April 6, 2015

Antipsychotic Use May Increase the Risk for Diabetes in Some Children

PHILADELPHIA -- April 6, 2015 -- Prescription antipsychotics may elevate a child’s risk not only for significant weight gain, but also for type 2 diabetes by nearly 50%, according to a study published today in JAMA Pediatrics.

The study also showed that among children who were receiving antipsychotics and antidepressants, the risk for diabetes may double.

Traditionally, antipsychotics have been narrowly prescribed to children with a diagnosis of schizophrenia or bipolar disorder, or to those with significant developmental delays who were displaying aggressive behaviours. However, in recent years, these medications are increasingly being prescribed in the absence of strong supporting safety and efficacy data to treat healthier children and adolescents with disruptive behaviours, such as those who are diagnosed with attention-deficit/hyperactivity disorder (ADHD).

The current study, which used national Medicaid data on more than 1.3 million youth aged 10 to 18 years with a mental health diagnosis from the Centers for Medicare and Medicaid Services, must be interpreted in the context of emerging evidence that Medicaid-enrolled children are far more likely than privately insured children to be prescribed antipsychotic medications. Overall, over 25% of Medicaid-enrolled children receiving prescription medications for behavioural problems were prescribed antipsychotics by 2008, largely for less severe disorders.

“With such vast numbers of children being exposed to these medications, the implications for potential long-lasting harm can be jarring,” said David Rubin, MD, Children's Hospital of Philadelphia's, Philadelphia, Pennsylvania.

Nevertheless, the researchers remain cautious in over-reacting to these findings. The baseline risk for diabetes among youth who were not exposed to antipsychotics in the study was only 1 in 400, rising to 1 in 260 among those initiating antipsychotics, and at most to 1 in 200 among those who initiated antipsychotics while they were simultaneously receiving antidepressants.

“Although these findings should certainly give us pause, we should not reflexively over-react to them,” said Dr. Rubin. “Rather, we need to incorporate these new revelations about the risk for diabetes into a more thoughtful consideration of the true risks and benefits of prescribing an antipsychotic to a child. Yes, we should try, by all means possible, to minimise the numbers of children and adolescents exposed to these powerful medications, but for some children in immediate crisis, we must also concede that the benefit of the antipsychotic for acute management may still outweigh the risk.”

The authors recommend that clinicians and families who are making medication decisions periodically revisit the treatment strategy to address challenging behaviours. For example, when planning to prescribe antipsychotics to a child, professional organisations recommend beginning cautiously with the lowest dose possible, while strictly monitoring for early evidence of weight gain or abnormal lab tests that often predict later onset of diabetes.

“Once a child is on the antipsychotic drug, a plan should be agreed upon and periodically revisited to see whether or not an evidence-based counselling service, such as trauma-focused cognitive therapy, could address underlying emotional trauma, which is often the root cause for the behaviour,” said Dr. Rubin. “That same periodic review would also seek to transition the child off the antipsychotic as soon as possible, once these problems are more suitably addressed.”

SOURCE: Children's Hospital of Philadelphia
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