Antipsychotics for Children and Young Adults: A Comparative Effectiveness Review

Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
PEDIATRICS (Impact Factor: 5.47). 03/2012; 129(3):e771-84. DOI: 10.1542/peds.2011-2158
Source: PubMed


Despite increasing on-label and off-label use of antipsychotics, prescribing antipsychotics to children remains controversial due to uncertainty of their relative benefits and safety. We systematically reviewed the effectiveness and safety of first- (FGA) and second-generation antipsychotics (SGA) for patients aged ≤24 years with psychiatric and behavioral conditions.
We searched 10 databases from January 1987 to February 2011, gray literature, trial registries, and reference lists. Two reviewers independently selected studies, assessed methodologic quality, and graded the evidence. One reviewer extracted, and a second verified, data. We summarized findings qualitatively and conducted meta-analyses when appropriate.
Sixty-four trials and 17 cohort studies were included. Most trials had a high risk of bias; cohort studies had moderate quality. All comparisons of FGAs versus SGAs, FGAs versus FGAs, and FGAs versus placebo had low or insufficient strength of evidence. There was moderate strength of evidence for the following comparisons. Olanzapine caused more dyslipidemia and weight gain, but fewer prolactin-related events, than risperidone. Olanzapine caused more weight gain than quetiapine. Compared with placebo, SGAs improved clinical global impressions (schizophrenia, bipolar and disruptive behavior disorders) and diminished positive and negative symptoms (schizophrenia), behavior symptoms (disruptive behavior disorders), and tics (Tourette syndrome).
This is the first comprehensive review comparing the effectiveness and safety across the range of antipsychotics for children and young adults. The evidence on the comparative benefits and harms of antipsychotics is limited. Some SGAs have a better side effect profile than other SGAs. Additional studies using head-to-head comparisons are needed.

