Biomaterial Database

Metabolic and cardiovascular adverse events associated with antipsychotic treatment in children and adolescents. 2008

Roger S McIntyre, and Jeanette M Jerrell

Department of Psychiatry and Pharmacology, Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. roger.mcintyre@uhn.on.ca

OBJECTIVE To identify factors associated with incident cardiovascular events and metabolic disturbance in children and adolescents treated with antipsychotics. METHODS A retrospective cohort design evaluating Medicaid medical and pharmacy claims. METHODS South Carolina's Medicaid program covering outpatient and inpatient medical services and medication prescriptions from January 1, 1996, through December 31, 2005. METHODS A treatment cohort of 4140 children and adolescents prescribed 1 of 5 atypical or 2 conventional antipsychotics, and a random sample of 4500 children not treated with psychotropic medications. Main Exposure Antipsychotics. METHODS Incidence/prevalence rates for obesity, type 2 diabetes mellitus, dyslipidemia, cardiovascular events, cerebrovascular events, hypertension, and orthostatic hypotension. RESULTS Compared with the control sample, the treated cohort had a higher prevalence of obesity (odds ratio [OR], 2.13), type 2 diabetes mellitus (OR, 3.23), cardiovascular conditions (OR, 2.70), and orthostatic hypotension (OR, 1.64). In the treated cohort, patients exposed to multiple antipsychotics were at significantly higher risk for incident obesity/weight gain (OR, 2.28), type 2 diabetes mellitus (OR, 2.36), and dyslipidemia (OR, 5.26). Incident cardiovascular events were more likely with the use of conventional (OR, 4.34) or multiple (OR, 1.57) antipsychotics and mood stabilizers (OR, 1.31). Incident orthostatic hypotension was more prevalent in those coprescribed selective serotonin reuptake inhibitors (OR, 1.77) and mood stabilizers (OR, 1.35). CONCLUSIONS Antipsychotics are associated with several metabolic and cardiovascular-related adverse events in pediatric populations, especially when multiple antipsychotics or classes of psychotropic medications are coprescribed, controlling for individual risk factors.

UI	MeSH Term	Description	Entries
D007024	Hypotension, Orthostatic	A significant drop in BLOOD PRESSURE after assuming a standing position. Orthostatic hypotension is a finding, and defined as a 20-mm Hg decrease in systolic pressure or a 10-mm Hg decrease in diastolic pressure 3 minutes after the person has risen from supine to standing. Symptoms generally include DIZZINESS, blurred vision, and SYNCOPE.	Hypotension, Postural,Orthostatic Hypotension,Postural Hypotension
D008297	Male		Males
D008659	Metabolic Diseases	Generic term for diseases caused by an abnormal metabolic process. It can be congenital due to inherited enzyme abnormality (METABOLISM, INBORN ERRORS) or acquired due to disease of an endocrine organ or failure of a metabolically important organ such as the liver. (Stedman, 26th ed)	Thesaurismosis,Diseases, Metabolic,Disease, Metabolic,Metabolic Disease,Thesaurismoses
D009765	Obesity	A status with BODY WEIGHT that is grossly above the recommended standards, usually due to accumulation of excess FATS in the body. The standards may vary with age, sex, genetic or cultural background. In the BODY MASS INDEX, a BMI greater than 30.0 kg/m2 is considered obese, and a BMI greater than 40.0 kg/m2 is considered morbidly obese (MORBID OBESITY).
D011336	Probability	The study of chance processes or the relative frequency characterizing a chance process.	Probabilities
D012016	Reference Values	The range or frequency distribution of a measurement in a population (of organisms, organs or things) that has not been selected for the presence of disease or abnormality.	Normal Range,Normal Values,Reference Ranges,Normal Ranges,Normal Value,Range, Normal,Range, Reference,Ranges, Normal,Ranges, Reference,Reference Range,Reference Value,Value, Normal,Value, Reference,Values, Normal,Values, Reference
D002318	Cardiovascular Diseases	Pathological conditions involving the CARDIOVASCULAR SYSTEM including the HEART; the BLOOD VESSELS; or the PERICARDIUM.	Adverse Cardiac Event,Cardiac Events,Major Adverse Cardiac Events,Adverse Cardiac Events,Cardiac Event,Cardiac Event, Adverse,Cardiac Events, Adverse,Cardiovascular Disease,Disease, Cardiovascular,Event, Cardiac
D002648	Child	A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL.	Children
D003924	Diabetes Mellitus, Type 2	A subclass of DIABETES MELLITUS that is not INSULIN-responsive or dependent (NIDDM). It is characterized initially by INSULIN RESISTANCE and HYPERINSULINEMIA; and eventually by GLUCOSE INTOLERANCE; HYPERGLYCEMIA; and overt diabetes. Type II diabetes mellitus is no longer considered a disease exclusively found in adults. Patients seldom develop KETOSIS but often exhibit OBESITY.	Diabetes Mellitus, Adult-Onset,Diabetes Mellitus, Ketosis-Resistant,Diabetes Mellitus, Maturity-Onset,Diabetes Mellitus, Non-Insulin-Dependent,Diabetes Mellitus, Slow-Onset,Diabetes Mellitus, Stable,MODY,Maturity-Onset Diabetes Mellitus,NIDDM,Diabetes Mellitus, Non Insulin Dependent,Diabetes Mellitus, Noninsulin Dependent,Diabetes Mellitus, Noninsulin-Dependent,Diabetes Mellitus, Type II,Maturity-Onset Diabetes,Noninsulin-Dependent Diabetes Mellitus,Type 2 Diabetes,Type 2 Diabetes Mellitus,Adult-Onset Diabetes Mellitus,Diabetes Mellitus, Adult Onset,Diabetes Mellitus, Ketosis Resistant,Diabetes Mellitus, Maturity Onset,Diabetes Mellitus, Slow Onset,Diabetes, Maturity-Onset,Diabetes, Type 2,Ketosis-Resistant Diabetes Mellitus,Maturity Onset Diabetes,Maturity Onset Diabetes Mellitus,Non-Insulin-Dependent Diabetes Mellitus,Noninsulin Dependent Diabetes Mellitus,Slow-Onset Diabetes Mellitus,Stable Diabetes Mellitus
D004305	Dose-Response Relationship, Drug	The relationship between the dose of an administered drug and the response of the organism to the drug.	Dose Response Relationship, Drug,Dose-Response Relationships, Drug,Drug Dose-Response Relationship,Drug Dose-Response Relationships,Relationship, Drug Dose-Response,Relationships, Drug Dose-Response