title: Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics.
abstract: OBJECTIVE
  Second-generation antipsychotic (SGA) effects in youth were monitored to quantify extrapyramidal side effects (EPS) and to identify risk profiles for treatment-emergent EPS.
  
  
  METHODS
  Data were analyzed for the nonrandomized, prospective Second-generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth (SATIETY) inception cohort study. EPS were assessed at baseline and 4, 8, and 12 weeks after naturalistic SGA initiation for schizophrenia, mood, disruptive behavior, and autism spectrum disorders using the Simpson-Angus Scale (SAS), Barnes Akathisia Scale, Abnormal Involuntary Movement Scale (AIMS), and Treatment Emergent Side Effect Scale. Drug-induced parkinsonism was defined by incident mean SAS score >0.33, anticholinergic initiation, or increasing total SAS score ≥2 in patients with baseline EPS.
  
  
  RESULTS
  In 342 youth aged 13.6 ± 3.5 years (male = 58.2%, antipsychotic-naive = 65.8%), 15.2% developed drug-induced parkinsonism. Raw SGA-grouped drug-induced parkinsonism rates were as follows: quetiapine = 1.5%, olanzapine = 13.8%, risperidone = 16.1%, ziprasidone = 20.0%, and aripiprazole = 27.3%. SGA type, dose, higher age, and lower baseline functioning were jointly associated with drug-induced parkinsonism (R(2) = 0.18; p < .0001). Controlling for these factors, drug-induced parkinsonism rates were significantly lower only for quetiapine and olanzapine. Subjectively reported EPS (5%), EPS-related treatment discontinuation (3.3%), and anticholinergic initiation (3%) were infrequent. Anticholinergic initiation was most frequent with risperidone (10.2%; p = .0004). Treatment-emergent dyskinesia ranged from 4.5% (aripiprazole) to 15.5% (olanzapine). SGA type, younger age, white race/ethnicity, and baseline AIMS were jointly associated with treatment-emergent dyskinesia (R(2) = 0.31; p < .0001). Controlling for these factors, treatment-emergent dyskinesia rates differed among SGA subgroups, with higher rates with olanzapine and ziprasidone. At baseline, psychostimulant use was associated with dyskinesia, and number of psychotropic comedications was associated with subjective EPS.
  
  
  CONCLUSIONS
  In youth, SGA-related EPS rates did not generally exceed those reported in adults, with particularly low rates with quetiapine and olanzapine.
authors: The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Charité Berlin, Berlin.
authors: Maren
authors: M
authors: Carbon
authors: The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Feinstein Institute for Medical Research, Manhasset, NY.
authors: Sandeep
authors: S
authors: Kapoor
authors: The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY.
authors: Eva
authors: E
authors: Sheridan
authors: New York Methodist Hospital, Brooklyn, NY.
authors: Aseel
authors: A
authors: Al-Jadiri
authors: The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY.
authors: Sally
authors: S
authors: Azzo
authors: The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY.
authors: Tania
authors: T
authors: Sarkaria
authors: The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Feinstein Institute for Medical Research, Manhasset, NY; Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, NY.
authors: John M
authors: JM
authors: Kane
authors: The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Feinstein Institute for Medical Research, Manhasset, NY.
authors: Ema
authors: E
authors: Saito
authors: The Zucker Hillside Hospital, Psychiatry, Glen Oaks, NY; Feinstein Institute for Medical Research, Manhasset, NY; Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, NY. Electronic address: ccorrell@nshs.edu.
authors: Christoph U
authors: CU
authors: Correll
mesh_terms: D000293:Adolescent; D017109:Akathisia, Drug-Induced / Q000453:epidemiology*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068180:Aripiprazole / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D004359:Drug Therapy, Combination; D004409:Dyskinesia, Drug-Induced / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000188:drug therapy*; D015999:Multivariate Analysis; D009518:New York; D000077152:Olanzapine; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000453:epidemiology*; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D000069348:Quetiapine Fumarate / Q000009:adverse effects / Q000627:therapeutic use; D012044:Regression Analysis; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000068180:Aripiprazole; D018967:Risperidone; D000077152:Olanzapine
keywords: dyskinesia; extrapyramidal; parkinsonism; second-generation antipsychotic; youth