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Transcript
Atypical Antipsychotic Drug
Use in Children and
Adolescents
By: Alicia Shell
Spring 2008
Advisor: Dr. Bill Grimes, PA-C
Why is this important to us?
 As
primary care providers we are going to
have the opportunity to act as a psychiatric
first responder
 Referral to psychologist/psychiatrist
 Follow-up care (esp. in rural areas)
Background
Drugs: A “newer”
class of prescription medications used to
treat psychiatric conditions
 Exact MOA unknown but thought to be
due to blockade of both the dopamine-2
receptor as well as the serotonin 5-HT2A
receptor
 Atypical Antipsychotic
Atypical Antipsychotic Drugs
 Clozapine
(BN: Clozaril)
 Risperidone* (Risperdal)
 Olanzapine (Zyprexa)
 Quetiapine (Seroquel)
 Ziprasidone (Geodon)
 Aripiprazole (Abilify)
Atypical Antipsychotic Drugs cont’d…

Used to treat a wide variety of psychiatric
disturbances including:
 Schizophrenia
 Acute mania
 Bipolar mania
 Psychotic agitation
 Bipolar maintenance
Atypical Antipsychotic Drugs cont’d…
 Their
use has supplanted the older
“typical” antipsychotic drugs due to the fact
that they are thought to cause less
extrapyramidal side effects such as tardive
dyskinesia
 This has resulted in a substantial increase
in the use of antipsychotics for childhood
behavioral disorders
Atypical Antipsychotic Drugs cont’d…
 Dangerous
side effects include: weight
gain, diabetes, and hyperlipidemia
 Few studies have been done to show how
these drugs affect children
 Possibility that children are more likely to
develop these side effects than adults
(Fritz 2006)
Atypical Antipsychotic Drugs cont’d…
 Recent
studies have documented a
dramatic increase in prescribing rates for
all of these medications to children and
adolescents ranging from 200% to over
500%
(Fritz 2006)
They are being prescribed in the
pediatric population to treat:
 Oppositional
defiant disorder (ODD)
 Conduct disorder (CD)
 Mood disorders (i.e. Bipolar disorder)
 Attention deficit/hyperactivity disorder
(ADHD)
 Childhood-onset schizophrenia
Early-onset Bipolar Disorder or
Childhood Bipolar Disorder
 Historically
under-recognized, now
occasionally over-diagnosed, mood
disorder affecting approximately 1% of all
children and adolescents (Faust 2006)
 Diagnosing this disorder is particularly
difficult because it can present with a
broad spectrum of symptoms of varying
severity
Initial presentation may involve
complaints of:
 Moodiness
 Frequent
or aggressive oppositional
behaviors
 Anger that does not resolve within 15
minutes
 Sadness and easy crying
 Inattention
 Impulsiveness
Why is early diagnosis of this
disorder important?
 Decrease
the morbidity and mortality that
is associated with it
 Currently estimated that 25-50% of all BD
patients will make a suicide attempt in
their lifetime and approx. 20% will succeed
(Faust 2006)
 Adolescents with BD are at the greatest
risk, particularly those who are rapid
cyclers
How do we treat it?

Unfortunately, there are no specific medications
that are indicated for treating this condition in
children
 Instead, physicians are using antipsychotic
medications designed for adults
 The problem with this is that the usual adult
treatment may not address the needs of young
people with recent-onset psychosis and the
psychological therapies for psychosis need to be
age-specific (Haddock 2006)
Antipsychotic prescribing practices
in children and adolescents:
 Clinical
experience rather than scientific
evidence (Pappadopulos 2002)
 May be the result of social pressure to
use these meds when patient behavior is
particularly disruptive or dangerous
FIND strategy to identify manic
symptoms:

Frequency: symptoms occur most days in a
week
 Intensity: symptoms are severe enough to
cause extreme disturbance in one domain or
moderate disturbance in two or more domains
 Number: symptoms occur three or four times a
day
 Duration: symptoms occur 4 or more hours a
day, total, not necessarily contiguous
(Am. Acad. Child & Adolesc. Psychiatry 2005)
If a psychiatric diagnosis is
confirmed…
 Start



with family-focused psychotherapy
Parent management training
Dyadic (parent-child) psychotherapy
If drugs are deemed necessary, suggest that
that they be used in conjunction with
psychotherapy
(Grimes 2007)
Before initiating treatment with an
atypical antipsychotic:
 A personal
and family history of obesity,
diabetes, dyslipidemia, hypertension, or
cardiovascular disease
 Weight and height so that BMI can be
calculated
 Measurement of waist circumference
 Blood pressure
 Fasting plasma glucose
 Fasting lipid profile

Weight should be reassessed at 4, 8, and 12
weeks after initiating or changing therapy with
an atypical antipsychotic and quarterly thereafter
at the time of routine visits
 If a patient gains more than 5% of his or her
initial weight at any time during therapy, the
patient should be switched to an alternative
agent
 Note: These guidelines were not written for a
pediatric population and the 5% weight gain
threshold may not be sensitive enough for
children and adolescents
(Kowatch 2005)
Conclusions
 Be
very discriminate in regards to who we
give these drugs to
 Proper evaluation of child’s condition
 Monitor, monitor, monitor!


Don’t get complacent
Be vigilant in regards to lab tests, psychiatric
evaluations, weight monitoring, etc.
References
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ACP Medicine 3rd edition. Volume 2: 208, 211
Ananth, J., Parameswaran, S., and Gunatilake, S. Side effects of atypical antipsychotic drugs. 2004; Current
Pharmaceutical Design 10: 2219-2229.
Cooper, W., Hickson, G. et al. New users of antipsychotic medications among children enrolled in TennCare.
2007; Arch Pediatr Adolesc Med 158: 753-759.
Curtis, L., Masselink, L. et al. Prevalence of atypical antipsychotic drug use among commercially insured youths
in the United States. 2005; Arch Pediatr Adolesc Med 159: 362-366.
Dunner, DL. Safety and tolerability of emerging pharmacological treatments for bipolar disorder. 2005; Bipolar
Disorders 7: 307-325.
Faedda, G., Baldessarini, R. et al. Pediatric bipolar disorder: phenomenology and course of illness. 2004;
Bipolar Disorders 6: 305-313.
Faust, D., Walker, D., and Sands, M. Diagnosis and management of childhood bipolar disorder in the primary care
setting. 2006; Clinical Pediatrics 45: 801-808.
Fritz, G. First do no harm: prescribing new antipsychotic medications to children. 2006; The Brown Univ Child
and Adolescent Behavior Letter 22(10): 8.
Gogtay, N., Sporn, A. et al. Comparison of progressive cortical gray matter loss in childhood-onset schizophrenia
with that in childhood-onset atypicalpsychoses. 2004; Arch Gen Psychiatry 61: 17-22.
Grimes, J.C. Psychiatric medication treatment guidelines for preschoolers: issued by child mental health experts.
2007; Medical News Today
Haddock, G., Lewis, S. et al. Influence of age on outcome of psychological treatments in first-episode psychosis.
British J. of Psychiatry 188: 250-254.
Hermann, R., Yang, D. et al. Prescription of antipsychotic drugs by office-based physicians in the United States,
1989-1997. 2002; Psychiatric Services 53(4): 425-430.
Holt, R. and Peveler, R. Association between antipsychotic drugs and diabetes. 2006; Diabetes, Obesity and
Metabolism 8: 125-135.
Kowatch, R., Fristad, M. et al. Treatment guidelines for children and adolescents with bipolar disorder: child
psychiatric workgroup on bipolar disorder, 2005; J. Am. Acad. Child Adolesc. Psychiatry 44(3): 213-232.
Kumra, S., Briguglio, C. et al. Including children and adolescents with schizophrenia in medication-free research.
1999; Am J Psychiatry 156(7): 1065-1068.
Meltzer, H., McGurk, S. The effects of clozapine, risperidone, and olanzapine on cognitive function in
schizophrenia. 1999; Schizophrenia Bulletin 25(2): 233-255.
References










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


Moore, C., Biederman, J. et al. Mania, glutamate/glutamine and risperidone in pediatric bipolar disorder: a proton
magnetic resonance spectroscopy study of the anterior cingulate cortex. 2007; J. Affect Disord 99(1-3): 19-25.
Olfson, M., Blanco, C. et al. National trends in the outpatient treatment of children and adolescents with
antipsychotic drugs. 2006; Arch Gen Psychiatry 63: 679-685.
Pappadopulos, E., Jensen, P. et al. “Real world” atypical antipsychotic prescribing practices in public child and
adolescent inpatient settings. 2002; Schizophrenia Bulletin 28(1): 111-121.
Raggi, M., Mandrioli, R. et al. “Atypical antipsychotics: pharmacokinetics, therapeutic drug monitoring and
pharmacological interactions. 2004; Current Medicinal Chemistry 11: 279-296.
Saxena, K., Chang, K. et al. Treatment of aggression with risperidone in children and adolescents with bipolar
disorder: a case series. 2006; Bipolar Disorders 8: 405-410.
Shaw, P., Sporn, A. et al. Childhood-onset schizophrenia. 2006; Arch Gen Psychiatry 63: 721-730.
Sikich, L., Hamer, R. et al. A pilot study of risperidone, olanzapine, and haloperidol in psychotic youth: a doubleblind, randomized, 8-week trial. 2004; Neuropsychopharmacology 29: 133-145.
Sivaprasad, L., Hassan, T., Handy, S. Survey of atypical antipsychotic medication use
by child and adolescent
psychiatrists. 2006; Child and Adoles Mental Hlth 11(3): 164-167.
Taniguchi, T., Sumitani, S. et al. Effect of antipsychotic replacement with quetiapine on the symptoms and quality
of life of schizophrenic patients with extrapyramidal symptoms. 2006; Hum Psychopharmacol Clin Exp 21: 439445.
Vieweg, W., Sood, A. et al. Newer antipsychotic drugs and obesity in children and adolescents. How should we
assess drug-associated weight gain? 2005; 111: 177-184.
West, L., Waldrop, J. Risperidone use in the treatment of behavioral symptoms in children with autism. 2006;
Pediatric Nursing 32(6): 545-549.
Wooten, J. Metabolic effects of the atypical antipsychotics. 2007; Southern Medical J 100(8): 771-772.
Child and Adolescent Bipolar Foundation [www.bpkids.org] Retrieved on 12.3.07
Rapid Cycling Bipolar Disorder [www.about.com] Retrieved on 2.28.08