Metabolic and hormonal safety
Childhood obesity is increasing worldwide and is associated with an increase in other cardiovascular risk factors in childhood, such as dyslipidemia, hypertension, and impaired glucose tolerance (Weiss et al., 2004). In addition, there is increasing concern about second-generation antipsychotics having metabolic side effects such as weight gain, hyperglycaemia, and dyslipidemia in the paediatric population (Correll, 2008). In the first study directly comparing weight gain and other metabolic and hormonal risk factors after treatment with 3 different new-generation antipsychotics in children and adolescents (mean age 15.2 years), it was shown that, after 6 months, body mass index scores and total cholesterol levels increased significantly, with 33 patients (50.0%) with no previous antipsychotic exposure showing significant weight gain (Fraguas et al., in press). The number of patients at risk for adverse health outcomes increased from 11 (16.7%) to 25 (37.9%). These changes in metabolic parameters were different for the different antipsychotics studied.
In the naturalistic study conducted by our group in early-onset psychosis patients, weight gain was also greater with olanzapine than with risperidone or quetiapine (Castro-Fornieles et al., in press). Weight gain in children raises the concern that, if treated for long periods, these patients may be at higher risk of insulin resistance, diabetes, hypertension, and cardiovascular disease in the future. If drugs likely to induce weight gain must be used, compensatory behavioural or pharmacological approaches should be implemented (Laita et al. 2007; Correll, 2007). A further concern with antipsychotic treatment in paediatric populations is the hyperprolactine
|Contact: Sonja Mak|
European College of Neuropsychopharmacology