Metabolske og endokrine bivirkninger av andregenerasjons antipsykotika hos barn og unge: Systematisk oversikt over randomiserte placebokontrollerte studier og retningslinjer for klinisk praksis

Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: A systematic review of randomized, placebo controlled trials and guidelines for clinical practice

Forfattere
De Hert, M. Dobbelaere, M. Sheridan, E. M. Cohen, D. Correll, C. U.
Årstall
2011
Tidsskrift
European Psychiatry
Volum
26
Sider
144-158
Second-generation antipsychotics (SGA) are being used more often than ever before in children and adolescents with psychotic and a wide range of non-psychotic disorders. Several SGA have received regulatory approval for some paediatric indications in various countries, but off-label use is still frequent. The aim of this paper was to perform a systematic review and critically evaluate the literature on cardiometabolic and endocrine side-effects of SGA in children and adolescents through a Medline/Pubmed/Google Scholar search of randomized, placebo controlled trials of antipsychotics in children and adolescents (<18 years old) until February 2010. In total, 31 randomized, controlled studies including 3595 paediatric patients were identified. A review of these data confirmed that SGA are associated with relevant cardiometabolic and endocrine side-effects, and that children and adolescents have a high liability to experience antipsychotic induced hyperprolactinaemia, weight gain and associated metabolic disturbances. Only weight change data were sufficiently reported to conduct a formal meta-analysis. In 24 trials of 3048 paediatric patients with varying ages and diagnoses, ziprasidone was associated with the lowest weight gain (-0.04 kg, 95% confidence interval [CI]: -0.38 to +0.30), followed by aripiprazole (0.79 kg, 95% CI: 0.54 to 1.04], quetiapine (1.43 kg, 95% CI: 1.17 to 1.69) and risperidone (1.76 kg, 95% CI: 1.27 to 2.25) were intermediate, and olanzapine was associated with weight gain the most (3.45 kg, 95% CI: 2.93 to 3.97). Significant weight gain appeared to be more prevalent in patients with autistic disorder who were also younger and likely less exposed to antipsychotics previously. These data clearly suggest that close screening and monitoring of metabolic side effects is warranted and that the least cardiometabolically problematic agents should be used first whenever possible. A good collaboration between child- and adolescent psychiatrists, general practitioners and paediatricians is essential to maximize overall outcomes and to reduce the likelihood of premature cardiovascular morbidity and mortality. (C) 2010 Elsevier Masson SAS. All rights reserved.

Oversett med Google Translate
-
Tiltaksnivå

Behandling og hjelpetiltak

Tema

Psykiske vansker og lidelser

Atferdsproblemer

Atferdsforstyrrelser

Følelsesmessige problemer

Bipolare lidelser

Autismespekter

Andre problemer

Psykose

Biologiske risikofaktorer, sykdommer og symptomer

Bivirkninger/uønskede effekter

Tiltak

Medikamentell behandling

Antipsykotisk medisin

Aldersgruppe

Barn i skolealder (6-12 år)

Ungdom (13-18 år)

Uklar aldersgruppe

Mer informasjon
Leter du etter mer informasjon om temaet? Trykk på lenkene nedenfor for å søke i PsykTestBarn og Tiltakshåndboka for barn og unges psykiske helse.