How Does Antipsychotic Treatment Affect Cardiometabolic Factors in Young Patients?

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Early psychotic symptoms in child or adolescent patients were predictive of elevated BMI and waist circumference scores.
Early psychotic symptoms in child or adolescent patients were predictive of elevated BMI and waist circumference scores.

Researchers assessed cardiometabolic risk status in antipsychotic-naïve or briefly exposed, early-onset, children and adolescents with first episode psychosis (FEP).

Clinicians need to take weight gain and dyslipidemia into account when prescribing antipsychotic treatment in children and adolescents with psychosis, according to a study published in Journal of Clinical Psychiatry.

This determination comes from a study conducted by the Centre for Child and Adolescent Mental Health, part of the department of clinical medicine at University of Copenhagen, Denmark. The researchers conducting this study sought to examine whether children and adolescents with FEP had higher cardiometabolic factors such as higher body mass index (BMI), waist circumference (WC), and lipids than youths not experiencing FEP.1

“To our knowledge, this is the first study in which  cardiometabolic risk status was assessed in antipsychotic-naïve or briefly exposed, early-onset, [FEP] children and adolescents and compared to concurrently enrolled, matched healthy controls,” Anne Katrine Pagsberg, MD, PhD, lead researcher, said.

Researchers utilized data from the Tolerability and Efficacy of Antipsychotics (TEA) trial. This double-blind trial compared 113 patients between the ages of 12 and 17 with FEP to 60 controls, from 7 mental health centers through Denmark. Patients had to meet ICD-10 diagnostic criteria.

The average age of patients was 15.74 years, while for controls it was 15.69 years, and the most frequent diagnoses were schizophrenia and schizoaffective disorders. Slightly less than 50% of patients had received antipsychotic treatment before the study, while 50.4% of patients had never taken antipsychotics.

While there was no significant difference in BMI scores between patients and controls, WC scores were significantly higher in patients than in controls (P = 0.18).  More patients also had a WC z score greater than the 90th percentile (P <.019) than controls. Additionally, more antipsychotically-naïve patients than antipsychotically-exposed patients had a WC z score above the 90th percentile (P =0.23).

Meanwhile, both the diastolic and systolic BP were lower in patients than in controls (BP rates showed no statistical difference between antipsychotically-exposed and -naïve patients, however). Heart rate was higher in patients than controls (although the patient subgroups again showed no statistical difference). Patients also had significantly higher total, low-density lipoprotein (LDL), and non-high-density lipoprotein (HDL) cholesterol levels than controls; controls demonstrated slightly higher fasting glucose levels.

“Early onset of psychotic symptoms predicted both higher BMI and WC z scores, indicating that psychotic symptoms at an early age may interfere with the adaption of healthy eating habits after the growth spurt in early adolescence,” Pagsberg said. The high cholesterol scores in patients also indicated “that the severity of the psychotic disorders has a negative impact on the patient's ability to maintain a healthy diet.”

Given that children and adolescents with psychosis have a predilection for “elevated abdominal obesity and lipid abnormalities…routine monitoring of anthropometric and metabolic parameters is essential,” Pagsberg added. “Furthermore, interventions to minimize the impact of offending medications, either through exercise, dose reduction, dietary changes, or use of medications…as well as interventions to prevent or stop smoking, are essential to reduce the long-term risk of cardiovascular disease in patients with early-onset psychosis.”2-4

References

  1. Jensen KG, Correll CU, Rudå D, et al. Pretreatment Cardiometabolic Status in Youth With Early-Onset Psychosis: Baseline Results From the TEA Trial [published online January 17, 2017]. J Clin Psychiatry. doi: 10.4088/JCP.15m10479. [Epub ahead of print]
  2. Mostafavi A, Solhi M, Mohammadi MR, et al. Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Acta Med Iran. 2014;52(10):734-739.
  3. Romo-Nava F, Alvarez-Icaza González D, et al. Melatonin attenuates antipsychotic metabolic effects: an eight-week randomized, double-blind, parallel-group, placebo-controlled clinical trial. Bipolar Disord. 2014;16(4):410-421. doi: 10.1111/bdi.12196 [Epub 2014 Mar 17].
  4. Tse L, Procyshyn RM, Fredrikson DH, et al. Pharmacological treatment of antipsychotic-induced dyslipidemia and hypertension. Int Clin Psychopharmacol. 2014;29(3):125-137. doi: 10.1097/YIC.0000000000000014.
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