Metabolic effects of second-generation antipsychotics in bipolar youth: comparison with other psychotic and nonpsychotic diagnoses.
OBJECTIVE
Despite known metabolic effects of second-generation antipsychotics (SGAs) on children and adolescents, comparative effects in youth with different diagnoses remain underreported. We compared differences in metabolic changes three months after starting treatment with SGAs in youth with bipolar disorder and with other psychotic and nonpsychotic disorders.


METHODS
Weight and metabolic differences among diagnostic groups before and three months after starting treatment with SGAs were compared in a naturalistic cohort of children and adolescents (14.9 +/- 3.0 years) diagnosed with bipolar disorder (n = 31), other psychotic disorders (n = 29), and other nonpsychotic disorders (n = 30), with no (35.6%) or very little (6.6 +/- 9.0 days) previous exposure to antipsychotics. Composite measurements of significant weight gain [weight increase > or = 5% at three months or increase > or = 0.5 in body mass index (BMI) z-score] and 'risk for adverse health outcome' (> or = 95(th) BMI percentile, or > or = 85(th) BMI percentile plus presence of one other obesity-related complication) were included. SGAs (risperidone, olanzapine, and quetiapine) were prescribed in comparable proportion among groups.


RESULTS
Baseline weight and metabolic indices were not significantly different among diagnoses. Three months after starting treatment with SGAs, more than 70% patients had significant weight gain, BMI z-score increased in all diagnostic groups (p < 0.001 for all comparisons), total cholesterol increased in the bipolar (p = 0.02) and psychotic (p = 0.01) disorder groups, low-density lipoprotein cholesterol increased in the bipolar group (p = 0.02), and free T4 decreased in the psychotic disorder group (p = 0.05). More patients with bipolar disorder presented overweight plus > or = 1 obesity-related complication at follow-up.


CONCLUSIONS
There are early weight gain and metabolic changes across diagnoses in youth treated with SGAs.
Moreno
Carmen
C
Unidad de Adolescentes, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain. cmoreno@hggm.es
Merchán-Naranjo
Jessica
J
Alvarez
Mar
M
Baeza
Inmaculada
I
Alda
Jose A
JA
Martínez-Cantarero
Carmen
C
Parellada
Mara
M
Sánchez
Bernardo
B
de la Serna
Elena
E
Giráldez
Marisa
M
Arango
Celso
C
D000293:Adolescent; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy*; D015992:Body Mass Index; D002648:Child; D008078:Cholesterol, LDL / Q000097:blood; D002851:Chromatography, High Pressure Liquid; D003987:Dibenzothiazepines / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy; D009765:Obesity / Q000139:chemically induced*; D000077152:Olanzapine; D011618:Psychotic Disorders / Q000097:blood / Q000188:drug therapy*; D000069348:Quetiapine Fumarate; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects*; D013974:Thyroxine / Q000097:blood; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects*
D014150:Antipsychotic Agents; D015415:Biomarkers; D008078:Cholesterol, LDL; D003987:Dibenzothiazepines; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D018967:Risperidone; D000077152:Olanzapine; D013974:Thyroxine