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Metabolic and Hormonal Side Effects in Children and Adolescents Treated With Second-Generation Antipsychotics

J Clin Psychiatry 2008;69(7):1165-1175

Objective: The aim of this study was to evaluate metabolic and hormonal side effects in children and adolescents after 6 months of treatment with 3 different second-generation antipsychotics (SGAs).

Method: 66 children and adolescents (44 male [66.7%], mean±SD age=15.2±2.9 years) treated for 6 months with risperidone (N= 22), olanzapine (N=20), or quetiapine (N=24) composed the study sample. 34 patients (51.5%) suffered from schizophrenia or other psychosis (according to DSM-IV criteria). Patients were consecutively attending different programs from March 2005 to October 2006. Prior to enrollment in the study, patients were either antipsychotic-naive (37.9%, N=25) or had been taking an antipsychotic drug for fewer than 30 days. Significant weight gain was defined as a 0.5 increase in body mass index (BMI) z score (adjusted for age and gender) at 6 months. Based on recent criteria for pediatric populations, patients were considered "at risk for adverse health outcome" if they met at least 1 of the following criteria: (1) 85th BMI percentile plus presence of 1 or more negative weight-related clinical outcomes, or (2) 95th BMI percentile.

Results: After the 6 months, BMI z scores increased significantly in patients receiving olanzapine and risperidone. At the 6-month follow-up, 33 patients (50.0%) showed significant weight gain. The number of patients at risk for adverse health outcome increased from 11 (16.7%) to 25 (37.9%) (p=.018). The latter increase was significant only in the olanzapine group (p=.012). Total cholesterol levels increased significantly in patients receiving olanzapine (p=.047) and quetiapine (p=.016). Treatment with quetiapine was associated with a significant decrease in free thyroxin (p=.011).

Conclusion: Metabolic and hormonal side effects of SGAs in children and adolescents should be carefully monitored when prescribing these drugs.