Psychiatry Research EG

The use of atypical antipsychotic (AAP) drugs has increased in the last decade such that it is gradually replacing typical antipsychotics such as haloperidol, aiming for better tolerance and a more benign side effect profile. In a recent Canadian survey of child psychiatrists and developmental pediatricians [1], 12% of all AAP prescriptions were for children 8 years of age and younger, which is of particular concern. However, in adults, there has been a clear link between AAPs and metabolic adverse effects for some time. Many studies in adults confirm that AAPs can precipitate weight gain [2], hyperlipidemia [3], and insulin resistance [4], and that their use is associated with the development of metabolic syndrome [5,6] and type 2 diabetes [7,8]. There have been recent reports [9,10] of similar metabolic effects in children and adolescents. Meanwhile, the third National Cholesterol Education Program Adult Treatment Panel (ATP III) [11] defines the metabolic (or insulin resistance) syndrome as the presence in an individual of at least three of the following five risk factors: central or abdominal obesity, hypertriglyceridemia, hypertension, low high-density lipoprotein (HDL) cholesterol, and high fasting blood glucose (FBG) levels. However, there is no agreement on the definition of the metabolic syndrome as a whole in children. Some researchers use definitions that follow the ATP III guidelines (having at least three of five components) [12,13], whereas others have included an elevated fasting insulin level as a component of the syndrome [14]. Central obesity, which is considered a key component of the metabolic syndrome, is a good example of the problem of defining risk levels in children. Although there are accepted risk cut points for waist circumference in adults, there are no accepted normative values for children. Some researchers have used the BMI z-score, a measure of overall overweight, rather than a more specific indicator of central overweight, such as waist circumference [15]. Recently, there have been a few FDA-approved indications for some of the typical and AAP drug; although recently, many of AAPs prescriptions to youth may lack evidence. This raises the importance of the fact that child and adolescent psychiatrists should be aware of the possible serious metabolic side effects of these drugs on young children, and indicates the importance of monitoring of our patients for possible side effects. In developing countries, the situation is more serious because of lack of information gathered from local researches on the possible side effects of these drugs and insufficient monitoring because of the shortage of resources in many areas. This is why we tested the hypothesis that, similar to developed countries, AAP drug may predispose to weight gain and serious metabolic side effects in children. Therefore, our objectives were to describe the pattern of weight gain and metabolic side effects in a group of children and adolescents who took antipsychotic drug (APD) in a naturalistic setting and also to compare those side effects between different groups of APD