Second-generation antipsychotic medications in children and adolescents.
ABSTRACT We reviewed available pediatric literature on second-generation antipsychotic medications to assess current evidence of efficacy and safety.
An English language MEDLINE search (1974-2003) was conducted using key words-atypical antipsychotics, children and adolescents, toxicity, clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole. Additional efficacy and safety data were obtained from drug manufacturers.
We identified 176 reports, including 15 double-blind, controlled trials, 58 openlabel studies, 18 retrospective chart reviews, and 85 case series/reports. The majority of these studies (43%) were of risperidone. Evidence suggests that second-generation antipsychotics are efficacious in the treatment of psychosis, bipolar disorders, pervasive developmental disorders, and Tourette's Disorder, and are potentially useful in mental retardation, conduct disorder, and severe attention deficit hyperactivity disorder (ADHD). The most frequently reported side effects included cardiovascular effects, weight gain, sedation, sialorrhea, extrapyramidal signs, and hyperprolactinemia, although the relative frequencies of these untoward effects vary among medications.
Although the evidence base for pediatric use of second-generation antipsychotics is expanding, the majority of available studies are anecdotal, or short-term, openlabel trials. Reports suggest that these compounds are effective for a variety of psychiatric disorders in children and adolescents, but additional double-blind, controlled studies are required to establish definitive efficacy. Although these medications appear to be well tolerated in short-term studies, long-term follow-up investigations and ongoing clinical monitoring are necessary to confirm their safety in this age group.
SourceAvailable from: Ismael Lares-Asseff[Show abstract] [Hide abstract]
ABSTRACT: Background: Psychoactive drugs represent an alternative for the management of mental disorders during infancy and adolescence, which are not exempt from adverse events. We undertook this study to deter-mine the prevalence of psychiatric disorders and their pharmacological management in children and ado-lescents who attend the Child Psychiatry Service of the General Hospital of Durango, Mexico. Methods: Clinical and pharmacological histories of 111 patients from 2 to 17 years of age under treatment for 1 year in the Service of Infantile Psychiatry of the General Hospital of Durango (SSA) were reviewed. Results: The most frequent disorder found was attention deficit hyperactivity disorder (ADHD) (23.4%). Monotherapy was used in 23.4% of the patients, whereas in 75.6% of the cases polypharmacy was used. The most common prescribed drugs were antipsychotics, antidepressants and their combinations. Conclusions: This study emphasizes pharmacoepidemiological knowledge with the purpose of improving efficiency and safety of drug use in an attempt to optimize and individualize treatment with psychoactive drugs in pediatric patients.
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ABSTRACT: This article examined the continuity of atypical antipsychotic medications among children and adolescents following discharge from a residential mental health treatment facility in the state of Florida from 2005 through 2011. Discharge data are reported by the residential providers, while post-discharge data are from Medicaid enrollment and claims files. Fifty-five percent of youth were receiving antipsychotic medications when discharged from residential treatment. Of those receiving such medications, 55% continued with their medication after discharge. Antipsychotics were more likely at discharge among youth who were older, had longer treatment episodes, showed greater improvements during treatment, and had prior involuntary examinations and out-of-home treatment episodes. Continuation of antipsychotic medication was more common among youth who had greater family involvement in treatment, longer treatment episodes, improved more during treatment, and had prior involuntary examinations. Continuation was less likely for youth with prior out-of-home treatment episodes. These results contribute to the existing literature by examining the continuity of atypical antipsychotic medication among children and adolescents following residential treatment.Residential Treatment for Children & Youth 10/2013; 30(4):306-318. DOI:10.1080/0886571X.2013.852455
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ABSTRACT: Atypical antipsychotic drugs (AAPDs) are widely used in children and adolescents to treat a variety of psychiatric disorders. However, little is known about the long-term effects of AAPD treatment before the brain is fully developed. Indeed, we and others have previously reported that treatment of adolescent rats with olanzapine (OLA; a widely prescribed AAPD) on postnatal days 28-49, under dosing conditions that approximate those employed therapeutically in humans, causes long-term behavioral and neurobiological perturbations. We have begun to study the mechanisms of these effects. Dopamine (DA) and serotonin (5HT) regulate many neurodevelopmental processes. Currently approved AAPDs exert their therapeutic effects principally through their DAergic activities, although in schizophrenia (SZ) and some other diseases for which AAPDs are prescribed, DAergic dysfunction is accompanied by abnormalities of glutamatergic (GLUergic) and γ-aminobutyric acidergic (GABAergic) transmission. Here, we use proton magnetic resonance spectroscopy ((1)H MRS) to investigate the effects of adolescent OLA administration on GABA and GLU levels. We found that the treatment caused long-term reductions in the levels of both GLU and GABA in the nucleus accumbens (NAc) of adult rats treated with OLA during adolescence. The NAc is a key node in the brain's "reward" system, whose function is also disrupted in schizophrenia. Further research into potential, OLA-induced changes in the levels of GLU and GABA in the NAc and other brain areas, and the dynamics and mechanisms of those changes, are an essential step for devising new adjunct therapies for existing AAPDs and for designing new drugs that increase therapeutic effects and reduce long-term abnormalities when administered to pediatric patients. Copyright © 2014 Elsevier B.V. All rights reserved.Schizophrenia Research 12/2014; 161(2-3). DOI:10.1016/j.schres.2014.10.034 · 4.43 Impact Factor