Full-text preview

Available from:
  • Source
    • "The highest rates of cardiovascular effects have been reported for clozapine (40%) and quetiapine (13%) (U.S. Food and Drug Administration, 2000). Recent literature review by the Agency for Healthcare Research and Quality (AHRQ) had found limited evidence for the effectiveness of second-generation antipsychotics in the treatment of ADHD (Seida et al., 2012). AAP are increasingly used in children and adolescent with ADHD to control behavioral symptoms of ADHD and for the management of comorbid psychiatric conditions like bipolar disorders and other non-approved indications. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: This study examined cardiovascular safety of concomitant use of long-acting stimulants (LAS) and atypical antipsychotics (AAP) in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Method: The study used 2004-2007 IMS LifeLink™ claims data involving 6- to 16-year-old children with ADHD and at least one LAS prescription from July 2004 to December 2006. Time-dependent Cox regression analysis was performed to evaluate the risk of cardiovascular disease (CVD) events due to concomitant use of LAS and AAP. Results: The analytical cohort consisted of 37,903 children: 538 (1.9%) used LAS and AAP concurrently and the rest used LAS monotherapy. Time-dependent Cox regression analysis revealed no difference in CVD risk among concomitant users of LAS and AAP (hazard ratio = 1.19; 95% confidence interval = [0.60, 2.53]) when compared with users of LAS monotherapy. Conclusion: Concomitant use of LAS and AAP was not associated with risk of CVD events in ADHD patients when compared with LAS monotherapy.
    Full-text · Article · Oct 2015 · Journal of Attention Disorders
  • Source
    • "A ntipsychotics are a mainstay of treatment for people with serious mental illness including psychotic disorders (e.g., early psychosis, schizophrenia). Prescription of second generation antipsychotics to people under 25 years of age continues to increase (Alessi-Severini, Biscontri , Collins, Sareen, & Enns, 2012; Cooper et al., 2006; Harrison-Woolrych, Garcia-Quiroga, Ashton, & Herbison, 2007; Murphy et al., 2013; Olfson, Blanco, Liu, Wang, & Correll, 2012; Pringsheim, Lam, & Patten, 2011; Rani, Murray, Byrne, & Wong, 2008; Vitiello et al., 2009; Zito et al., 2008) despite controversy regarding effectiveness and safety data (Canadian Adverse Reaction Newsletter, 2012; Panagiotopoulos, Ronsley, Elbe, Davidson, & Smith, 2010; Pringsheim, Lam, Ching, & Patten, 2011; Seida et al., 2012). Young people's experiences of psychotropics, especially antipsychotics, have not been substantively explored . "
    [Show abstract] [Hide abstract]
    ABSTRACT: To explore the lived experience of youth who are prescribed antipsychotics. We conducted an interpretive phenomenology study of young people with recent experience of taking antipsychotics. Youth were interviewed and a staged approach was used for data analysis of transcriptions. We collected approximately 13 hours of audio from 18 youth aged 13 to 26 years between January and August of 2010. Ambivalence was significant and antipsychotic adverse effects frequently tempered benefits. Both illness and antipsychotics had significant impacts on physical and mental wellbeing with adverse effects on relationships and functioning in various contexts (e.g., school). Stigma related to both antipsychotics and illness was also prominent. Participants' limited knowledge about their antipsychotics and pressure to conform within their youth culture and context affected decisions on starting, adhering to, and persisting with treatment. The lived experience of youth taking antipsychotics is complex and the benefits (e.g., symptom improvement) and consequences (e.g., adverse effects) associated with antipsychotics affect all facets of life. More research is needed to better understand youth priorities in treatment decisions and whether youth who demonstrate substantive gaps in their knowledge about antipsychotics are truly given the opportunity to be informed and engage in management decisions including whether to initiate, persist with, and discontinue treatments.
    Full-text · Article · Sep 2015 · Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent
  • Source
    • "Für das europäische und außereuropäische Ausland reichen die Angaben für die ambulante " off-label " -Verordnung von Antipsychotika und Antidepressiva bei Kindern und Jugendlichen von 52,0 % bis zu 94,5 % (Olfson et al., 2012;Alexander et al., 2011;Zoëga et al., 2009;Volkers et al., 2007). Der " off-label use " bringt verschiedene rechtliche und ethische Problemlagen mit sich (Kölch et al., 2009; ausführliche Übersicht: Dörks 2013Bourgeois et al., 2014;Seida et al., 2012;Ben Amor, 2012).Quiao et al., 2014;Gerlach et al., 2013).Wirkstoffen unterscheidet (Leucht et al., 2013). Diese UAW sind gerade in diesem Lebensalter von großer Relevanz für die Compliance () und im weiteren Verlauf vermutlich auch für die Lebenserwartung (Weinmann et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this dissertation thesis, health insurance funds data on psychotropic prescriptions for children and adolescents in Germany are presented and analysed. The data refer to prescription patterns in different child and adolescent psychiatric disorders (depressive disorders, autism spectrum disorders, tic disorders, eating disorders, functional urinary incontinence) and also to prescription of defined pharmacological substance groups (antidepressants, antipsychotics). The psychotropic prescriptions were stratified by age groups, sex and sub-diagnosis of the respective child and adolescent psychiatric disorder. In some of the papers compiled in this thesis, the specialty of the prescribing physician was also evaluated. The use of the mentioned health insurance funds data allowed to study the data of up to 1.6m children and adolescents (population under risk). Study designs involved both cross-sectional and longitudinal analyses over time periods of up to eight years, employing various statistical methods. The two papers analysing time trends in the prescription of antidepressants and antipsychotics show a marked increase in the prescription of these substance groups over recent years. Regarding antipsychotics, a considerable increase in the prescription of atypical antipsychotics and a substantial proportion of non-guideline adherent therapies was found. The study on antidepressant prescriptions showed a distinct increase in SSRI prescriptions, with TCA still accounting for a significant percentage of prescriptions. The papers on psychotropic prescriptions in various child and adolescent psychiatric disorders (autism spectrum disorders, depressive disorders, tic disorders, eating disorders, functional urinary incontinence) constitute a foundational inventory of psychopharmacological therapy in German children and adolescents with mental health problems. They show that for some of these conditions, current guidelines are applied only in a fraction of patients. Concluding, the findings compiled in this thesis indicate a general trend towards increased psychotropic prescriptions in children and adolescents and point to the need of implementation of child and adolescent psychiatric guidelines into daily practice.
    Full-text · Article · Jan 2015
Show more