Second-Generation Antipsychotic Use in Children and Adolescents: A Six-Month Prospective Cohort Study in Drug-Naive Patients
Second-Generation Antipsychotic Use in Children and Adolescents: A Six-Month Prospective Cohort Study in Drug-Naive Patients
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DOI：
10.1016/j.jaac.2014.08.009
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发表时间：
2014-11-01
影响因子：
13.3
通讯作者：
Parellada, Mara
中科院分区：
文献类型：
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作者：
Arango, Celso;Giraldez, Miriam;Parellada, Mara
目的：评估初治/准初治青少年接受第二代抗精神病药治疗6个月后的体重和代谢影响。方法：本研究观察了一项非随机、自然、多中心、初始队列研究，纳入279例4至17岁（平均年龄= 14.6 ± 2.9岁）的患者。其中，248例（88.8%）接受了单一抗精神病药（利培酮、奥氮平或奎替利）并完成了2次访视，178例（63.8%）完成了6个月随访。患者患有精神分裂症谱系障碍（44.5%）、情绪谱系障碍（23.2%）、破坏性行为障碍（17.3%）或其他障碍（15.1%）。15名年龄和性别匹配的健康未用药个体作为对照组。结果如下：从基线到1个月、3个月和6个月，每种抗精神病药物治疗后，所有人体测量指标均显著增加，即利培酮治疗后6个月的变化（n = 157; 7.1 kg和0.66体重指数[BMI] z评分），奥氮平（n = 44; 11.5 kg和1.08 BMI z评分）和奎替鲁胺（n = 47; 6.3 kg和0.54 BMI z评分），但在健康对照参与者中没有（-0.11 kg和0.006 BMI z评分）。利培酮组空腹代谢参数显著升高（葡萄糖[3.8] mg/dL，胰岛素[4.9] mU/L，胰岛素抵抗的稳态模型评估[HOMA-IR：1.2]、甘油三酯[15.6] mg/dL）和奥氮平（葡萄糖[5.0] mg/dL，总胆固醇[21.2] mg/dL，低密度脂蛋白胆固醇[44.6] mg/dL），但不与奎替鲁肽或健康对照参与者。在6个月内，利培酮组被认为“有不良健康后果风险”的研究参与者的百分比从8.9%增加到29.2%（p
Objective: To assess weight and metabolic effects of 6 months of treatment with second-generation antipsychotics in naive/quasi-naive youths. Method: This study looked at a nonrandomized, naturalistic, multicenter, inception cohort study of 279 patients aged 4 to 17 years (mean = 14.6 +/- 2.9 years). Of those, 248 (88.8%) received a single antipsychotic (risperidone, olanzapine, or quetiapine) and completed 2 visits, and 178 (63.8%) completed the 6-month follow-up. Patients had schizophrenia-spectrum disorders (44.5%), mood-spectrum disorders (23.2%), disruptive behavioral disorders (17.3%), or other disorders (15.1%). Fifteen age- and gender-matched, healthy, nonmedicated individuals served as a comparison group. Results: From baseline to 1 month, 3 months, and 6 months, all anthropometric measures increased significantly with each antipsychotic, that is, 6-month changes with risperidone (n = 157; 7.1 kg and 0.66 body mass index [BMI] z score), olanzapine (n = 44; 11.5 kg and 1.08 BMI z score), and quetiapine (n = 47; 6.3 kg and 0.54 BMI z score), but not in healthy control participants (-0.11 kg and 0.006 BMI z score). Fasting metabolic parameters increased significantly with risperidone (glucose [3.8] mg/dL, insulin [4.9] mU/L, homeostasis model assessment of insulin resistance [HOMA-IR: 1.2], triglycerides [15.6] mg/dL), and olanzapine (glucose [5.0] mg/dL, total cholesterol [21.2] mg/dL, and low-density lipoprotein cholesterol [44.6] mg/dL), but not with quetiapine or in healthy control participants. The percentage of research participants considered to be "at risk of adverse health outcome" increased during the 6 months from 8.9% to 29.2% for risperidone (p