Clinical drug monitoring in child and adolescent psychiatry: side effects of atypical neuroleptics.
OBJECTIVE
The aim of this study was to improve and evaluate the practibility of a method for the assessment of drug-associated side effects, and we implemented a clinical drug monitoring for atypical neuroleptics.


METHODS
Side effects of initially hospitalized patients treated with clozapine (n = 16), olanzapine (n = 16), and risperidone (n = 19) were prospectively monitored on a weekly basis for the first 3 weeks. In the case of stable medication, measurements of all variables were made every 4 weeks or upon discharge. We used the Dosage Record Treatment Emergent Symptom Scale (DOTES) in a supplemented version to measure the presence and severity of side effects.


RESULTS
Drowsiness and decreased motor activity were common, especially in the first 2 weeks. Orthostatic hypotension, increased salivation, constipation, and nasal congestion were seen in more than 30% to 60% of patients treated with clozapine and were less common in adolescents treated with olanzapine and risperidone. Rigidity, tremor, and dystonia were seen in 5% to 15% of patients treated with risperidone and olanzapine. The average weight gain after 6 weeks of treatment with the atypical neuroleptics was significantly higher for the olanzapine group (4.6 +/- 1.9 kg) than for the risperidone (2.8 +/- 1.3 kg) and clozapine (2.5 +/- 2.9 kg) groups.


CONCLUSIONS
The authors' supplemented DOTES version is generally applicable to clinical use in mental health centers. The differences among the side effects of these three agents may affect compliance with medication and medical risks of metabolic syndrome, diabetes, and cardiovascular disease. More research on the short- and long-term safety of psychotropic drugs in children and adolescents, using standardized methods, should be considered.
Fleischhaker
Christian
C
Department of Child and Adolescent Psychiatry and Psychotherapy, Albert-Ludwigs-University Freiburg, Hauptstrasse 8, 79104 Freiburg, Germany. fleischhaker@psyallg.ukl.uni-freiburg.de
Heiser
Philip
P
Hennighausen
Klaus
K
Herpertz-Dahlmann
Beate
B
Holtkamp
Kristian
K
Mehler-Wex
Claudia
C
Rauh
Reinhold
R
Remschmidt
Helmut
H
Schulz
Eberhard
E
Warnke
Andreas
A
D000293:Adolescent; D000296:Adolescent Psychiatry; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects; D002648:Child; D002665:Child Psychiatry; D003024:Clozapine / Q000009:adverse effects*; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D000077152:Olanzapine; D018967:Risperidone / Q000009:adverse effects*
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine