Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 May;19(2):124-37.

First do no harm: promoting an evidence-based approach to atypical antipsychotic use in children and adolescents

Constadina Panagiotopoulos  1 , Rebecca Ronsley, Dean Elbe, Jana Davidson, Derryck H Smith
Affiliations

First do no harm: promoting an evidence-based approach to atypical antipsychotic use in children and adolescents

Constadina Panagiotopoulos et al. J Can Acad Child Adolesc Psychiatry. 2010 May.

Abstract

Objectives: To review the evidence for efficacy and metabolic effects of atypical antipsychotics (AAPs), and to propose a metabolic monitoring protocol for AAP use in children and adolescents.

Methods: A PubMed search was performed to obtain all studies related to efficacy, metabolic side-effects, and monitoring in those less than 18 years of age.

Results: There are no approved indications for AAP use in children and adolescents in Canada. Based on US Food and Drug Administration approvals and a review of randomized controlled trials, we identified 7 indications for AAP use that target specific symptoms in youth including schizophrenia, bipolar I disorder, autism, pervasive developmental disorder, disruptive behaviour disorders (including conduct disorder and ADHD), developmental disabilities and Tourette Syndrome. A wide range of metabolic effects including weight gain, increased waist circumference, dysglycemia, dyslipidemia, hypertension, elevated hepatic transaminases and prolactin levels have been reported. We have developed a proposal for metabolic monitoring that includes anthropometric measurements and laboratory testing at baseline and appropriate intervals thereafter.

Conclusion: There is an urgent need for national clinical practice guidelines that provide, not only appropriate treatment algorithms for AAP-use based on evidence, but also address metabolic monitoring and subsequent management of complications in this vulnerable population.

Keywords: adolescents; atypical antipsychotics; children; efficacy; metabolic; monitoring.

PubMed Disclaimer

Figures

Figure 1a.
Figure 1a.
Sex distribution of atypical antipsychotic prescriptions in youth ≤ 19 years
Figure 1b.
Figure 1b.
Distribution of atypical antipsychotic prescriptions by age group and sex
See this image and copyright information in PMC

References

    1. Addington AM, Rapoport JL. The genetics of childhood-onset schizophrenia: When madness strikes the pre-pubescent. Current Psychiatry Reports. 2009;11(2):156–161. - PMC - PubMed
    1. Alfaro CL, Wudarsky M, Nicolson R, Gochman P, Sporn A, Lenane M, et al. Correlation of antipsychotic and prolactin concentrations in children and adolescents acutely treated with haloperidol, clozapine, or olanzapine. Journal of Child and Adolescent Psychopharmacology. 2002;12(2):83–91. - PubMed
    1. Aman MG, Hollway JA, Leone S, Masty J, Lindsay R, Nash P, et al. Effects of Risperidone on cognitive-motor performance and motor movements in chronically medicated children. Research in Developmental Disabilities. 2009;30:386–396. - PubMed
    1. Aman MG, Hollway JA, McDougle CJ, Scahill L, Tierney E, McCracken JT, et al. Cognitive effects of risperidone in children with autism and irritable behavior. Journal of Child and Adolescent Psychopharmacology. 2008;18(3):227–236. - PMC - PubMed
    1. Aman MG, Arnold LE, McDougle CJ, Vitiello B, Scahill L, Davies M, et al. Acute and long-term safety and tolerability of risperidone in children with autism. Journal of Child and Adolescent Psychopharmacology. 2005;15(6):869–884. - PubMed

LinkOut - more resources