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Second-Generation Antipsychotics and the Risk of Insulin Resistance, Dyslipidemia in Children

Second-Generation Antipsychotics and the Risk of Insulin Resistance, Dyslipidemia in Children

Psychiatric Times July 2005 Vol. XXII
Issue 8


Comparative data are emerging on the metabolic effects of second-generation antipsychotics (SGAs) used in treating children and adolescents suffering from psychotic, mood and disruptive behavior disorders.

Christoph Correll, M.D., a child and adolescent psychiatrist and research scientist affiliated with Zucker Hillside Hospital and Schneider Children's Hospital in New York, and Anil Malhotra, M.D., director of psychiatry research at Zucker Hillside Hospital, are principal investigators in a longitudinal study examining biological and genetic risk factors for weight gain and metabolic abnormalities in young people taking atypical antipsychotics.

"We are looking at three different treatment conditions: antipsychotic-naive, pretreated but currently drug free and switchers, and we are also looking at six different medications," Correll told Psychiatric Times. The medications are aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon).

In order to really say something definitively, Correll said they wanted to have enough antipsychotic-naive patients for the first pass, explaining that combining such patients with those who had been pretreated and those were being switched from one SGA to another would not lead to clear, clean findings. In studies of adults, he pointed out that what may obscure some of the findings about the real risk "is that many of those patients have been chronically pretreated or were switchers."

"We are now at 421 patients. Two months ago, we locked the database, and we are at the tail end of the first set of analyses on just antipsychotic-naive children," Correll said. Currently he and his colleagues are preparing a journal article that will focus on the first 159 antipsychotic-naive youngsters who have had at least one post-baseline assessment. The article will compare olanzapine, quetiapine and risperidone with regard to weight gain, body composition, insulin resistance and dyslipidemia.

Although the study is not randomized, it is the largest study ever done in antipsychotic-naive individuals taking novel antipsychotics, Correll explained, and the only one to date on children that includes prospective, systematic measurements of glucose and lipid metabolism.

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