CONTEXT: Cardiometabolic effects of second-generation antipsychotic medications are concerning but have not been sufficiently studied in pediatric and adolescent patients naive to antipsychotic medication. OBJECTIVE: To study the association of second-generation antipsychotic medications with body composition and metabolic parameters in patients without prior antipsychotic medication exposure. DESIGN, SETTING, AND PATIENTS: Nonrandomized Second-Generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth (SATIETY) cohort study, conducted between December 2001 and September 2007 at semi-urban, tertiary care, academic inpatient and outpatient clinics in Queens, New York, with a catchment area of 4.5-million individuals. Of 505 youth aged 4 to 19 years with 1 week or less of antipsychotic medication exposure, 338 were enrolled (66.9%). Of these patients, 272 had at least 1 postbaseline assessment (80.5%), and 205 patients [corrected] completed the study (60.7%). Patients had mood spectrum (n = 130; 47.8%), schizophrenia spectrum (n = 82; 30.1%), and disruptive or aggressive behavior spectrum (n = 60; 22.1%) disorders. Fifteen patients who refused participation or were nonadherent served as a comparison group. INTERVENTION: Treatment with aripiprazole, olanzapine, quetiapine, or risperidone for 12 weeks. MAIN OUTCOME MEASURES: Weight gain and changes in lipid and metabolic parameters. RESULTS: After a median of 10.8 weeks (interquartile range, 10.5-11.2 weeks) of treatment, weight increased by 8.5 kg (95% confidence interval [CI], 7.4 to 9.7 kg) with olanzapine (n = 45), by 6.1 kg (95% CI, 4.9 to 7.2 kg) with quetiapine (n = 36), by 5.3 kg (95% CI, 4.8 to 5.9 kg) with risperidone (n = 135), and by 4.4 kg (95% CI, 3.7 to 5.2 kg) with aripiprazole (n = 41) compared with the minimal weight change of 0.2 kg (95% CI, -1.0 to 1.4 kg) in the untreated comparison group (n = 15). With olanzapine and quetiapine, respectively, mean levels increased significantly for total cholesterol (15.6 mg/dL [95% CI, 6.9 to 24.3 mg/dL] P < .001 and 9.1 mg/dL [95% CI, 0.4 to 17.7 mg/dL] P = .046), triglycerides (24.3 mg/dL [95% CI, 9.8 to 38.9 mg/dL] P = .002 and 37.0 mg/dL [95% CI, 10.1 to 63.8 mg/dL] P = .01), non-high-density lipoprotein (HDL) cholesterol (16.8 mg/dL [95% CI, 9.3 to 24.3 mg/dL] P < .001 and 9.9 mg/dL [95% CI, 1.4 to 18.4 mg/dL] P = .03), and ratio of triglycerides to HDL cholesterol (0.6 [95% CI, 0.2 to 0.9] P = .002 and (1.2 [95% CI, 0.4 to 2.0] P = .004). With risperidone, triglycerides increased significantly (mean level, 9.7 mg/dL [95% CI, 0.5 to 19.0 mg/dL]; P = .04). Metabolic baseline-to-end-point changes were not significant with aripiprazole or in the untreated comparison group. CONCLUSIONS: First-time second-generation antipsychotic medication use was associated with significant weight gain with each medication. Metabolic changes varied among the 4 antipsychotic medications.
CONTEXT: Cardiometabolic effects of second-generation antipsychotic medications are concerning but have not been sufficiently studied in pediatric and adolescent patients naive to antipsychotic medication. OBJECTIVE: To study the association of second-generation antipsychotic medications with body composition and metabolic parameters in patients without prior antipsychotic medication exposure. DESIGN, SETTING, AND PATIENTS: Nonrandomized Second-Generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth (SATIETY) cohort study, conducted between December 2001 and September 2007 at semi-urban, tertiary care, academic inpatient and outpatient clinics in Queens, New York, with a catchment area of 4.5-million individuals. Of 505 youth aged 4 to 19 years with 1 week or less of antipsychotic medication exposure, 338 were enrolled (66.9%). Of these patients, 272 had at least 1 postbaseline assessment (80.5%), and 205 patients [corrected] completed the study (60.7%). Patients had mood spectrum (n = 130; 47.8%), schizophrenia spectrum (n = 82; 30.1%), and disruptive or aggressive behavior spectrum (n = 60; 22.1%) disorders. Fifteen