

Conclusion