patients who refused participation or were nonadherent served as a comparison group. INTERVENTION: Treatment with aripiprazole, olanzapine, quetiapine, or risperidone for 12 weeks. MAIN OUTCOME MEASURES: Weight gain and changes in lipid and metabolic parameters. RESULTS: After a median of 10.8 weeks (interquartile range, 10.5-11.2 weeks) of treatment, weight increased by 8.5 kg (95% confidence interval [CI], 7.4 to 9.7 kg) with olanzapine (n = 45), by 6.1 kg (95% CI, 4.9 to 7.2 kg) with quetiapine (n = 36), by 5.3 kg (95% CI, 4.8 to 5.9 kg) with risperidone (n = 135), and by 4.4 kg (95% CI, 3.7 to 5.2 kg) with aripiprazole (n = 41) compared with the minimal weight change of 0.2 kg (95% CI, -1.0 to 1.4 kg) in the untreated comparison group (n = 15). With olanzapine and quetiapine, respectively, mean levels increased significantly for total cholesterol (15.6 mg/dL [95% CI, 6.9 to 24.3 mg/dL] P < .001 and 9.1 mg/dL [95% CI, 0.4 to 17.7 mg/dL] P = .046), triglycerides (24.3 mg/dL [95% CI, 9.8 to 38.9 mg/dL] P = .002 and 37.0 mg/dL [95% CI, 10.1 to 63.8 mg/dL] P = .01), non-high-density lipoprotein (HDL) cholesterol (16.8 mg/dL [95% CI, 9.3 to 24.3 mg/dL] P < .001 and 9.9 mg/dL [95% CI, 1.4 to 18.4 mg/dL] P = .03), and ratio of triglycerides to HDL cholesterol (0.6 [95% CI, 0.2 to 0.9] P = .002 and (1.2 [95% CI, 0.4 to 2.0] P = .004). With risperidone, triglycerides increased significantly (mean level, 9.7 mg/dL [95% CI, 0.5 to 19.0 mg/dL]; P = .04). Metabolic baseline-to-end-point changes were not significant with aripiprazole or in the untreated comparison group. CONCLUSIONS: First-time second-generation antipsychotic medication use was associated with significant weight gain with each medication. Metabolic changes varied among the 4 antipsychotic medications.
Authors: D B Allison; J L Mentore; M Heo; L P Chandler; J C Cappelleri; M C Infante; P J Weiden Journal: Am J Psychiatry Date: 1999-11 Impact factor: 18.112
Authors: Ludmila A Kryzhanovskaya; Carol K Robertson-Plouch; Wen Xu; Janice L Carlson; Karen M Merida; Ralf W Dittmann Journal: J Clin Psychiatry Date: 2009-02-10 Impact factor: 4.384
Authors: Linmarie Sikich; Jean A Frazier; Jon McClellan; Robert L Findling; Benedetto Vitiello; Louise Ritz; Denisse Ambler; Madeline Puglia; Ann E Maloney; Emily Michael; Sandra De Jong; Karen Slifka; Nancy Noyes; Stefanie Hlastala; Leslie Pierson; Nora K McNamara; Denise Delporto-Bedoya; Robert Anderson; Robert M Hamer; Jeffrey A Lieberman Journal: Am J Psychiatry Date: 2008-09-15 Impact factor: 18.112
Authors: Olli T Raitakari; Markus Juonala; Mika Kähönen; Leena Taittonen; Tomi Laitinen; Noora Mäki-Torkko; Mikko J Järvisalo; Matti Uhari; Eero Jokinen; Tapani Rönnemaa; Hans K Akerblom; Jorma S A Viikari Journal: JAMA Date: 2003-11-05 Impact factor: 56.272
Authors: Chadi A Calarge; Laura Acion; Samuel Kuperman; Michael Tansey; Janet A Schlechte Journal: J Child Adolesc Psychopharmacol Date: 2009-04 Impact factor: 2.576
Authors: Gail L Daumit; Donald C Goff; Jonathan M Meyer; Vicki G Davis; Henry A Nasrallah; Joseph P McEvoy; Robert Rosenheck; Sonia M Davis; John K Hsiao; T Scott Stroup; Jeffrey A Lieberman Journal: Schizophr Res Date: 2008-09-04 Impact factor: 4.939
Authors: Marc De Hert; Dan Cohen; Julio Bobes; Marcelo Cetkovich-Bakmas; Stefan Leucht; David M Ndetei; John W Newcomer; Richard Uwakwe; Itsuo Asai; Hans-Jurgen Möller; Shiv Gautam; Johan Detraux; Christoph U Correll Journal: World Psychiatry Date: 2011-06 Impact factor: 49.548
Authors: Benjamin U Nwosu; Bruce Meltzer; Louise Maranda; Carol Ciccarelli; Daniel Reynolds; Laura Curtis; Jean King; Jean A Frazier; Mary M Lee Journal: J Pediatr Endocrinol Metab Date: 2011 Impact factor: 1.634
Authors: Eric A Storch; Elysse B Arnold; Anna M Jones; Chelsea M Ale; Jeffrey J Wood; Jill Ehrenreich-May; Adam B Lewin; P Jane Mutch; Tanya K Murphy Journal: Child Psychiatry Hum Dev Date: 2012-10
Authors: Constadina Panagiotopoulos; Rebecca Ronsley; Dean Elbe; Jana Davidson; Derryck H Smith Journal: J Can Acad Child Adolesc Psychiatry Date: 2010-05